Yamamoto Masatoshi, Ohta Koji, Hirano Daisuke, Noguchi Maki, Ayukawa Shuhei, Shirasaki Keigo, Ishizu Kenya, Watanabe Tetsuya, Iida Keiichiro
Department of Orthopaedic Surgery, Shimonoseki City Hospital, Shimonoseki, Japan.
Asian Spine J. 2025 Jun;19(3):408-414. doi: 10.31616/asj.2024.0494. Epub 2025 Mar 4.
Retrospective cohort study.
To evaluate whether the timing of balloon kyphoplasty (BKP) affects the risk of adjacent vertebral fractures (AVFs) in the management of osteoporotic vertebral fractures.
Osteoporotic vertebral fractures are usually managed conservatively; however, complications such as nonunion, neurologic deficits, and high-grade kyphosis can arise. BKP, a minimally invasive procedure for pain relief, has been associated with AVF risk. Although meta-analyses suggest no significant difference in AVF rates between BKP and conservative treatment, retrospective studies report higher AVF rates after BKP. Many of these cases involve patients resistant to conservative treatment, which implies that differences in the incidence of AVF may be influenced by the delay before performing BKP.
We retrospectively analyzed 189 patients who underwent BKP between 2012 and 2023, excluding those with pathological fractures. The incidence of AVF was assessed at 3 months after BKP. Risk factors, including age, sex, fracture site, prior vertebral fractures, bone mineral density, kyphosis angle, endplate damage, signal changes in the fractured vertebral body on magnetic resonance imaging, vertebral instability, and timing of BKP, were evaluated.
The overall incidence of AVFs was 29%. The AVF rate was 21% in patients treated with BKP within 30 days, as compared with 32% in those treated later; however, this difference was not statistically significant (p =0.15). Multivariate analysis identified vertebral instability as the only significant risk factor for AVF (odds ratio, 2.73; p =0.01), whereas the timing of BKP showed no significant association with AVF risk.
Early BKP does not significantly reduce the risk of AVF. The findings suggest that the management of osteoporotic vertebral fractures should focus on vertebral stability rather than intervention timing.
回顾性队列研究。
评估球囊椎体后凸成形术（BKP）的时机是否会影响骨质疏松性椎体骨折治疗中相邻椎体骨折（AVF）的风险。
骨质疏松性椎体骨折通常采用保守治疗；然而，可能会出现诸如骨不连、神经功能缺损和严重后凸畸形等并发症。BKP是一种用于缓解疼痛的微创手术，与AVF风险相关。尽管荟萃分析表明BKP与保守治疗之间的AVF发生率无显著差异，但回顾性研究报告BKP后AVF发生率更高。其中许多病例涉及对保守治疗有抵抗的患者，这意味着AVF发生率的差异可能受BKP实施前延迟时间的影响。
我们回顾性分析了2012年至2023年间接受BKP的189例患者，排除病理性骨折患者。在BKP后3个月评估AVF的发生率。评估了包括年龄、性别、骨折部位、既往椎体骨折、骨密度、后凸畸形角度、终板损伤、磁共振成像上骨折椎体的信号变化、椎体不稳定以及BKP时机等危险因素。
AVF的总体发生率为29%。30天内接受BKP治疗的患者AVF发生率为21%，而稍后接受治疗的患者为32%；然而，这种差异无统计学意义（p =0.15）。多因素分析确定椎体不稳定是AVF的唯一显著危险因素（比值比，2.73；p =0.01），而BKP时机与AVF风险无显著关联。
早期BKP并不能显著降低AVF的风险。研究结果表明，骨质疏松性椎体骨折的治疗应侧重于椎体稳定性而非干预时机。
