J Korean Soc Spine Surg 2017 Jun;24(2): Originally published online June 30, 2017;

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1 Journal of Korean Society of Spine Surgery Survival Analysis Based on the Incidence of a New Fracture in an Adjacent Vertebra After Vertebroplasty or Kyphoplasty Sung-Soo Kim, M.D., Dong-Hyok Kim, M.D., Jung-Hoon Kim, M.D. J Korean Soc Spine Surg 2017 Jun;24(2): Originally published online June 30, 2017; Korean Society of Spine Surgery Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea Tel: Fax: Copyright 2017 Korean Society of Spine Surgery pissn eissn The online version of this article, along with updated information and services, is located on the World Wide Web at: This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 Original Article J Korean Soc Spine Surg Jun;24(2): Survival Analysis Based on the Incidence of a New Fracture in an Adjacent Vertebra After Vertebroplasty or Kyphoplasty Sung-Soo Kim, M.D., Dong-Hyok Kim, M.D., Jung-Hoon Kim, M.D. Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea Study Design: Retrospective study. Objectives: To evaluate the factors affecting the incidence of new vertebral fractures and the survival rate associated with the occurrence of a new fracture in an adjacent vertebra after vertebroplasty or kyphoplasty for single-vertebral body fracture due to osteoporosis. Summary of Literature Review: It is controversial whether adjacent-vertebra fractures after vertebroplasty or kyphoplasty are due to the natural course of osteoporosis or are a complication of vertebroplasty. Materials and Methods: From May 2002 to January 2010, among 490 cases of vertebroplasty and kyphoplasty for the fracture of a single vertebral body due to osteoporosis, 250 cases were analyzed retrospectively, and a survival rate analysis was performed based on the incidence of a new fracture in an adjacent vertebral body. The survival rate analysis was conducted based on age at the time of surgery, gender, surgical method, leakage of cement into the vertebral disc, compression rate before surgery, recovery of vertebral height after surgery, bone density before surgery, surgeon, the presence of diabetes, and smoking. The average follow-up period was 13.8 months (range, 1 month to 7 years and 11 months) and the mean age at the time of surgery was 72.1 years (range, years). Results: Among the 250 cases, a new fracture in an adjacent vertebral body occurred in 30 cases (12%). The 1-year survival rate of patients undergoing vertebroplastry or kyphoplasty for a vertebral fracture was 88.4%, the 5-year rate was 66.8%, and the 7-year rate was 53.5%. When the cases were analyzed according to whether the patient s age at the time of surgery was under or over 70 years, the survival rate was significantly higher in the under-70 group (p=0.026). Moreover, when analyzing the survival rate using a 3% vertebral height recovery rate after surgery as baseline, the group that showed 3% or less had a significantly higher survival rate (p=0.04); moreover, the survival rate was significantly higher in patients with a bone density higher than 3.6 (p=0.046). In multiple factor analysis, age at the time of surgery (p=0.022) and the vertebral height recovery rate after surgery (p=0.046) were found to be statistically significant factors. Conclusions: The survival rate associated with a new fracture in an adjacent vertebra after vertebroplasty or kyphoplasty for osteoporotic compression fractures was significantly decreased at 1, 5, and 7 years. Based on the survival rate analysis, the most crucial factors were age and the vertebral height recovery rate after surgery. Key words: Osteoporosis, Vertebral compression fracture, Vertebroplasty, Kyphoplasty 골다공증으로인한척추체압박골절은노년층에서심한요통의흔한원인이되고있으며근래에는평균수명의연장으로노인인구가증가함에따라그발생빈도및골절위험이증가되고있다. 일반적인골다공증성척추압박골절의치료로는침상안정, 약물을통한통증조절, 보조기착용과같은보존적인치료가시행되나이러한보존적치료에도통증이지속되거나효과가없는환자에서추체를안정화시키고통증을완화시키는시술로써경피적추체성형술이시행되고있다. 경피적추체성형술은 1987 년 Galibert 등에의해처음소개되 Received: January 20, 2017 Revised: February 6, 2017 Accepted: April 25, 2017 Published Online: June 30, 2017 Corresponding author: Jung-Hoon Kim, M.D. ORCID ID: Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine, #170, Juhwaro, Ilsanseogu, Goyang, Gyeonggido, Korea TEL: , FAX: jhkim@paik.ac.kr 80 Copyright 2017 Korean Society of Spine Surgery Journal of Korean Society of Spine Surgery. pissn eissn This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

3 Journal of Korean Society of Spine Surgery Survival Rate of New Fracture in Adjacent Vertebral Body After Vertebroplasty 어초기에는혈관종환자에서추체유지를위해사용되었으나그후압박골절뿐만아니라혈관종, 골수종, 임파종, 전이성암의치료에도사용되고있다. 1) 이러한경피적추체성형술은수많은연구에서좋은결과를보고하고있으며 Diamond 등은추체성형술이보존적치료보다예후가낫다고보고하는등 2) 골다공증으로인한척추체압박골절환자에있어최소침습적시술법으로시멘트주입으로인한골절부안정성증가, 동통의감소및조기거동에있어괄목할만한치료효과가보고되었으며시술의빈도도증가하고있는추세이다. 3,4) 그러나, 단순한골시멘트의강제적주입에의한추체성형술에서추체외, 척수강내및혈관내로의시멘트유출이라는문제점이알려져있으며이로인한신경마비, 폐색전및감염, 출혈및기흉등의합병증이보고되고있다. 5-7) 이외에인접추체에대한새로운골절발생이 12~52% 로다양하게보고되고있으며이는추체성형술에의한합병증인지골다공증의자연경과인지에대해논란이많은실정이다. 이에저자들은단일척추체에골다공증성압박골절로경피적추체성형술을시행한후인접척추체에발생된새로운골절에따른생존율을분석하고그에관여하는요인을알아보고자하였다. 대상및방법 1. 대상 2002년 5월부터 2010년 1월까지본교실에서골다공증으로인한단일척추체압박골절에대해경피적척추체성형술및풍선성형술시행한총 490예중추적가능했던 250예를대상으로후향적으로분석하여인접척추체에새로운골절발생에대한생존분석을시행하였다. 시술시나이, 성별, 시술방법, 추간판내로의시멘트유출, 시술전압박율, 시술후추체높이회복율, 술전골밀도, 수술집도의, 당뇨및흡연여부등에따른단 일인자및다중인자생존분석을시행하였다. 추시기간 ( 생존기간 ) 은평균 13.8개월 (1개월 ~7년 11개월 ) 로마지막방문했을시까지의기간, 또는인접분절에새로운골절이발생할때까지의기간으로하였으며 1년이상추시는 90예, 5년이상 9예, 7 년이상은 2예였다. 시술시평균나이는 72.1세 (47~92 세 ) 였다. 남자는 37명이었으며여자는 213명이었다. 추체성형술을시행하였던부위는제 1요추가 88명 (35.2%), 제 12흉추가 65명 (26%), 제 2요추가 37명 (14.8%), 제 11흉추가 17명 (6.8%), 제 3요추가 16명 (6.4%), 제 10흉추가 8명 (3.2%), 제 4요추가 6명 (2.4%), 기타부위가 13명 (5.2%) 으로제 1요추와제 12흉추의흉요추부가전체의 61.2% 였다. 경피적추체성형술을시행하 Table 1. Demographic and clinical data obtained in patients Parameter value No.of patient 250 Gender, No of M:F 37 : 213 Vertabroplasty : kyphoplasty 119 : 131 Mean age(years) 72.1 Mean BMD(T-score) -3.0 No.of DM 35 No.of Smoking 24 No. of adjacent fracture 30 Follow up period(months) 13.7 Level, No.of TL: Others 153:97 No. of Cement leakage Proximal 47 Distal 13 mixed 5 A B C D Fig. 1. Receive operating characteristic curve. 81

4 Sung-Soo Kim et al Volume 24 Number 2 June 2017 였던경우가 119예 (47.6%) 였으며풍선추체성형술을시행한경우는 131예 (52.4%) 였다. 평균골밀도수치는 -3.03( ) 이었다. 수술집도의는갑이 120예, 을이 70예, 병이 60예였으며흡연자는 48명, 비흡연자는 202명이었고당뇨가있었던환자는 70명, 없었던환자는 180명이었다 (Table 1). 2. 연구방법수술당시나이, 술전골밀도, 술전전방추체압박률및술후추체높이회복율은 ROC (receive operating characteristic) 곡선을근거하여기준을정하여분석하였다 (Fig. 1). 수술당시나이는 70세를기준으로하였으며 (70세이상 162명, 70세미만 88명 ) 술전골밀도는 -3.6을기준으로하였고 (-3.6 초과 53명, -3.6 이하 197명 ) 술전전방추체압박율은 36%(36% 초과 94 명, 36% 이하 156명 ) 를기준으로하였다. 또한, 술후추체높이회복율은수술전단순방사선사진에서측정한추체전방높이와수술후단순방사선사진에서측정한추체전방높이의차이를백분율로나타냈으며 3%(3% 초과 176명, 3% 이하 74명 ) 으로구분하였고시술부위는제 12흉추와제 1요추의흉요추부위와이외의부위를나누어구분하여분석하였다. 생존율은 Kaplan-Meier 법으로, 단일인자분석은 Log-rank 법을이용하였고, 다중인자분석은 Cox proportional hazard regression 법을이용하였다. p값이 0.05보다작은경우에유의한것으로판단하였다. 접분절에골절이발생하였던경우는 11예 (36.7%) 였다 (Table 2). 기존에골다공증성압박골절이있었던경우는 51예였으며인접추간판으로시멘트유출이있었던경우는총 56예였으며이중에서근위부추간판으로유출은 47예, 원위부추간판으로유출은 13예였고근위부와원위부의추간판으로동시에유출된경우는 5예가있었다 (Table 1). 술전평균전방추체압박율은 30.3%(4 84%) 였고술후평균추체높이회복율은 14.6% (0 74%) 였다. 골다공증성척추체압박골절환자에서경피적척추체성형술및풍선성형술을시행하고인접척추체에새로운골절발생이없었던 1년생존율은 88.4% 였으며 5년생존율은 66.8% 였고, 7년생존율은 53.5% 였다 (Fig. 2). 수술당시나이 70세를기준으로나누어분석한결과 70세미만의생존율이유의하게높게분석되었다 (p=0.026, Hazard ratio=0.403, CI= )(Fig. 3A). 또한, 술후추체높이회복율 3% 를기준으로나누어분석한결과 3% 이하일경우생존율이유의하게높게분석되었고 (p=0.04, Hazard ratio=0.420, CI= )(Fig. 3B), 술전골밀도 -3.6을기준으로나누어분석한결과 -3.6 초과에서생존율이유의하게높게분석되었다 (p=0.046, Hazard ratio=0.476, CI= ) (Fig. 결과 연구대상총 250 예중추체성형술시행후인접분절에새 로운골절이발생한예는 30 예 (12%) 였으며그중근위부인 접분절에골절이발생한경우는 19 예 (63.3%) 였고, 원위부인 Fig. 2. The graph of survival rate. Table 2. New fracture at adjacent vertebra Vertebroplasty Kyphoplasty Number of new fracture Proximal adjacent new fracture Distal adjacent new fracture T7 1 1 T8 1 1 T T L L L3 1 1 L4 1 1 Total 30/250 (12%) 19 (63.3%) 11 (36.7%) 82

5 Journal of Korean Society of Spine Surgery Survival Rate of New Fracture in Adjacent Vertebral Body After Vertebroplasty A B C Fig. 3. Univariate analysis (A) age (B) reduction rate (C) preoperative BMD. 3C, Table 3). 성별에따른차이 (p=0.078), 수술집도의에따른차이 (p=0.728), 흡연여부에따른차이 (p=0.420), 당뇨병유무에따른차이 (p=0.308), 술전압박율에따른차이 (p=0.186), 인접추간판내로시멘트유출유무에따른차이 (p=0.721), 시술부위에따른차이 (p=0.087), 시술방법에따른차이 (p=0.181), 이전압박골절의존재유무에따른차이 (p=0.789) 는인접척추체에새로운골절발생생존율에유의한차이를보이지않았다. 이를바탕으로한다중인자분석에서는수술당시나이 (p=0.022, Hazard ratio=0.347, CI= ) 와술후추체높이회복율 (p=0.046, Hazard ratio=0.362, CI= ) 에서통계적으로의미있는요인으로분석되었다 (Table 4). 그러나, 술전골밀도는 p값이 0.05 이상으로유의한의미를가지지못했다 (p=0.153, Hazard ratio=0.556, CI= ). 고찰 골다공증성추체압박골절에대해최근에는경피적추체성형술후새롭게발생하는추체의골절에대한보고가많아지면서추체성형술과추가골절사이의관련성에대한관심이증가하고있다. Jensen 등과 Grados 등이발표한연구를비롯한많은연구에서추체성형술후발생하는다른인접추체골절가능성은 12~58% 로보고하고있으며 Trout 등은추체성형술후인접추체에새로운골절이발생할가능성은비인접추체보다 4배이상된다고보고하고있다. 7-9) 또한, Uppin 등은 177명의환자중 12.4% 가추체성형술이후새로운골절이발생하였으며골절된추체중 67% 가인접추체에발생하였고처음시술후 30일이내에발생한것을보고하고있다. 10) 본연구에서도추체성형술후추가골절발생률은 12% 로보이고있으며골절발생한군에서의근위부인접분절골절의경 Table 3. Risk factors (Univariate analysis) Risk factors p Hazard ratio CI Age: <70 vs ~0.829 Postop. Reduction rate: >3 vs ~0.880 Preop BMD: >-3.6 vs ~1.179 Table 4. Risk factors (Multivariate analysis) Variables Hazard ratio CI p Age < ~ Postop. Reduction rate ~ >

6 Sung-Soo Kim et al Volume 24 Number 2 June 2017 우는 63.3% 로비슷한결과를보이고있음을볼수있다. 또한, 경피적척추체성형술및풍선성형술을시행하고인접척추체에새로운골절발생이없었던 1년생존율은 88.4% 로다른년수에비하여생존율감소가큰것을알수있었으며술후 7년째에도역시생존율감소가크게나타나전체적인생존율은점점감소하는양상을보였다. 본연구에서사용된생존분석은기본적으로모든환자가동일한날동일시점에수술을받았다는전제하에시간에따른생존율의변화를보여줌으로장기추시의결과를시간적추이에따라살펴보는데에의의가있다. 추시중지속적인추적관찰이불가능한경우나추가골절이있었으나본원에서치료받지않은경우또한있을수있어생존율감소나추가골절발생빈도는더높을것이라추정된다. 이런인접추체의골절을유발할수있는골다공증, 이전의척추체골절, 인접추간판으로의시멘트유출, 고령, 초기후만각혹은후만각의변화, 스테로이드의사용, 흉요추이행부의골절등의여러가지인자에대한연구들이이루어지고있는데 Shaofeng Yang 등은 BMD가높을수록인접추체의골절가능성은낮다고보고하고있으며 Uppin 은골다공증이심할수록골절의가능성은증가한다고하였다. 10,11) 본연구에서도술전골밀도가 -3.6 초과일경우에생존율이높은것을확인할수있었으나 Laredo 등 12) 은골다공증과추가골절의발생과는상관관계가없다고보고하고있어골다공증과추가골절과의상관관계에대해서는지속적인역학적연구가더필요할것으로보인다. 인접추체의골절을유발하는또다른요인으로시멘트의유입자체가인접추체의골절을유발한다는보고들도있다. Liebschner 등은골시멘트의과다한주입은인접운동분절의정상적물리역학의변화를초래하여이경우과부하가발생하여추체성형술이후압박골절의발생은인접된추체에밀집되어서나타나는경향이있다고하였다. 13) 추체성형술부위와인접상하추체간의관계에서추체의부하및형태에서의미있는변화를보이는생역학적자료들도있는데 Baroud 등은시멘트주입으로인하여인접추간판으로의압력이증가하고이것이다시인접추체의추체판 (endplate) 으로전달되어추체판의팽윤 (bulging) 을초래하고인접부위골절위험을증가시키는지지효과 (pillar effect) 를설명하였다. 14) Berleman 등은시멘트주입으로인한추체의 stiffness 의증가로인해인접추체로의부하장애를증가시켜골절을유발시킬수있다고보고하고있다. 15) 척추성형술시시멘트누출의가능성은 11.3%~33.9% 로보고되고있고 Lin 등은시멘트누출이있는군에서없는군에비해인접추체의골절이나타나는기간이더짧았다하며 Chen 등도시멘트누출이인접추체의골절을유발한다보고하고있 으나본연구에서의시멘트누출과의관계는유의하지않은것으로나타났다. 16,17) 추체성형술중시멘트누출은보통영상투시기관찰하에어느정도의점도가형성된후주입되기시작하기때문에골절부위를통한과도한누출은어느정도예방이되고누출된다하더라고그양이미미할가능성이커소량의누출이인접추체골절을유발시키는것보다는추체내시멘트유입으로인한요인이더클것으로생각된다. 김등은압박변형을일으킨척추체의높이증가가추체주변연부조직의긴장도를증가시키고이것이다른추체에하중을증가시킬수있으며특히골절부위와가까운추체일수록그영향이클것이라고하였으며추체높이회복률이높을수록인접추체골절의위험도는증가하는것으로보고하고있으며특히전방추체보다는중앙부척추체의높이회복률이클수록인접추체골절위험이증가한다고보고하였다. 18) 본연구에서도술후추체높이회복율이단일인자분석과다중인자분석에서 3% 초과에서인접분절의새로운골절발생에영향을끼치는것으로나타났다. Papanastassious ID 등의연구및다른여러연구에서풍선추체성형술이추체성형술보다추체높이회복율이높다고보고하고있으며 19) 앞에언급한바와같이추체높이회복율이높을수록인접추체의골절위험이증가한다는연구결과를종합해보면풍선추체성형술에서인접추체골절위험이더높을것으로볼수있다. 또한본연구에서도추체성형술 119례중에서 13예 (12.3% ) 의인접추체골절이발생하였고풍선추체성형술 131예중 17예 (17.1%) 에서골절이발생하였으며인접추체에골절이발생된 13예중 9예 (69.2%) 가, 17예중 15예 (88.2%) 가 3% 초과추체높이회복율을보여풍선추체성형술에서골절발생률이높은경향을보였다. 그러나통계적으로는추체성형술과풍선추체성형술간의인접추체골절의발생생존율에유의한차이를보이지않았다. 이는본연구에서인접추체골절수가 30예로증례수가적어통계적결과를산출하는데제한이있었으리라생각되며이에대해향후더많은증례를통한추가연구가필요하리라사료된다. 본연구의단일인자분석에서성별, 수술집도의, 흡연, 당뇨병, 술전추체전방압박율, 인접추간판내로시멘트유출, 시술부위, 시술방법, 이전압박골절의존재유무는인접척추체에새로운골절발생생존율에유의한차이를보이지않았으나나이, 술후추체높이회복율및술전골밀도에대한결과가의미를가지는것으로나타났다. 또한, 이를바탕으로다중인자분석을시행한결과나이가가장큰의미를가지는것으로분석되었고술후추체높이회복율또한의미가있는것으로나타났다. 위의결과를토대로보았을때경피적추체성형술을시행한경우에나이가 70세이상인경우, 술후추체높이회복 84

7 Journal of Korean Society of Spine Surgery Survival Rate of New Fracture in Adjacent Vertebral Body After Vertebroplasty 율이 3% 초과인경우, 술후 1년이경과한때와 7년때에인접분절에재골절이발생할가능성이높을것이라사료된다. 본연구에서는추체성형술후인접분절의척추체에골절발생에관여하리라생각되는여러인자들에대한분석이자료가충실히갖추어지지못하여시행하지못한한계가있으며특히추체성형술부위와인접상하추체간의생역학적측면을고려하지않았고임상적평가및골다공증약물치료에대한평가가첨가되지못한제한이있어향후이에대한연구가필요하리라사료된다. 결론 골다공증성압박골절로경피적추체성형술후인접분절척추체에새로운골절발생이없었던 1년생존율은 88.4% 였으며 5년생존율은 66.8% 였고, 7년생존율은 53.5% 였다. 또한, 생존분석결과가장중요한인자는나이와술후추체높이회복율임을알수있었다. REFERENCES 1. Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie. 1987;33: Diamond TH, Champion B, Clark WA. Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vetebroplasty with conservative therapy. Am J Med. 2003;114: Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361: Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361: Lo YP, Chen WJ, Chen LH, et al. New vertebral fracture after vertebroplasty. J Traum. 2008;65: Ahn Y, Lee JH, Lee HY, et al. Predictive factors for subsequent vertebral fracture after percutaneous vertebroplasty. J Neurosurg Spine. 2008;9: Jensen ME, Evans AJ, Mathis JM, et al. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol. 1997;18: Gardos F, Hardy N, Cayrlle G, et al. Treatment of vertebral compression fractures by vertebroplasty. Rev Rhum (Engl Ed). 1997;64: Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol. 2006;27 : Uppin AA, Hirsch JA, Centenera LV, et al. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoprosis. Radiology. 2003;226: Yang S, Liu Y, Yang H, et al. Risk factors and correlation of secondary adjacent vertebral compression fracture in percutaneous kyphoplasty. Int J Surg. 2016; Laredo JD, Hamz B. Complication of percutaneous vertebroplasty and their prevention. Skeletal Radiol. 2004;33: Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffnes after vertebroplasty. Spine (Phila Pa 1976). 2001;26: Baroud G, Nemes J, Ferguson SJ, et al. Material changes in osteoporotic human cancellous bone following infiltration with acrylic bone cement for a vertebral cement augmentation. Comput Methods Biomech Biomed Engin. 2003;6: Berlemann U, Ferguson SJ, Nolte LP, et al. Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg Br. 2002;84: Lin EP, Ekholm S, Hiwatashi A, et al. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol. 2004;25: Chen YD, Teng MM, Chang CY, et al. Intrathecal cement leakage as a rare and serious complication of percutaneous vertebroplasty: case report and literature review. Chin J Radiol. 2007;32: Kim MH, Andrew S, Min SH, et al. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Asian Spine J. 2011;5: Papnastassious ID, Phillips FM, Van Meirhaeghe J, et al. Comparing effects of kyphoplasty, vertebroplasty, and nonsurgical management in a systematic review of randomized and non-randomized controlled studies. Eur Spine J. 2012;

8 Original Article J Korean Soc Spine Surg Jun;24(2): 경피적척추체성형술후인접척추체의새로운골절발생에대한생존분석 김성수 김동혁 김정훈인제대학교일산백병원정형외과학교실연구계획 : 후향적연구목적 : 골다공증으로인한단일추체압박골절에서경피적추체성형술후인접추체골절발생에대한생존율을분석하고그에관여하는요인을알아보고자하였다. 선행문헌의요약 : 추체성형술후인접추체에새로운골절발생이수술에의한것인지골다공증의자연경과인지에대해논란이많다. 대상및방법 : 2002년 5월부터 2010년 1월까지본교실에서골다공증으로인한단일추체압박골절에대해추체성형술및풍선성형술시행한총 490 예중추적가능했던 250예를대상으로후향적으로인접추체에새로운골절발생에대한생존분석을시행하였다. 시술시나이, 성별, 시술방법, 추간판내로의시멘트유출, 시술전압박율, 시술후추체높이회복율, 술전골밀도, 집도의, 당뇨및흡연여부등에따른생존분석을시행하였다. 평균추시기간은 13.8개월 (1개월 ~7년 11개월 ), 시술시평균나이는 72.1세 (47~92 세 ) 였다. 결과 : 총 250예중인접추체에새로운골절이발생한경우는 30예 (12%) 였으며추체압박골절환자에서추체성형술및풍선성형술후인접추체에새로운골절발생이없었던 1년생존율은 88.4%, 5년생존율은 66.8%, 7년생존율은 53.5% 였다. 수술당시나이 70세를기준으로 70세미만의생존율이유의하게높게분석되었다 (p=0.026). 또한, 술후추체높이회복율 3% 를기준으로 3% 이하일경우생존율이유의하게높게분석되었고 (p=0.04), 술전골밀도 -3.6을기준으로 -3.6 초과에서생존율이유의하게높게분석되었다 (p=0.046). 다중인자분석에서는수술당시나이 (p=0.022) 와술후추체높이회복율 (p=0.046) 에서통계적으로의미있는요인으로분석되었다. 결론 : 골다공증성압박골절로추체성형술후인접분절추체에새로운골절발생에대한생존율은 1년, 5년, 7년째에의미있는감소가있었고생존분석결과가장중요한인자는나이와술후추체높이회복율임을알수있었다. 색인단어 : 골다공증, 척추체압박골절, 추체성형술, 풍선추체성형술 약칭제목 : 추체성형술후추체골절의생존율 접수일 : 2017년 1월 20일 수정일 : 2017년 2월 6일 게재확정일 : 2017년 4월 25일 교신저자 : 김정훈 경기도고양시일산서구주화로 170 인제대학교일산백병원정형외과교실 TEL: FAX: jhkim@paik.ac.kr 86 Copyright 2017 Korean Society of Spine Surgery Journal of Korean Society of Spine Surgery. pissn eissn This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.