Kyphoplasty Complicated By Short Interval and Adjacent Multiple Vertebral Compression Fractures: Eight Is Enough!

Presentation Number: SUN 325
Date of Presentation: April 2nd, 2017

Summaya Latif*1, Pamela Ohri2 and Pamela Taxel3
1University of Connecticut Health Center, Farmington, CT, 2UCONN Health, Farmington, CT, 3Univ of Connecticut Hlth Ctr, Farmington, CT

Abstract

Introduction: Kyphoplasty is a minimally invasive procedure for treatment of painful osteoporotic vertebral compression fractures. Recent studies suggest that patients treated with kyphoplasty may have a significantly higher rate of secondary vertebral fractures after this procedure when compared to conservatively managed patients. We describe a case of severe osteoporosis with vertebral compression fractures treated with kyphoplasty which led to further adjacent vertebral fractures.

 

Case presentation: A previously healthy 63 year old female was seen recently in consultation in our Osteoporosis Clinic with a history of osteoporosis diagnosed by BMD in 2006, with a L-spine T-score of -3.2. Secondary evaluation at that time was unclear. She had no significant risk factors and family history was negative. She initiated treatment with hormone replacement therapy (HRT) as well as alendronate, which was discontinued within weeks due to heartburn. She suffered a first compression fracture at L3 after lifting a heavy object in 2011 and underwent kyphoplasty. She was subsequently treated with teriparatide from 2011 to 2013, and HRT was also continued simultaneously until 2013, when both were discontinued. No further anti-resorptive treatment was given. In 2015 she felt back pain and was noted to have compression fractures at L1 and T12, and underwent kyphoplasty at these levels. Two months later, back pain without associated trauma occurred and further compression fractures were seen at L2, T10 and T11, and these underwent kyphoplasty. Several months later she suffered further compression fractures at T8 and T9, and again underwent kyphoplasty for a total of eight levels. She initiated treatment with risedronate therapy after this last procedure, but did not tolerate it due to severe muscle aches. Complete evaluation was done recently in our Osteoporosis Clinic which showed no evidence of secondary etiology of her osteoporosis. Her most recent bone mineral density in
December 2015 revealed left total hip mean BMD of 0.675 g/cm2with T-score of -2.2. Her spine could not be assessed due to the kyphoplasty procedures.

Discussion: Although limited studies exist and results are mixed, recent data suggests that kyphoplasty is associated with an increased risk of incident and adjacent vertebral fractures, and these fractures occur at shorter intervals than in conservatively managed patients (1). The underlying pathologic mechanism remains unknown. Providers should be aware of this potential consequence, and advise patients as to these risks. Based on this evidence, conservative management with anti-resorptive therapy was offered to our patient with the recommendation to avoid further kyphoplasty.

 

Nothing to Disclose: SL, PO, PT