title: Incidence of adjacent vertebral fractures in patients treated with balloon kyphoplasty: two years' prospective follow-up.
abstract: OBJECTIVE
  To evaluate the long-term outcomes of 37 patients with 60 osteoporotic vertebral fractures, located in the thoracic and lumbar spine, treated with balloon kyphoplasty.
  
  
  METHODS
  Fourty-two patients (15 males and 27 females) with 67 osteoporotic vertebral fractures were treated with balloon kyphoplasty. We were able to have 2-year follow-up of 37 patients with 60 treated vertebrae. Baseline fracture rate in these 37 patients was 1.9 (60 fresh fractures and 11 old fractures already healed). Symptomatic levels were identified by correlating the clinical presentation with conventional radiographs, computed tomography (CT), and/or magnetic resonance imaging (MRI). During the 2-year follow-up, reduction in pain was determined. The effects on pain symptoms were measured on a self-reported visual analog scale (VAS) and the Oswestry score was documented to assess disability. Radiographic scans were performed pre- and postoperatively, and after 3, 6, 12, and 24 months. The vertebral height and endplate angles were measured to assess the restoration of the sagittal alignment.
  
  
  RESULTS
  The median pain scores (VAS) decreased significantly from pre- to post-treatment as did the Oswestry Disability Score (P<0.05). This improvement was maintained at 2-year follow-up. In eight patients (21.6%) (five female, three male), an adjacent fracture occurred in 11 vertebrae (18.3%) within 3 weeks to 22 months of follow-up (after 22 months no adjacent fracture occurred). This makes an annualized refracture rate of 10% (18.3/22 x 12). In three patients the adjacent fractures were asymptomatic. Five patients with symptomatic adjacent fractures (eight vertebrae) wanted to be treated again with balloon kyphoplasty. Clinically asymptomatic cement leakage occurred in nine of 67 vertebral bodies (13.4%). During 2-year follow-up, this surgical technique demonstrated restoration and stabilization of the height of the vertebral body.
  
  
  CONCLUSIONS
  Balloon kyphoplasty is an effective, minimally invasive procedure for the stabilization of osteoporotic vertebral fractures, leading to a statistically significant reduction of pain status.
authors.affiliation: Centrum für Muskuloskeletale Chirurgie and Abteilung für Strahlenheilkunde, Universitätsmedizin Berlin, Charité, Campus Virchow-Klinikum, Berlin, Germany. robert.pflugmacher@charite.de
authors.forename: R
authors.initials: R
authors.lastname: Pflugmacher
authors.forename: R-J
authors.initials: RJ
authors.lastname: Schroeder
authors.forename: C K
authors.initials: CK
authors.lastname: Klostermann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*; D010147:Pain Measurement; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome