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Endplate anatomical restoration may reduce adjacent fracture occurrence, 12 month result after using a new cranio-caudal expandable implant for Vertebral Compression Fracture treatment.

International Meeting on Advanced Spine Techniques/July 13-16, 2011. Copenhagen, Denmark

Background
Literature about subsequent adjacent vertebral fractures occurring after VCF treatment has shown that there are fewer subsequent fractures when using balloon kyphoplasty than with non-surgical care. A recent biomechanical study has demonstrated the role that can play the endplate deformity on the disc pressure profile load sharing and then on the adjacent fracture occurrence.

Purpose
The purpose of this study is therefore to analyze the occurrence rate of subsequent adjacent vertebral fractures when using a new vertebral cranio-caudal expandable implant in combination with PMMA cement injection.

Materials and Methods
Two clinics participated in prospective observational studies enrolling 96 patients designed to evaluate the ability of the VCCEI to restore the anatomy of the fractured vertebrae and to limit the occurrence of adjacent fractures. Assessments of clinical and radiological parameters were performed prior to surgery, after surgery, 6 month [46 pat] and 12 month [43 pat] postop. Using CTscans images, heights restoration, endplates’ angles changes were obtained for each scheduled visit. Any subsequent fracture was registered.
CT scan data were analyzed by an independent laboratory (LBM, ENSAM – PARIS) to build a 3D reconstruction of the involved vertebra for each evaluation step. Then, 3D reconstructions were superimposed using a validated matching algorithm based on anatomical points on the posterior arch to evaluate the study parameters.

Results
The VCCEI allows achieving VCF reduction thanks to an anatomical restoration of the injured endplate as well as kyphotic angle improvement up to 92%, and up to 10,8 mm height increase in the anterior part. 5 subsequent fractures were reported at 6 month, another 2 fractures at 12 month over 43 VCF.

Conclusion
While providing an anatomical restoration of the vertebral body including the vertebral endplates, this new procedure could be of interest when looking at the adjacent fracture occurrence rate in the mid and long-term results.

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