gms | German Medical Science

Objectives: This study aimed to evaluate the incidence and risk factors associated with adjacent segment fracture (ASF) following percutaneous vertebroplasty (PVP) to treat osteoporotic vertebral compression fractures (VCF).

Methods: From January 2009 to September 2012, 68 patients (47 women, 21 men; mean age 68.7±9.8 years) who underwent PVP at 102 levels for osteoporotic VCFs were retrospectively enrolled in this study. The mean follow-up time 37.3±10.4 months. The risk factors for ASF included age, gender, mean bone mineral density (BMD), mean body mass index (BMI), the number of treated vertebral level, the localization of treated vertebral fracture, presence of an intravertebral cyst before treatment, kyphosis angle, anterior height restoration, the injected cement volumes, fracture-free interval, and intradiskal cement leakage were analyzed using univariate and multivariate binary logistic regression analyses.

Results and Conclusion: New ASFs were observed in 27 (26.4%) of 102 treated vertebral fracture. Among the risk factors, the localization of treated vertebral fracture, especially the thoracolumbar junction (univariate analysis, p:0.026; multivariate analysis, p:0.034), the number of treated vertebral level, (multilevel PVP> single level PVP) (univariate analysis, p:0.039; multivariate analysis, p:0.042), low BMD (<-3 SD) (univariate analysis, p:0.022; multivariate analysis, p:0.028), low BMI (< 20 kg/m²) (univariate analysis, p:0.044; multivariate analysis, p:0.049), the greater the anterior height restoration ( >15%) (univariate analysis, p:0.04; multivariate analysis, p:0.047), shorter fracture-free interval (< 10 weeks) (univariate analysis, p:0.025; multivariate analysis, p:0.033) showed a significant relationship to new ASFs. There was no statistically significant association between the other risk factors and new ASFs (p >0.05 for all).

Osteoporotic VCFs located at thoracolumbar junction, multilevel treated VCFs, low BMD, low BMI, greater anterior height restoration, and the shorter fracture-free interval are the risk factors correlated with a new ASF following PVP. Therefore, alternative strategies should be considered for reducing the risk of new fractures in such patients. Further studies with larger sample sizes are required to obtain more precise data on new VCF after PVP.