Is there a risk of adjacent fractures after surgery for Osteoporotic Vertebral Compression Fractures?
After surgery for osteoporotic vertebral compression fractures (OVCFs), such as vertebroplasty or kyphoplasty, there is a risk of developing a new fracture in a vertebra next to the treated one. This is called an adjacent vertebral fracture (AVF). Research shows that AVF occurs in a notable number of patients, and certain factors can increase or decrease this risk. Understanding these factors can help you and your doctor make informed decisions about treatment and follow-up care.
What the research says
Multiple studies confirm that adjacent vertebral fractures are a real concern after OVCF surgery. A large meta-analysis of 26 studies including 7,604 patients found several risk factors for adjacent fractures after vertebroplasty or kyphoplasty 5. These include bone cement leakage into the disc space, excessive restoration of vertebral height, injecting too little or too much cement, low bone mineral density (osteoporosis), not taking anti-osteoporosis medication after surgery, having multiple fractured vertebrae, a prior history of fracture, older age, and being female 5. Another meta-analysis similarly identified low bone mineral density, cement leakage, and lack of postoperative anti-osteoporosis treatment as key risk factors 6.
The type of surgical technique may also influence the risk. One study comparing unilateral extrapedicular kyphoplasty (UEA-PKP) with bilateral transpedicular kyphoplasty (BTA-PKP) found that UEA-PKP resulted in lower cement volume and a lower cement leakage rate 1. Since cement leakage is a known risk factor for adjacent fractures, techniques that reduce leakage might lower the risk, but this has not been directly proven in that study 1. A different study comparing percutaneous curved kyphoplasty (PCKP) with unilateral kyphoplasty (UPKP) found no significant difference in re-fracture rates between the two groups (11.94% vs. 15.28%) 3.
A prediction model developed specifically for adjacent fractures after percutaneous kyphoplasty identified 10 predictors: gender, age, number of surgical vertebrae, cement volume, bone mineral density, diabetes, hypertension, bone cement leakage, duration of anti-osteoporosis treatment after surgery, and whether the fracture was at the thoracolumbar junction 7. This model can help estimate an individual patient's risk 7. Notably, a retrospective study of 429 patients who underwent vertebroplasty found that 143 (33.3%) developed an adjacent vertebral fracture, highlighting that this complication is common 2.
Importantly, consistent use of anti-osteoporosis medication after surgery appears to be a protective factor. In one study, only about 28-33% of patients had good compliance with anti-osteoporosis treatment, and poor compliance was linked to higher re-fracture rates 3. Both meta-analyses emphasize that postoperative anti-osteoporosis treatment reduces the risk of adjacent fractures 56.
What to ask your doctor
- What is my personal risk of developing an adjacent vertebral fracture after surgery?
- Based on my bone density and other factors, what type of surgical technique might be best for me to minimize the risk?
- How important is it for me to take anti-osteoporosis medication after surgery, and what are my options?
- Should I be concerned about cement leakage, and how will my surgeon try to prevent it?
- What follow-up imaging or monitoring is recommended to check for new fractures?
This question is drawn from common patient questions about Orthopedics & Sports Medicine and answered using cited medical research. We do not provide individualized advice.