Objective To explore the safety and efficacy of prophylactic upper vertebral body augmentation for preventing adjacent vertebral fracture after percutaneous kyphoplasty.

Methods From Dec 2013 to Dec 2017, 26 patients who underwent kyphoplasty due to osteoporotic compression fractures and simultaneous prophylactic vertebral augmentation in Beijing Jishuitan Hospital were enrolled. The inclusion criteria included intra-disc leakage, elderly, severe osteoporosis, and medical comorbidities (eg. high blood pressure, diabetes mellitus), history of corticoid usage, or osteoporotic fractures. The perioperative parameters and follow-up data were collected, and the occurrence of subsequent fractures was analyzed.

Results A total of 26 patients were enrolled with 41 fractured vertebrae, the median age was 73.2(70.0-86.0) years, preoperative pain visual analog scale (VAS) was 7.2 points, preoperative quantitative computed tomography was 43.2 mg/mL. All patients had intra-disc cement leakage, among whom 20 patients had upper endplate fissures before surgery, 4 patients had suspicious damage to the upper endplate during balloon expansion, and 2 patients had upper endplate damage during puncture. The average median of bone cement in fractured vertebrae was 3.5 (2.5-7.5) mL, and 4.0 (3.5-8.0) mL in upper-level augmentation (P=0.036). A total of three patients had remote vertebral re-fractures within the first year after surgery, none of which occurred in adjacent segments.

Conclusions In high-risk patients with intra-disc cement leakage, selective upper vertebral cement augmentation can avoid re-fractures of upper segments and will not cause new adjacent vertebral body fractures.