Early-Onset Anterior Endplate Fractures of Adjacent Vertebras in Balloon Kyphoplasty and Spinejack®

Abstract Background: Vertebral compression fractures (VCFs) occur most commonly on the thoracolumbar junction, which are the most vulnerable biomechanical regiments at the thoracolumbar junction between the thoracic kyphosis and lumbar lordosis. Percutaneous vertebroplasty and kyphoplasty are currently the primary minimally invasive surgical treatments for thoracolumbar VCFs. The principal aim of this study is to compare the clinical efficacies of percutaneous balloon kyphoplasty (BKP) and SpineJack® (SJ) techniques in the treatment of thoracolumbar VCFs by evaluating the risk factors for early-onset adjacent level fractures (ALFs) over a 6-month follow-up. Methods: A total of 106 patients with thoracolumbar (T11-L2) VCFs, treated with kyphoplasty techniques (64 with BKP and 42 with SJ), were enrolled in this retrospective study. Patterns of preoperative, postoperative day 1, and postoperative 6-month thoracolumbar spine images and discrepancies of long-term kyphosis correction functions were compared using two different kyphoplasty procedures. Results: A total of 19 new early-onset ALFs were found within one month postoperatively (9 in BKP and 10 in SJ groups), and all presented as anterior vertebral endplate fractures. The early-onset ALFs in the BKP group were anterior inferior endplate fractures at the superior vertebral levels mainly. The preoperative anterior-type and severe VCFs were the statistically significant risk factors for early-onset ALFs. The timing of kyphoplasty intervention for acute VCFs within 1 month and patients with advance age were also presented risk factors to developed early-onset ALFs in our study (p = 0.018; p < 0.001 ). Conclusions: There was no superiority in the occurrence rate of early-onset ALFs and kyphosis correction effects of BKP or SJ techniques in the treatment of thoracolumbar VCFs. The factors, including pre-OP anterior-type and severe VCFs, patients with advance ages, and kyphoplasty timing within one month since the appearance of symptoms, are the primary risk factors for subsequent early-onset ALFs after kyphoplasty to thoracolumbar VCFs.