Efficiency and Safety of Repeated Vertebroplasty for Adjacent Segment Fractures

<b>Objectives:</b> To review the outcomes of patients who underwent repeated vertebroplasty (VP) surgery for adjacent segment fractures (ASF), defined as new osteoporotic vertebral fractures occurring at levels immediately above or below a previously treated vertebra. <b>Methods:</b> From 1 January 2018, to 31 December 2020, forty-one patients who developed ASF following initial VP and underwent repeated VP were enrolled in our study. Radiographic measurements included single and two-segment kyphotic angles (SKA and TKA), and anterior and mid-vertebral body height (AVH and MVH). Patient-reported outcomes included back pain assessed with the visual analog scale (VAS) and the Oswestry Disability Index (ODI). <b>Results:</b> The procedure significantly reduced the mean single kyphotic angle (SKA) by 4.8° ± 6.8° (<i>p</i> < 0.01) and the two-segment kyphotic angle (TKA) by 3.0° ± 7.9° (<i>p</i> = 0.02), along with increases in anterior and mid-body height by 0.3 ± 0.5 cm and 0.3 ± 0.6 cm (both <i>p</i> < 0.01). However, there was a slight restoration loss in SKA and TKA at a 20.1-month follow-up. Patient-reported outcomes revealed substantial pain reduction, with the VAS score dropping from 8 to 1 (<i>p</i> < 0.0001) and the mean ODI score improving from 59.7 to 28.9 (<i>p</i> < 0.0001). The complication rate was 34.1%, including nonunion, de novo fractures, cement leakage, and neurological deficits. Additionally, 7.3% of cases necessitated further surgical interventions. <b>Conclusions:</b> Repeated VP for ASF improves vertebral alignment parameters and patient-reported outcomes, but with a high rate of complications and reoperation.