University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
University of Pittsburgh School of Medicine, Pittsburgh, PA.
Pain Physician. 2024 Jul;27(5):333-339.
Balloon-assisted kyphoplasty (BAK) is a minimally invasive procedure to treat vertebral compression fractures (VCF). BAK not only restores vertebral height and corrects kyphotic deformity by cement augmentation, but it also may alter spinal biomechanics, leading to subsequent adjacent level VCFs.
This study aims to investigate the timing, location, and incidence of new VCFs following BAK and identify the risk factors associated with their occurrence.
Single-institution observational study.
A prospectively collected cohort of 1,318 patients who underwent BAK by a single-surgeon from 2001 through 2022 was analyzed. The patients had pain that was unresponsive to nonsurgical management and a VCF secondary to osteoporosis, trauma, or neoplasm. The time between the index and subsequent fracture, fracture level, number of initial fractures, age, body mass index (BMI), tobacco use, and chronic corticosteroid use were recorded.
Of 1,318 patients, 204 (15.5%) patients underwent a second BAK procedure an average of 373 days following BAK (range: 2-3,235 days). Third, fourth, and fifth procedures were less common (45, 12, and 6 patients, respectively). A total of 142 patients (69.6%) developed a subsequent fracture adjacent to the index level; adjacent and remote level fractures developed at different times (mean: 282 vs 581 days, P = 0.001). Patients treated for multiple VCFs in a single surgery were more likely to develop subsequent VCFs (P = 0.024) and at adjacent levels (P = 0.007). Subsequent VCFs were associated with older age (P < 0.001), women (P = 0.045), osteoporosis (P < 0.001), and chronic corticosteroid use (P < 0.001). A subgroup analysis of 812 (61.6%) patients who underwent BAK for degenerative indications revealed that osteoporosis (b = 0.09; 95% CI, 0.03-0.16; P = 0.005) and chronic corticosteroid use (b = 0.06; 95% CI, 0-0.11; P = 0.055) were associated with adjacent level fracture. For the entire cohort, almost every patient treated for both a thoracic and lumbar fracture (92.3%) developed an adjacent level second fracture (P = 0.005).
The true incidence of post-BAK fractures may be underestimated as surveillance is not routine in asymptomatic or osteoporotic patients.
Symptomatic post-BAK VCFs are infrequent and may occur long after the initial procedure. Nearly two-thirds of subsequent fractures in our study occurred adjacent to the initially treated level; almost every patient who suffered thoracic and lumbar fractures at the same time developed an adjacent level second fracture. Additionally, osteoporosis and chronic corticosteroid use were associated with adjacent level fractures in patients who underwent surgery for degenerative indications.
球囊辅助椎体后凸成形术（BAK）是一种治疗椎体压缩性骨折（VCF）的微创手术。BAK 不仅通过骨水泥增强来恢复椎体高度和纠正后凸畸形，还可能改变脊柱生物力学，导致随后相邻水平的 VCF。
本研究旨在探讨 BAK 后新 VCF 的发生时间、部位和发生率，并确定与 VCF 发生相关的危险因素。
单机构观察性研究。
对 2001 年至 2022 年间由一位外科医生进行的 BAK 的前瞻性收集队列的 1318 例患者进行了分析。这些患者的疼痛对非手术治疗无反应，且存在骨质疏松、创伤或肿瘤引起的 VCF。记录了从指数骨折到后续骨折的时间、骨折水平、初始骨折数量、年龄、体重指数（BMI）、吸烟和慢性皮质类固醇使用情况。
在 1318 例患者中，204 例（15.5%）患者在 BAK 后平均 373 天（范围：2-3235 天）进行了第二次 BAK 手术。第三次、第四次和第五次手术较少见（分别为 45、12 和 6 例）。共有 142 例（69.6%）患者在指数水平相邻处发生了后续骨折；相邻和远处水平的骨折发生在不同的时间（平均：282 天和 581 天，P=0.001）。在单次手术中治疗多个 VCF 的患者更有可能发生后续 VCF（P=0.024）和相邻水平的 VCF（P=0.007）。后续 VCF 与年龄较大（P<0.001）、女性（P=0.045）、骨质疏松症（P<0.001）和慢性皮质类固醇使用（P<0.001）相关。对 812 例（61.6%）因退行性疾病接受 BAK 的患者进行亚组分析表明，骨质疏松症（b=0.09；95%CI，0.03-0.16；P=0.005）和慢性皮质类固醇使用（b=0.06；95%CI，0-0.11；P=0.055）与相邻水平骨折有关。对于整个队列，几乎所有同时接受胸腰椎骨折治疗的患者（92.3%）都发生了相邻水平的第二次骨折（P=0.005）。
未对无症状或骨质疏松症患者进行常规监测，因此 BAK 后骨折的真实发生率可能被低估。
症状性 BAK 后 VCF 很少见，可能在初始手术后很长时间才发生。我们研究中的近三分之二的后续骨折发生在最初治疗的水平相邻处；几乎同时患有胸腰椎骨折的患者中，几乎每一位都发生了相邻水平的第二次骨折。此外，骨质疏松症和慢性皮质类固醇使用与退行性疾病患者的相邻水平骨折相关。
