title: Incidence and risk factors for early adjacent vertebral fractures after balloon kyphoplasty for osteoporotic fractures: analysis of the SWISSspine registry.
abstract: OBJECTIVE
  The SWISSspine registry (SSR) was launched in 2005 to assess the safety and effectiveness of balloon kyphoplasty (BKP). In the meantime, repeated reports on high rates of adjacent vertebral fractures (ASF) after BKP of vertebral insufficiency fractures were published. The causes for ASF and their risk factors are still under debate. The purpose of this study was to report the incidence and potential risk factors of ASF within the SSR dataset.
  
  
  METHODS
  The SSR data points are collected perioperatively and during follow-ups, with surgeon- and patient-based information. All patients documented with a monosegmental osteoporotic vertebral insufficiency fracture between March 2005 and May 2012 were included in the study. The incidence of ASF, significant associations with co-variates (patient age, gender, fracture location, cement volume, preoperative segmental kyphosis, extent of kyphosis correction, and individual co-morbidities) and influence on quality of life (EQ-5D) and back pain (VAS) were analyzed.
  
  
  RESULTS
  A total of 375 patients with a mean follow-up of 3.6 months was included. ASF were found in 9.9 % (n = 37) and occurred on average 2.8 months postoperatively. Preoperative segmental kyphosis >30° (p = 0.026), and rheumatoid arthritis (p = 0.038) and cardiovascular disease (p = 0.047) were significantly associated with ASF. Furthermore, patients with ASF had significantly higher back pain at the final follow-up (p = 0.001). No further significant associations between the studied co-variates and ASF were seen in the adjusted analysis.
  
  
  CONCLUSIONS
  The findings suggest that patients with a preoperative segmental kyphosis >30° or patients with co-morbidities like rheumatoid arthritis and a cardiovascular disease are at high risk of ASF within 6 months after the index surgery. In case of an ASF event, back pain levels are significantly increased.
  
  
  METHODS
  IV.
authors.affiliation: Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Spross
authors.forename: Emin
authors.initials: E
authors.lastname: Aghayev
authors.forename: Rouven
authors.initials: R
authors.lastname: Kocher
authors.forename: Christoph
authors.initials: C
authors.lastname: Röder
authors.forename: Thomas
authors.initials: T
authors.lastname: Forster
authors.forename: Fabrice A
authors.initials: FA
authors.lastname: Kuelling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000453:epidemiology; D001416:Back Pain / Q000453:epidemiology; D001843:Bone Cements / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D050815:Fractures, Compression / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D058498:Kyphoplasty / Q000009:adverse effects* / Q000379:methods; D007738:Kyphosis / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000601:surgery*; D012042:Registries; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology*; D013557:Switzerland / Q000453:epidemiology
chemical_list: D001843:Bone Cements