Does Augmentation in osteoporotic compression fractures further increase the risk of new spinal fractures?

Introduction: Vertebroplasty and kyphoplasty have showed reliability in improving the quality of life and pain control in osteoporotic spinal fractures. However, literature still hasn’t explained the relationship between these percutaneous techniques and the incidence of new osteoporotic vertebral fractures. Materials and methods: We have retrospectively studied the incidence and the site of new osteoporotic spinal fractures occurred in 124 patients (193 fractures) who previously underwent 105 vertebroplasties and 88 kyphoplasty at our Institution. Results: 13,4 % of the patients suffer from a new vertebral fracture at a mean follow-up of 16 months (1-35) from surgery. 28,1 % of these fractures occurred next to the level of the surgically treated fractures at a mean follow-up of 7 months, while 71,9 % of the new fractures were not close to the previous ones at a mean follow-up of 21 months. Vertebroplasty have been found to be more often related to this complication than kyphoplasty (66 %). Discussion and conclusion: Biomechanical changes secondary to polymethylmethacrylate injections in vertebral bodies lead to a higher risk of developing new spinal compression fractures in levels next to that of surgically treated fractures. However, the incidence of this complication does not show a higher rate than fractures due to the degenerative cascade related to osteoporosis and to biomechanical modifications caused by the fracture itself.