This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic
deformity in 144 patients with osteoporotic vertebral
compression fracture (OVCF), who received balloon
kyphoplasty. Patients were divided into four groups: Group 1 had no superior endplate fracture, Group 2 had fractures on the anterior portion of the superior endplate, Group 3 had fractures on the posterior portion of the superior endplate, and Group 4 had complete superior endplate fractures. Anterior and middle vertebral body height, vertebral compression ratio, vertebral height loss rate, and
kyphosis Cobb angle of each patient were measured and visual analogue scale (VAS) and Oswestry disability index (ODI) scores were recorded. The anterior vertebral height and
kyphosis deformity of all groups significantly improved after the surgery, whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up. Although the vertebral height loss rate and the Cobb angle in Group 2, 3 and 4 were larger compared with Group 1 at the last follow-up, only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1. The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores, but there was no significant difference among these groups. Balloon
kyphoplasty significantly improved vertebral fracture height and
kyphosis. Vertebral height loss and increased kyphotic
deformity were observed in OVCF patients with endplate fractures after the surgery. Postoperative aggravation of
kyphosis was observed in Group 2. Furthermore, severe vertebral height loss and increased kyphotic
deformity were confirmed in Group 4 after the surgery. Our results suggested that postoperative vertebral height loss and aggravation of
kyphosis may be associated with biomechanical changes in the vertebral body caused by endplate fracture. Therefore, surgery should not only restore compressed vertebral body height and correct
kyphosis, but also correct the
deformity of endplate to achieve an effective treatment of OVCF patients with endplate fracture.