Predictors and prevalence of patients undergoing additional kyphoplasty procedures after an initial kyphoplasty procedure.
BACKGROUND
Vertebral cement augmentation, including kyphoplasty, has been shown to be a successful treatment for pain relief for vertebral compression fracture (VCF). Patients can sustain additional symptomatic VCFs that may require additional surgical intervention.


OBJECTIVE
To examine the prevalence and predictors of patients who sustain additional symptomatic VCFs that were treated with kyphoplasty.


METHODS
A retrospective review of patients who previously underwent kyphoplasty for VCFs and had additional VCFs that were treated with kyphoplasty.


METHODS
A total of 256 patients underwent kyphoplasty for VCFs from 2000 to 2007 at a single medical center.


METHODS
The outcome measure of interest was the need for an additional kyphoplasty procedure for a symptomatic VCF.


METHODS
Risk factors such as age, sex, smoking status, and steroid use were assessed, as well as bisphosphonate use. Sagittal spinal alignment via Cobb angles for thoracic, thoracolumbar, and lumbar regions was assessed.


RESULTS
About 22.2% of the patients had an additional symptomatic VCF that was treated with a kyphoplasty procedure. Steroid use was the only significant risk factor for predicting patients with additional symptomatic VCFs who underwent additional kyphoplasty. The average time to the second VCF was 33 days. Adjacent-level VCFs were most common in the thoracic and thoracolumbar spine. Bisphosphonate use was not shown to be protective of preventing additional VCFs during this follow-up period.


CONCLUSIONS
This is the first single-center review of a large cohort of patients who underwent additional-level kyphoplasty for symptomatic VCFs after an index kyphoplasty procedure. Our results suggest that patients with a VCF who use chronic oral steroids should be carefully monitored for the presence of additional symptomatic VCFs that may need surgical intervention. Patients with prior thoracic VCFs who have additional back pain should be reevaluated for a possible adjacent-level fracture.
Department of Orthopedic Surgery, Oregon Health & Sciences University, Portland, OR 97239, USA. rtatsumi@orspine.com
Robert L
RL
Tatsumi
Alexander C
AC
Ching
Gregory D
GD
Byrd
Jayme R
JR
Hiratzka
Judson E
JE
Threlkeld
Robert A
RA
Hart
D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D005260:Female; D050815:Fractures, Compression / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D058498:Kyphoplasty; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology* / Q000601:surgery*
D000305:Adrenal Cortex Hormones