Prophylactic vertebral augmentation in patients with intra-disc leakage after kyphoplasty

A uperior adjacent vertebral fracture (SAVF) is a common complication after kyphoplasty. Intra-disc leakage is a significant risk factor of SAVF. However, to date, no studies on the prevention of SAVF after intra-disc leakage have been conducted. This study sought to evaluate the clinical outcome of prophylactic vertebral augmentation in high-risk patients, and explore the other risk factors of SAVF.

Of 2,571 patients who received kyphoplasty, 82 with intra-disc leakage were retrospectively enrolled in the study, and divided into 2 groups based on whether they had a superior level of prophylactic vertebral augmentation. To ensure that any possible early complications were examined, there was a minimum follow-up period of 12 months.

The pre-operation parameters were comparable between the 2 groups. In the non-prophylactic group, 9 of 59 (15.3%) patients had SAVF superior to the level of intra-disc leakage. Of these 9 SAVF cases, 8 fractures (88.9%) occurred within 6 months after surgery. Overall, 14 (23.7%) patients developed a new fracture. In the prophylactic group, no patients had a SAVF (0.0%), but 3 (13.0%) had remote fractures (P=0.047 and 0.284). No complications were associated with vertebral augmentation. Further, the risk factor analysis showed that patients with comorbidities and a history of corticoid use had a higher risk of fracture compared with patients with none of these risk factor [odds ratios: 12.0, 95% confidence interval (CI): 1.0-143, and 34.3, 95% CI: 3.2-364.5, respectively].

Prophylactic vertebral augmentation can prevent SAVF without complications. Patients with comorbidities and a history of corticoid use had a higher risk of SAVF compared with patients without corticoid use. Thus, we recommend prophylactic vertebral augmentation in the selected high-risk patients.