Survival Rate and Risk Factor Analysis in Patients Who Experience a New Fracture after Kyphoplasty

Dong-Hyok Kim; Jung-Hoon Kim

doi:10.4184/jkss.2018.25.3.99

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Kim and Kim: Survival Rate and Risk Factor Analysis in Patients Who Experience a New Fracture after Kyphoplasty

Original Article

Journal of Korean Spine Surg 2018;25(3):99-107.

Published online: 30 September 2018

DOI: https://doi.org/10.4184/jkss.2018.25.3.99

Survival Rate and Risk Factor Analysis in Patients Who Experience a New Fracture after Kyphoplasty

Dong-Hyok Kim, M.D., Jung-Hoon Kim, M.D.

Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang. Korea

Corresponding author: Jung-Hoon Kim, M.D. Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine, #170, Juhwaro, Ilsanseogu, Goyang, Gyeonggido, Korea ORCID ID: Jung-Hoon Kim: https://orcid.org/0000-0002-9997-0263 Dong-Hyok Kim: https://orcid.org/0000-0002-6181-808X TEL: +82-31-910-7968, FAX: +82-31-910-7967 E-mail: jhkim@paik.ac.kr

Received 15 February 201819 April 2018 Accepted 10 July 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study.

Objectives

To evaluate the factors related to the incidence of a new fracture in an adjacent vertebra after kyphoplasty for single vertebral body fracture due to osteoporosis and to assess the impact of such factors on patients'survival rate.

Summary of Literature Review

It is controversial whether fracture of an adjacent vertebra after kyphoplasty is due to the natural course of osteoporosis or as a complication of kyphoplasty.

Materials and Methods

From December 2006 to December 2016, among 490 cases of kyphoplasty for single vertebral body fracture due to osteoporosis, 153 cases were analyzed retrospectively. The survival rate was analyzed based on age, gender, body mass index (BMI), fracture level, leakage of cement, amount of cement, compression rate, recovery rate, bone density, osteoporotic medication rate and compliance, existence of a compression fracture, hypertension, diabetes, and smoking habit. The average follow-up duration was 15.1 months (range, 1 month to 8 years and 8 months) and the mean age was 74.4 years (range, 54–93 years).

Results

A new fracture in an adjacent vertebral body occurred in 27 cases (17.3%). The 1-year survival rate was 82.6%, the 2-year survival rate was 72.5%, and the 6-year survival rate was 53.7%. The survival rate was significantly higher in patients younger than 75 years (p=0.0495). The survival rate was also significantly higher in patients with a preoperative vertebral bone density greater than −3.7 and hip bone density greater than −2.2 (p<0.0001, p=0.0114). The survival rate was significantly higher in patients with a BMI greater than 18.1 kg/m2 at the time of surgery (p=0.0014). Furthermore, the survival rate was significantly higher in patients with a postoperative recovery of vertebral height of 14% or less (p=0.0031). In addition, the survival rate was higher in patients without a compression fracture before surgery (p=0.0297). In multiple factor analysis, vertebral bone density (p=0.0049) and age (p=0.0408) were identified as statistically significant factors.

Conclusions

The survival rate was significantly lower at 1, 2, and 6 years in patients with an adjacent vertebral fracture. The most crucial factors affecting the survival rate were age and vertebral bone density.

Keywords: Osteoporosis, Vertebral compression fracture, Kyphoplasty, Survival rate analysis

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Fig. 1.

Graph of the survival rate.

Fig. 2.

Univariate analysis: (A) age, (B) preoperative spine bone mineral density, (C) preoperative hip bone mineral density, (D) body mass index, (E) reduction rate, (F) previous fractures.

Table 1.

Demographic and clinical data obtained in patients

Parameter		Value
No. patient		153
Gender (M:F)		35:118
Mean age		74.4(54∼93)
Mean BMI		22.6(13.6∼33.3)
Mean BMD	Spine	−2.1(−4.9∼0.7)
	Hip	−2.7(−5.1∼0.5)
HTN		89
DM		28
Smoking		13
Follow up period(months)		15.2

M: Male, F: Female, BMI: Body mass index, BMD: Bone mineral density, HTN: Hypertension, DM: Diabete.

Table 2.

ROC (receive operating characteristic) curves

Parameter	Criterion	Sensitivity	Specificty
Age	>75	56.0	57.5
Hip BMD	≤2.2	92.6	34.9
Spine BMD	≤-3.7	29.6	94.4
BMI	≤18.0802	33.3	95.2
Cement amount	>4	59.3	57.1
Compression rate	≤22.9071	37.0	78.6
Reductino rate	>14	37.0	84.1

Table 3.

New fracture at adjacent vertebra

Kyphoplasty level	Number of new fracture	Proximal djacent new fracture	Distal adjacent new fracture
T8	2	1	1
T9	1	1
T10
T11	3	1	2
T12	8	2	6
L1	7	4	3
L2	2	2
L3	4	3	1
Total	27/156 (17.3%)	14 (52%)	13 (48%)

Table 4.

Result

Parameter		Value
Postop. Adjacent fx. rate		27
	Proximal	14
	Distal	13
Preop. Compression fx.		46
Cement leakage	Proximal	40
	Distal	11
	Proximal&distal	2
Average amount of cement(cc)		4.4
Average preop. compression rate(%)		35.3
Average postop. reduction rate(%)		9.0

Table 5.

Risk factors (Univariate analysis)

Risk factors	p	Hazard ratio	CI
Age: ≤75 vs>75	0.0495	0.4953	0.2279∼1.0763
Preop spine BMD: ≤-3.7 vs >-3.7	<0.0001	0.1660	0.03606∼0.7639
Preop hip BMD: ≤-2.2 vs >-2.2	0.0114	0.1932	0.08434∼0.4426
Preop BMI: ≤18.1 vs >18.1	0.0014	0.2873	0.08519∼0.9690
Postop reduction: ≤14 vs >14	0.0031	0.3239	0.1090∼0.9625
No preop compression fx.	0.0297	0.4462	0.1994∼0.9987

BMD: Bone mineral density, CI: Confidence interval, BMI: Body mass index.

Table 6.

Risk factors (Multivariate analysis)

Variables	Hazard ratio	CI	p
Age
≤75	0.4535	0.1985∼1.0364	0.0408
>75	1.00
Preop spine BMD
>-3.7	0.2454	0.0923∼0.6523	0.0049
≤-3.7	1.00

BMD: Bone mineral density, CI: Confidence interval.

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