Is the incidence of sandwich vertebral fracture higher than that of ordinary adjacent vertebral fracture after PKP?

Abstract

Objective: To compare the incidence of fracture between sandwich vertebra and ordinary adjacent vertebra after percutaneous kyphoplasty (PKP). Method: We analyzed 225 consecutive patients with osteoporotic vertebral compression fractures who underwent PKP between January 2016 and December 2020 at our medical institution. The sandwich vertebrae was located between 2 cement-augmented vertebra and was followed for at least 12 months. The clinical data of patients with sandwich vertebra and ordinary adjacent vertebra were recorded, and the incidence of postoperative fracture between sandwich vertebra and ordinary adjacent vertebra was compared. Results: The mean continuous follow-up time was 31.30 ± 18.04 months in patients with sandwich vertebra and 25.85 ± 7.96 months in patients with ordinary adjacent vertebra. It should be noted that the incidence of sandwich vertebral fractures was 10.00%, which was not statistically higher than 3.26% for ordinary adjacent vertebral fractures. However, a significant difference was observed in the cement volume of single vertebral body, procedure time, and bleeding. Conclusion: Although the volume of cement in a single vertebral body is less and the procedure time and bleeding are more, the incidence of sandwich vertebral fracture is not higher than that of ordinary adjacent vertebral body.

Biomechanical analysis of sandwich vertebrae in osteoporotic patients: finite element analysis

“…Bo Yang et al. ( 9 ) collected the clinical data of 225 OVCF patients with sandwich vertebral bodies and common adjacent vertebral bodies to compare the incidence of postoperative fractures between sandwich vertebral bodies and common adjacent vertebral bodies. The incidence of sandwich vertebral fractures was comparable to that of adjacent vertebral bodies.…”

“…When multiple vertebral surgeries are performed on a single patient, a sandwich vertebra (SV) may be formed, which is an intact, unreinforced vertebra sandwiched between two cemented vertebral bodies. It has been suggested that sandwich vertebrae are subjected to double loading and hypothesized to be more susceptible to secondary fractures than other vertebrae, but only a few clinical articles have addressed sandwich vertebrae ( 1 , 7 , 9 ). Whether SV is a high-risk vertebra is only theorized, and whether SV should undergo preventive cement augmentation and other conclusions are inconsistent.…”

Are Sandwich Vertebrae Prone to Refracture After Percutaneous Vertebroplasty or Kyphoplasty? A Meta-Analysis

“…Nine studies were included in the meta-analysis, including 5 retrospective studies, 1 case-control study, and 3 cohort studies. 7,8,[12][13][14][15][16][17][18] A summary of included studies is provided in Table 1. The publication year ranged from 2007 to 2022, study sizes ranged from 55 to 1321 participants, and mean ages ranged from 67.8 to 77.8 years.…”

“…Several studies have investigated the incidence of SDV fracture in comparison with other refracture conditions, but inconsistent outcomes were reported. 7,8 Thus, we aimed to conduct a meta-analysis on this aspect by analyzing domestic and foreign clinical studies and discuss whether prophylactic sandwich vertebral augmentation is needed.…”

Prophylaktische Zementaugmentation zur Frakturprophylaxe und Vermeidung von Anschlusskyphosen – Sinn oder Unsinn?

“…So litten die Patienten unter schwereren Symptomen und benötigten häufiger eine zusätzliche operative Intervention als Patienten im Kollektiv mit generellen Anschlussfrakturen. Daher sollte in unseren Augen die prophylaktische Augmentation erwogen werden, gleichwohl sie auch hier in der Literatur nicht unumstritten ist [23].…”