Is Vertebroplasty Truly Associated with the Occurrence of Adjacent Vertebral Body Fractures?

Abstract

Introduction: Osteoporotic vertebral fractures may progress and eventually result in a significant reduction in the quality of life of affected patients owing to residual pain and neurological deficits. Although vertebroplasty has been a widely accepted treatment option, it has been occasionally followed by an adjacent vertebral fracture (AVF). This eventually results in inadequate pain relief. Since there was no consensus on the causal relationship between vertebroplasty and AVF, we examined this association.

Methods: We included consecutive patients who underwent vertebroplasty of a single vertebral body between April 2012 and June 2018 at 1 of 6 hospitals and followed them up for 6 months. We evaluated the incidence of AVF within 1 week, 1 month, 3 months, and 6 months postoperatively and determined the 95% confidence intervals (CIs). The Kaplan-Meier method was used to illustrate the cumulative incidence of AVF, censoring at 6 months after vertebroplasty.

Results: A total of 505 patients were included in this study, all of whom underwent balloon kyphoplasty. A total of 406 patients were included in the analysis after the exclusion of 99 patients who did not meet the inclusion criteria. Seventy-four AVFs were observed for up to 6 months postoperatively, with AVFs occurring within 1 week in 29 of 405 (7.2% [95% CI 4.8-10]), 1 month in 58 of 377 (15% [95% CI 12-19]), 3 months in 71 of 353 (20% [95% CI 16-25]), and 6 months in 74 of 317 (23% [95% CI 19-28]) patients. The median time to onset of the postoperative AVF was 16 days (interquartile range 6-35), with the time to onset of up to 1 week for 29 of 74 (39%) cases and up to 1 month for 58 of 74 (78%) cases. The cumulative incidence curve showed a steep rise in the early postoperative period.

Conclusions: The results of this study suggest that there is an association between vertebroplasty and AVF. These results may motivate further research on the prediction of the incidence, impact, prevention, and treatment of postoperative AVF.