Fracture As a Complication of Kyphoplasty
Vertebral compression fractures (VCFs) are common in older adults who have osteoporosis (brittle bones). Treatment is usually conservative (nonoperative). But when pain persists, surgical procedures such as kyphoplasty or vertebroplasty may be advised.

Both procedures involve injecting cement into the broken vertebra. In kyphoplasty, a balloon is inserted inside the bone and inflated first. Then the balloon is removed, and the cement is squirted into the opening made by the balloon.

In this study, the incidence of vertebral fracture was compared between these two procedures. Other complications such as pain and cement leaks were also compared. X-rays were used to look for cement leakage and fractures at the adjacent (next) level.

The authors report that less cement was used with the vertebroplasty method of repair. It was only necessary to inject cement from one side with most vertebroplasties. This was compared with kyphoplasty, which often required injection from both sides of the bone.

Cement leakage occurred in about 11 per cent of all patients. There was no difference in leakage between the two methods. The location of the injection and the number of levels treated did not seem to make a difference in the amount of cement that leaked out.

Patients who had kyphoplasty were more likely to experience new VCFs. The fractures were located at the next level. All new cases were reported within three months of the original kyphoplasty.

The authors conclude that vertebroplasty used less bone cement, was less invasive, and has a lower risk of adjacent-level fractures. The amount of pain relief was just as much as with kyphoplasty. Careful surgical technique by an experienced surgeon using fluoroscopy (imaging X-rays) to perform the procedure is important in reducing complications.
Bruce M. Frankel, MD, et al. Percutaneous Vertebral Augmentation: An Elevation in Adjacent-Level Fracture Risk in Kyphoplasty as Compared with Vertebroplasty. In The Spine Journal. November 2007. Vol. 7. No. 5. Pp. 575-582.