Risk Factors of Failed Conservative Treatment for Adjacent Vertebral Fractures Following Percutaneous Vertebroplasty

Study Design. A retrospective, single-center, observational study. Objective. This study investigated the risk factors associated with the failure of conservative treatment for adjacent vertebral fractures (AVFs). Summary of Background Data. Adjacent vertebral fractures following vertebroplasty for osteoporotic vertebral compression fractures are not uncommon. Presently, there is a lack of consensus regarding the management of adjacent vertebral fractures. Methods. We included patients who developed adjacent vertebral fractures within 2 years post single-level vertebroplasty between January 2013 and December 2020. All patients initially underwent 6 weeks of conservative treatment, including pain medications, bracing, and physical therapy. Surgical intervention was offered to those with intractable back pain due to AVFs. Baseline demographics, AVF characteristics, and radiologic measurements were systematically collected, and sequential univariable and multivariable logistic regression analyses were conducted to explore the risk factors. Results. Of the 114 patients with a mean age of 78.6 years, 2-thirds (76 patients) tolerated conservative treatment well, whereas 38 required surgical interventions for adjacent vertebral fractures. Both groups demonstrated similar baseline demographics and radiologic parameters regarding AVFs (P>0.05). The multivariable logistic regression analyses revealed that the development of AVFs later than 6 months post-vertebroplasty and their caudal location to the index vertebroplasty were the independent risk factors of unsuccessful conservative treatment, with odds ratios of 3.57 (95% confidence interval [CI]: 1.14-11.1, P=0.029) and 2.50 (95% CI, 1.09-5.88, P=0.032), respectively. Conclusion. Adjacent vertebral fractures following percutaneous vertebroplasty generally have favorable outcomes under conservative treatment. However, the timing and the relative anatomical location of adjacent vertebral fractures are associated with treatment efficacy. Adjacent vertebral fractures occurring later than 6 months following the initial vertebroplasty or situated in the caudal location to the index vertebroplasty may exhibit reduced responsiveness to conservative treatment. These patients might benefit from a more aggressive therapeutic approach. Level of Evidence. 3