Survival analysis and risk factors of new vertebral fracture after vertebroplasty for osteoporotic vertebral compression fracture |
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| Affiliation: | 1. Department of Orthopedic Surgery, Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri-si, Gyeonggi-do 11923, South Korea;2. Department of Orthopedics, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea;1. Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany;2. Helmholtz Zentrum München, German Research Center for Environmental Health, Individual Monitoring Service, Munich, Germany;3. Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;1. Laboratory of Cell Biology, Department of Orthopedic Surgery University Hospital of Tübingen, Waldhörnlestraße 22, 72072 Tübingen, Germany;2. Department of Orthopedic Surgery University Hospital of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany;3. Medical Faculty of the University of Tübingen, Geissweg 5/1, 72076 Tübingen, Germany;4. Bavarian Health and Food Authority, Veterinärstraße 2, 85764 Oberschleißheim, Germany;5. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center - Albert-Ludwigs-University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany;1. St. Joseph''s University Medical Center, Department of Orthopaedic Surgery, 703 Main Street, Paterson, NJ 07503, USA;2. Rutgers New Jersey Medical School, 185 South Orange Ave, Newark, NJ 07103, USA;1. Department of Orthopedic Surgery, Wake Forest Baptist Health, Medical Center Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA;2. Department of Anesthesiology, University of Virginia Health System, 200 Jeanette Lancaster Way Charlottesville, VA 22903, USA;3. Department of Neurosurgery , Wake Forest Baptist Health, Medical Center Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA |
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| Abstract: | BACKGROUND CONTEXTAlthough risk factors of new adjacent vertebral fracture (AVF) and remote vertebral fracture (RVF) after vertebroplasty may differ, research on this topic is lacking.PURPOSETo determine the natural course of new vertebral fractures after vertebroplasty for osteoporotic vertebral compression fracture (OVCF) and to analyze each risk factor for understanding the incidence of AVF and RVF.STUDY DESIGNRetrospective cohort study.PATIENT SAMPLEThe study subjects included 205 patients who received vertebroplasty for OVCF and were followed-up for at least 1-year.OUTCOME MEASURESData on factors that could affect the occurrence of vertebral fractures, such as age, body mass index, and bone density, were collected from the patients’ medical records. Fracture pattern, fracture location, sagittal imbalance, degree of segmental kyphosis after vertebroplasty, cement distribution, and cement leakage were radiologically examined.METHODSxDuring the follow-up period, any newly developed vertebral fractures were identified. We analyzed whether the time of occurrence differed between AVF and RVF by performing a survival analysis and each risk factor separately.RESULTSNew vertebral fractures occurred in 47 patients (22.9%) after vertebroplasty, AVF occurred in 21 patients (10.2%), and RVF occurred in 26 patients (12.7%). The onset time of AVF was 6.2±1.8 months after vertebroplasty, showing a significant difference from that of RVF, which was 15.2±1.8 months (p<.001). In the univariate analysis, the risk factors of AVF included severe osteoporosis (T-score<−3.0), vertebroplasty in the thoracolumbar junction, sagittal imbalance, and segmental kyphosis angle >15° (p=0.029, p=0.033, p=0.001, and p=0.021, respectively). The risk factors of RVF included severe osteoporosis (T-score <−3.0) and sagittal imbalance (p=0.013 and p=0.004). In the multivariate analysis, the risk factors of AVF included vertebroplasty in the thoracolumbar junction and sagittal imbalance (hazard ratio=3.34, p=0.032 and hazard ratio=4.05, p=0.008), and those of RVF included only sagittal imbalance (hazard ratio=2.66, p=0.024).CONCLUSONAfter vertebroplasty for OVCF, a significant difference in the meantime of occurrence was found; it took 6 months for AVF and 15 months for RVF to develop. Vertebroplasty in the thoracolumbar junction was identified as a risk factor for AVF, whereas sagittal imbalance was a risk factor of both AVF and RVF. |
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