Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2015; 6(9): 680-687
Published online Oct 18, 2015. doi: 10.5312/wjo.v6.i9.680
Vertebral fracture assessment: Current research status and application in patients with kyphoplasty
Efstathios Drampalos, Konstantinos Nikolopoulos, Christos Baltas, Alexia Balanika, Antonis Galanos, Nikolaos Papaioannou, Spyros Pneumaticos
Efstathios Drampalos, Christos Baltas, Alexia Balanika, Antonis Galanos, Nikolaos Papaioannou, Laboratory for the Research of the Musculoskeletal System (LRMS), Faculty of Medicine, University of Athens, 14561 Athens, Greece
Efstathios Drampalos, Center for Hip Surgery, Wrightington Hospital, Wigan WN6 9EP, United Kingdom
Konstantinos Nikolopoulos, Spyros Pneumaticos, C’ Orthopedic Department, University of Athens, “K.A.T” Hospital, Kifisia, 14561 Athens, Greece
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: Drampalos E, Nikolopoulos K, Baltas C, Balanika A, Galanos A, Papaioannou N and Pneumaticos S, hereby declare that, as authors of the manuscript, we have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Efstathios Drampalos, Associate Research Fellow at Laboratory for the Research of the Musculoskeletal System (LRMS), Faculty of Medicine, University of Athens, 2nd Nikis St, Kifisia, 14561 Athens, Greece. edrampalos@yahoo.gr
Telephone: +30-210-8018123
Received: May 29, 2015
Peer-review started: June 1, 2015
First decision: June 24, 2015
Revised: July 5, 2015
Accepted: August 10, 2015
Article in press: August 11, 2015
Published online: October 18, 2015
Processing time: 144 Days and 10.8 Hours
Abstract

Imaging of the spine is of paramount importance for the recognition of osteoporotic vertebral fractures (VFs), and standard radiography (SR) of the spine is the suggested diagnostic method but is not routinely used because of the cost and radiation exposure considerations. VF assessment (VFA) is an efficient, low radiation method for identifying VFs at the time of bone mineral density (BMD) measurement. Prediction models used to indicate the need for VFA may have little predictive power in subspecialty referral populations such as rheumatologic patients or patients who underwent kyphoplasty. Rheumatologic patients are frequently at increased risk for VFs, and VFA should be performed on an individual basis, also taking in account the guidelines for the general population. Kyphoplasty is a new minimal invasive procedure for the treatment of VFs and is being performed with increasing frequency. Following kyphoplasty, there may be a risk of new VFs in adjacent vertebrae. The assessment and follow-up of patients who underwent kyphoplasty requires repetitive X-ray imaging with the known limitations of SR. Thus, VFA may facilitate the evaluation of VFs in these patients because most of the kyphoplasty patients would fulfill the criteria. In a pilot study, we measured the BMD and performed VFA in 28 patients treated with kyphoplasty. Ratios of anterior to posterior (A/P) and middle to posterior (M/P) height were measured, and Genant’s method was used to classify vertebrae accordingly. Intraobserver and interobserver reliability for A/P, M/P and the Genant’s method were determined. Only 1 patient did not meet the criteria for VFA. Of the 364 available vertebrae, 295 could be analyzed. Most missing data (concerning 69 vertebrae) occurred in the upper thoracic region. Three of the 69 non-eligible vertebrae were lumbar vertebrae with cement leakage from the kyphoplasty procedure. In our hands, VFA was highly reproducible, demonstrating very good agreement in terms of intraobserver and interobserver reliability. Agreement was very good on the vertebral level, “vertebrae with kyphoplasty” level and “2 above and 1 below the kyphoplasty vertebrae” level. The application of Genant’s method to these patients also resulted in perfect agreement. We believe that the potential value of VFA in patients treated with kyphoplasty requires further evaluation, particularly comparing VFA with SR and performing a longitudinal follow-up. More research will help to adopt care processes that determine which patients require VFA and how often VFA should be performed, while also considering the impact of this technique on the cost of healthcare organizations.

Keywords: Vertebral fracture assessment; Current research; Kyphoplasty; Guideline

Core tip: Vertebral fracture assessment (VFA) is an efficient, low radiation method of identifying vertebral fractures at the time of bone mineral density measurement. Models used to indicate the need for VFA may have little predictive power in subgroups of the general population such as patients with kyphoplasty. In our hands, VFA applied in patients with kyphoplasty was highly reproducible, demonstrating very good agreement in terms of intraobserver and interobserver reliability. More research will help the adoption of care processes to determine when and how often VFA should be performed, considering also the impact of such cost on healthcare organizations.