Balloon kyphoplasty for vertebral compression fractures in solid organ transplant recipients: results of treatment and comparison with primary osteoporotic vertebral compression fractures.
BACKGROUND
Balloon kyphoplasty has become established as a useful treatment for vertebral compression fractures (VCF) associated with primary osteoporosis and osteolytic tumors. Organ transplant recipients are also at risk for VCF because of their underlying disease process and because they require long-term treatment with steroids and other immunosuppressive drugs.


OBJECTIVE
To explore whether balloon kyphoplasty is an effective treatment for VCF that develop in solid organ transplant recipients. A secondary goal was to determine whether there are any differences between VCF in transplant patients and VCF in patients with primary osteoporosis, with respect to disease severity and new fracture development.


METHODS
Prospective, longitudinal clinical series.


METHODS
The transplant group included 10 consecutive transplant patients (9 liver and 1 kidney), with a total of 29 symptomatic VCFs. The comparison group included 10 consecutive patients with primary osteoporosis and no history of organ transplantation, with a total of 15 VCFs.


METHODS
The primary clinical end point was back pain, measured using the Visual Analog Scale (VAS), which was recorded at baseline, and 1 and 12 months postprocedure. Radiographic evaluation included measurement of Cobb angles for each treated vertebral segment on preprocedure and 1-month postprocedure lateral radiographs. An improvement of >5 degrees was considered significant. The number of fractures seen at the time of diagnosis and the number of new fractures occurring during the follow-up period were recorded.


METHODS
Balloon kyphoplasty was performed at all symptomatic levels. All fractures were treated within 3 months of onset. Patient follow-up was 12 months.


RESULTS
The transplant group had significantly higher levels of pain at baseline, (mean VAS 9.3 and 7.7 for the transplant group and primary osteoporosis group, respectively: p=.013). After treatment, the VAS decreased to 3.2 in the transplant group and 1.5 in the comparison group. Improvement was highly significant in both groups (p<.001), and was maintained at 12-month follow-up. Sagittal alignment was improved by >5 degrees in three patients in each group (30%). There were no procedural complications in either group. Compared with the primary osteoporosis group, the transplant group was more likely to have multiple fractures at the time of diagnosis (2.9 vs. 1.5, p=.03), had a twofold greater incidence of new fractures during the follow-up period (40% vs. 20%), was more than a decade younger (64 vs. 75 years, p<.01), was much more likely to have received chronic immunosuppressive therapy with glucocorticoids and calcineurin phosphate inhibitors (100% vs. 0%, p<.001), and had a higher percentage of males (70% vs. 10%, p=.02),


CONCLUSIONS
These data suggest that balloon kyphoplasty can be performed safely in organ transplant recipients with VCFs. The degree of pain relief is equivalent to that seen in patients with primary osteoporosis. Results are durable at 12-month follow-up. Transplant patients developed earlier and more severe bony disease, with more severe baseline pain, a higher incidence of multiple fractures at the time of diagnosis, and a greater risk of new fracture development posttreatment, as compared with the primary osteoporosis group.
Deen
H Gordon
HG
Department of Neurosurgery, Mayo Clinic Jacksonville, Jacksonville, FL 32224, USA. hdeen@mayo.edu
Aranda-Michel
Jaime
J
Reimer
Ronald
R
Miller
David A
DA
Putzke
John D
JD
D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D050815:Fractures, Compression / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016377:Organ Transplantation; D010146:Pain; D011183:Postoperative Complications; D011446:Prospective Studies; D016103:Spinal Fractures / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome