INDICATIONS FOR PROPHYLACTIC STABILIZATIONS WITH KYPHOPLASTY AFTER OSTEOPOROTIC VERTEBRAL FRACTURES

Abstract

Purpose: After vertebroplasty and kyphoplasty the recurrent fracture risk after kyphoplasty is inferior to vertebroplasty, but the risk is still eminent. The reduction of kyphosis is strongly related to the age of the fracture, therefore the reduction and the correction of the kyphosis varies. We investigated the indication of a prophylactic kyphoplasty of adjacent levels to the fracture site in order to decrease the postoperative refracture risk.

Methods: Prospective randomized clinical study, 2 groups: monosegmental kyphoplasty versus bi- or mul-tisegmental kyphoplasty with prophylactic level superior to the fracture. F/U 6 months with X-rays.

Results: Group 1: monosegmental stabilization: (23 pat. 4 male, 19 female, 23 levels). 5 refractures. 3 refractures adjacent to the kyphoplasty, 2 cases not related to the primary stabilization. In 3 cases cement leakage was seen as direct cause of the refracture. |Group 2: pro-phylactic stabilization (27 pat. - 4 male, 23 female, 27 prophylactic levels). 7 refractures, all adjacent to kypho-plasty. In 3 cases cement leakage as cause of recurrent fracture. No statistical difference between both groups was found, however in 6 out of 12 recurrent fractures we found intradiscal cement leakage as the direct cause of the fracture.|

Conclusions: No statistical difference between both groups (group 1: 22% refracture risk, group 2: 26% refracture risk, p=1). Therefore we do not see the need for a generalized prophylactic stabilization of adjacent levels with kyphoplasty. However, we conclude that it is crucial to avoid any leakage, which has a direct impact on the fracture rate, only in those cases we advise a prophylactic stabilization at the leakage site. In general kyphoplasty is preferable to vertebroplasty due to generally decreased leakage and embolism rate.