Abstract

Background: Osteoporotic vertebral fracture (OVF) is a main cause of disability for the elderly. For intractable back pain after medical therapy, cement augmentation is an option. We report our results of multilevel percutaneous balloon kyphoplasty (PBK) for OVF.

Methods: This is a retrospective study. Patients receiving PBK for multilevel (at least two continuous segments) OVF from Jan. 2011 to Jan. 2017 were included. Their clinical and image results were analyzed at 6 months. The cement distribution was classified into three filling types: glandular, trabecular, and mix type. Patients were divided into two groups according to the presence of subsequent adjacent segment fracture (ASF). The clinical characters were analyzed between two groups.

Results: A total of 18 patients underwent multilevel PBK were enrolled. The mean age was 77.4 years. Fifteen of the patients were female. Sixteen patients underwent two levels PBK and two for three levels, resulting in a total of 38 levels. Twenty-one ASF occurred during follow-up period. Patients with ASF had lower body mass index (BMI) values than those without fracture (p < 0.05). More vertebral fractures at pre-operative magnetic resonance image (MRI) had higher incidence for ASF (p < 0.05). The glandular pattern of cement had higher risk in ASF (p < 0.05).

Conclusion: In our experience, lower BMI values, more vertebral fractures before operation, and glandular pattern of bone cement were associated with higher risk of ASF. For the higher incidence of ASF after PBK for multilevel of OVF, long term follow-up and medical therapy for osteoporosis are suggested.