William F Lavelle1, Robert Cheney. 1. Department of Orthopedic Surgery, Albany Medical College, 1367 Washington Ave., Albany, NY 12206, USA. lavellwf@yahoo.com
Abstract
BACKGROUND CONTEXT: Osteoporotic compression fractures cause great morbidity to the aging population. Various percutaneous methods have been developed to aid in treatment, including vertebral kyphoplasty. Biomechanical studies and recent published data relate concerns about adjacent fracture. PURPOSE: This study investigated the incidence of recurrent fracture after the kyphoplasty procedure. STUDY DESIGN/ SETTING: Retrospective review of kyphoplasty procedures preformed by a single surgeon. PATIENT SAMPLE: A total of 109 procedures in 94 patients were reviewed. OUTCOME MEASURES: Patient medical records were reviewed as well as the radiology database at two major regional hospitals. METHODS: Patient records were reviewed for fracture recurrence. RESULTS: Confounding factors of age at procedure, sex, and chronic steroid use were also considered and found to have no statistically significant difference between those with fracture recurrence and those without fracture recurrence (p=.1979, p=.2058, p=.4684, respectively). Eleven kyphoplasty procedures resulted in a recurrent fracture after kyphoplasty within the first 90 days (34+/-19). After the first 90 days, five recurrent fractures occurred (459+/-101). The number of vertebral levels treated was found to be related to incidence of recurrent fracture with a p value of .0005 via chi-square testing. Patients who sustained a recurrent fracture tended to have a higher number of vertebral levels treated. There was no statistically significant difference between the survival time of kyphoplasty procedures that resulted in recurrent adjacent versus distant vertebral body fracture (survival time 112+/-145 vs. 237+/-268, p value .2362). CONCLUSIONS: The incidence of recurrent fracture after kyphoplasty is substantial at 10% within the first 90 days. It is difficult to determine if this fracture rate is the result of surgical intervention or the natural history of the patient's osteoporosis.
BACKGROUND CONTEXT: Osteoporotic compression fractures cause great morbidity to the aging population. Various percutaneous methods have been developed to aid in treatment, including vertebral kyphoplasty. Biomechanical studies and recent published data relate concerns about adjacent fracture. PURPOSE: This study investigated the incidence of recurrent fracture after the kyphoplasty procedure. STUDY DESIGN/ SETTING: Retrospective review of kyphoplasty procedures preformed by a single surgeon. PATIENT SAMPLE: A total of 109 procedures in 94 patients were reviewed. OUTCOME MEASURES: Patient medical records were reviewed as well as the radiology database at two major regional hospitals. METHODS:Patient records were reviewed for fracture recurrence. RESULTS: Confounding factors of age at procedure, sex, and chronic steroid use were also considered and found to have no statistically significant difference between those with fracture recurrence and those without fracture recurrence (p=.1979, p=.2058, p=.4684, respectively). Eleven kyphoplasty procedures resulted in a recurrent fracture after kyphoplasty within the first 90 days (34+/-19). After the first 90 days, five recurrent fractures occurred (459+/-101). The number of vertebral levels treated was found to be related to incidence of recurrent fracture with a p value of .0005 via chi-square testing. Patients who sustained a recurrent fracture tended to have a higher number of vertebral levels treated. There was no statistically significant difference between the survival time of kyphoplasty procedures that resulted in recurrent adjacent versus distant vertebral body fracture (survival time 112+/-145 vs. 237+/-268, p value .2362). CONCLUSIONS: The incidence of recurrent fracture after kyphoplasty is substantial at 10% within the first 90 days. It is difficult to determine if this fracture rate is the result of surgical intervention or the natural history of the patient's osteoporosis.
Authors: Michael N Tzermiadianos; Susan M Renner; Frank M Phillips; Alexander G Hadjipavlou; Michael R Zindrick; Robert M Havey; Michael Voronov; Avinash G Patwardhan Journal: Eur Spine J Date: 2008-09-16 Impact factor: 3.134