Balloon kyphoplasty for vertebral compression fractures in solid organ transplant recipients: results of treatment and comparison with primary osteoporotic vertebral compression fractures

Balloon kyphoplasty has become established as a useful treatment for vertebral compression fractures (VCF) associated with primary osteoporosis and osteolytic tumors. Organ transplant recipients are also at risk for VCF because of their underlying disease process and because they require long-term treatment with steroids and other immunosuppressive drugs. To explore whether balloon kyphoplasty is an effective treatment for VCF that develop in solid organ transplant recipients. A secondary goal was to determine whether there are any differences between VCF in transplant patients and VCF in patients with primary osteoporosis, with respect to disease severity and new fracture development. Prospective, longitudinal clinical series. The transplant group included 10 consecutive transplant patients (9 liver and 1 kidney), with a total of 29 symptomatic VCFs. The comparison group included 10 consecutive patients with primary osteoporosis and no history of organ transplantation, with a total of 15 VCFs. The primary clinical end point was back pain, measured using the Visual Analog Scale (VAS), which was recorded at baseline, and 1 and 12 months postprocedure. Radiographic evaluation included measurement of Cobb angles for each treated vertebral segment on preprocedure and 1-month postprocedure lateral radiographs. An improvement of >5° was considered significant. The number of fractures seen at the time of diagnosis and the number of new fractures occurring during the follow-up period were recorded. Balloon kyphoplasty was performed at all symptomatic levels. All fractures were treated within 3 months of onset. Patient follow-up was 12 months. The transplant group had significantly higher levels of pain at baseline, (mean VAS 9.3 and 7.7 for the transplant group and primary osteoporosis group, respectively: p=.013). After treatment, the VAS decreased to 3.2 in the transplant group and 1.5 in the comparison group. Improvement was highly significant in both groups (p5° in three patients in each group (30%). There were no procedural complications in either group. Compared with the primary osteoporosis group, the transplant group was more likely to have multiple fractures at the time of diagnosis (2.9 vs. 1.5, p=.03), had a twofold greater incidence of new fractures during the follow-up period (40% vs. 20%), was more than a decade younger (64 vs. 75 years, p