Radiological and Clinical Outcomes of Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fracture in Patients with Rheumatoid Arthritis

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2021 Jul 7

PMID 34229715

Citations 3

Authors

Ji Guo

Weifeng Zhai

Licheng Wei

Jianpo Zhang

Lang Jin

Hao Yan

Zheng Huang

Yongwei Jia

Affiliations

Soon will be listed here.

Abstract

Background: This study was conducted to investigate the outcomes and complications of balloon kyphoplasty (KP) for the treatment of osteoporotic vertebral compression fracture (OVCF) in patients with rheumatoid arthritis (RA) and compare its radiological and clinical effects with OVCF patients without RA.

Methods: Ninety-eight patients in the RA group with 158 fractured vertebrae and 114 patients in the control group with 150 vertebrae were involved in this study. Changes in compression rate, local kyphotic angle, visual analog scale (VAS) and Oswestry disability index (ODI) scores, conditions of bone cement leakage, refracture of the operated vertebrae, and new adjacent vertebral fractures were examined after KP. In addition, patients in the RA group were divided into different groups according to the value of erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and whether they were glucocorticoid users or not to evaluate their influence on the outcomes of KP.

Results: KP procedure significantly improved the compression rate, local kyphotic angle, and VAS and ODI scores in both RA and control groups (p<0.05). Changes in compression rate and local kyphotic angle in the RA group were significantly larger than that in the control group (p<0.05), and patients with RA suffered more new adjacent vertebral fractures after KP. The outcomes and complications of KP from different ESR or CRP groups did not show significant differences. The incidence of cement leakage in RA patients with glucocorticoid use was significantly higher than those who did not take glucocorticoids. In addition, RA patients with glucocorticoid use suffered more intradiscal leakage and new adjacent vertebral fractures.

Conclusions: OVCF patients with RA obtained more improvement in compression rate and local kyphotic angle after KP when compared to those without RA, but they suffered more new adjacent vertebral fractures. Intradiscal leakage and new adjacent vertebral fractures occurred more in RA patients with glucocorticoid use.

Trial Registration: Retrospectively registered.

Citing Articles

Factors associated with new fractures in adjacent vertebrae after percutaneous vertebroplasty for osteoporotic vertebral compression fractures.

Weng Y, Wang L, Huang J, Cai L Am J Transl Res. 2024; 16(11):6972-6979.

PMID: 39678623 PMC: 11645567. DOI: 10.62347/WBBN6996.

Effectiveness of bone-filled mesh bag technology and angle vertebroplasty in the treatment of osteoporotic thoracic vertebral compression fractures in the elderly.

Tang C, Liu F Am J Transl Res. 2024; 16(7):3289-3297.

PMID: 39114704 PMC: 11301485. DOI: 10.62347/GHNQ5649.

Beyond Pain Relief: An In-Depth Review of Vertebral Height Restoration After Balloon Kyphoplasty in Vertebral Compression Fractures.

Patel S, Khan S, Dasari V, Gupta S Cureus. 2023; 15(9):e46124.

PMID: 37900521 PMC: 10612383. DOI: 10.7759/cureus.46124.

References

Tong J, Xu S, Zong H, Pan M, Teng Y, Xu J . Correction to: Prevalence and risk factors associated with vertebral osteoporotic fractures in patients with rheumatoid arthritis. Clin Rheumatol. 2020; 39(6):2023. DOI: 10.1007/s10067-020-05089-1. View

Haugeberg G, Uhlig T, Falch J, Halse J, Kvien T . Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum. 2000; 43(3):522-30. DOI: 10.1002/1529-0131(200003)43:3<522::AID-ANR7>3.0.CO;2-Y. View

Hulme P, Boyd S, Heini P, Ferguson S . Differences in endplate deformation of the adjacent and augmented vertebra following cement augmentation. Eur Spine J. 2009; 18(5):614-23. PMC: 3234009. DOI: 10.1007/s00586-009-0910-3. View

Tanaka Y, Ohira T . Mechanisms and therapeutic targets for bone damage in rheumatoid arthritis, in particular the RANK-RANKL system. Curr Opin Pharmacol. 2018; 40:110-119. DOI: 10.1016/j.coph.2018.03.006. View

Papanastassiou I, Phillips F, Van Meirhaeghe J, Berenson J, Andersson G, Chung G . Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies. Eur Spine J. 2012; 21(9):1826-43. PMC: 3459114. DOI: 10.1007/s00586-012-2314-z. View

Haugeberg G, Green M, Quinn M, Marzo-Ortega H, Proudman S, Karim Z . Hand bone loss in early undifferentiated arthritis: evaluating bone mineral density loss before the development of rheumatoid arthritis. Ann Rheum Dis. 2005; 65(6):736-40. PMC: 1798164. DOI: 10.1136/ard.2005.043869. View

Zhai W, Jia Y, Wang J, Cheng L, Zeng Z, Yu Y . The clinical effect of percutaneous kyphoplasty for the treatment of multiple osteoporotic vertebral compression fractures and the prevention of new vertebral fractures. Int J Clin Exp Med. 2015; 8(8):13473-81. PMC: 4612969. View

Mirovsky Y, Anekstein Y, Shalmon E, Blankstein A, Peer A . Intradiscal cement leak following percutaneous vertebroplasty. Spine (Phila Pa 1976). 2006; 31(10):1120-4. DOI: 10.1097/01.brs.0000216461.48751.d6. View

Wang B, Zhao C, Song L, Zhu L . Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review. J Orthop Surg Res. 2018; 13(1):264. PMC: 6196425. DOI: 10.1186/s13018-018-0952-5. View

10.

Liu T, Li Z, Su Q, Hai Y . Cement leakage in osteoporotic vertebral compression fractures with cortical defect using high-viscosity bone cement during unilateral percutaneous kyphoplasty surgery. Medicine (Baltimore). 2017; 96(25):e7216. PMC: 5484220. DOI: 10.1097/MD.0000000000007216. View

11.

Kumagai S, Kawano S, Atsumi T, Inokuma S, Okada Y, Kanai Y . Vertebral fracture and bone mineral density in women receiving high dose glucocorticoids for treatment of autoimmune diseases. J Rheumatol. 2005; 32(5):863-9. View

12.

Ghazi M, Kolta S, Briot K, Fechtenbaum J, Paternotte S, Roux C . Prevalence of vertebral fractures in patients with rheumatoid arthritis: revisiting the role of glucocorticoids. Osteoporos Int. 2011; 23(2):581-7. DOI: 10.1007/s00198-011-1584-3. View

13.

Voggenreiter G . Balloon kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976). 2005; 30(24):2806-12. DOI: 10.1097/01.brs.0000190885.85675.a0. View

14.

Lee S, Park Y, Park S, Kim T, Choi H, Lee S . Increased frequency of osteoporosis and BMD below the expected range for age among South Korean women with rheumatoid arthritis. Int J Rheum Dis. 2012; 15(3):289-96. DOI: 10.1111/j.1756-185X.2012.01729.x. View

15.

Kvien T, Haugeberg G, Uhlig T, Falch J, Halse J, Lems W . Data driven attempt to create a clinical algorithm for identification of women with rheumatoid arthritis at high risk of osteoporosis. Ann Rheum Dis. 2000; 59(10):805-11. PMC: 1753011. DOI: 10.1136/ard.59.10.805. View

16.

Liu J, Liao W, Tan W, Lee J, Liu C, Chen Y . Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int. 2009; 21(2):359-64. DOI: 10.1007/s00198-009-0952-8. View

17.

Hartmann K, Koenen M, Schauer S, Wittig-Blaich S, Ahmad M, Baschant U . Molecular Actions of Glucocorticoids in Cartilage and Bone During Health, Disease, and Steroid Therapy. Physiol Rev. 2016; 96(2):409-47. DOI: 10.1152/physrev.00011.2015. View

18.

Zhang Z, Huang H, Chen S, Liu D, Feng Y, Xie C . Comparison of high- and low-viscosity cement in the treatment of vertebral compression fractures: A systematic review and meta-analysis. Medicine (Baltimore). 2018; 97(12):e0184. PMC: 5895344. DOI: 10.1097/MD.0000000000010184. View

19.

Zhai W, Jia Y, Wang J, Cheng L . The clinical application and efficacy of percutaneous kyphoplasty via unilateral pedicular approach guided by CT image measurement. Int J Clin Exp Med. 2016; 8(11):20861-8. PMC: 4723856. View

20.

Hauser B, Riches P, Wilson J, Horne A, Ralston S . Prevalence and clinical prediction of osteoporosis in a contemporary cohort of patients with rheumatoid arthritis. Rheumatology (Oxford). 2014; 53(10):1759-66. DOI: 10.1093/rheumatology/keu162. View