Comparison of the adjacent-level fracture rate between instrumented fusion plus vertebroplasty and vertebroplasty alone in osteoporotic spine

Abstract

Background/PurposePrevious study revealed a high incidence of adjacent-level fracture after vertebroplasty. On the other hand, instrumented fusion plus bone cement augmentation of anterior column have been reported to achieve significant sagittal alignment reduction and strong spinal fixation. Our hypothesis is that instrumented fusion plus vertebroplasty can prevent adjacent-level fractures in high-risk patients. MethodsPatients with predisposing risk factor for adjacent-level fracture were included. All enrolled patients were treated with instrumented fusion plus vertebroplasty (IF) or vertebroplasty alone (VP), and a standardized postoperative care and follow-up protocol was followed. Data from charts and radiographs were collected and analyzed. ResultsA total of 59 patients (40 women and 19 men) with a mean age of 75.4 years were included in this study: 21 patients (15 females) in the IF group and 38 patients (25 females) in the VP group; the mean follow-up period was 34 months. Both groups were similar with respect to age, gender, bone density, involved level, preoperative visual analog scale, and image parameters. It was noted that a greater volume of bone cement was injected in the IF group. Both groups achieved significant improvement in pain scale and image parameters. The overall adjacent-level fracture was 57.89% in VP group. But no adjacent-level fracture was noted in the IF group. ConclusionInstrumented fusion plus vertebroplasty and vertebroplasty alone can provide significant image parameters recovery, and visual analog scale score improvement. However, instrumented fusion plus vertebroplasty is effective in prophylaxis against adjacent-level fracture.