Balloon kyphoplasty in the treatment of vertebral fractures

Approximately 500,000 vertebral fractures occur as a result of osteoporosis every year in Europe. One third of the patients thus affected complain of severe back pain and seek treatment. In the past, the treatment of such fractures was limited to conservative methods, such as the use of braces and analgesics and long-term immobilisation followed by physiotherapy. Since 1998 balloon kyphoplasty, a minimally invasive procedure, has also been available for their treatment. During balloon kyphoplasty a balloon system is introduced into the fractured vertebral body to achieve bitranspedicular augmentation, after which low-viscosity bone cement is injected into the vertebral body, where it sets very quickly. In general the patient can be fully mobilized 24-48 h after the procedure and in most cases the symptoms are then considerably attenuated; many patients are actually free of pain. Published studies and our own experience indicate that balloon kyphoplasty is a safe method of treating painful vertebral compression fractures sustained in various ways and that complications are rare with this procedure.     

Balloon kyphoplasty in the therapy of vertebral fractures

Approximately 500,000 vertebral fractures occur as a result of osteoporosis every year in Europe. One third of the patients thus affected complain of severe back pain and seek treatment. In the past, the treatment of such fractures was limited to conservative methods, such as the use of braces and analgesics and long-term immobilisation followed by physiotherapy. Since 1998 balloon kyphoplasty, a minimally invasive procedure, has also been available for their treatment. During balloon kyphoplasty a balloon system is introduced into a fractured vertebral body to achieve bitranspedicular augmentation, after which low-viscosity bone cement is injected into the vertebral body, where it sets very quickly. In general the patient can be fully mobilized 24-48 h after the procedure and in most cases the symptoms are then considerably attenuated; many patients are actually free of pain. Published studies and our own experience indicate that balloon kyphoplasty is a safe method of treating painful vertebral compression fractures sustained in various ways and that complications are rare with this procedure.     

Ballonkyphoplastie in der Therapie von Wirbelkörperfrakturen

Approximately 500,000 vertebral fractures occur as a result of osteoporosis every year in Europe. One third of the patients thus affected complain of severe back pain and seek treatment. In the past, the treatment of such fractures was limited to conservative methods, such as the use of braces and analgesics and long-term immobilisation followed by physiotherapy. Since 1998 balloon kyphoplasty, a minimally invasive procedure, has also been available for their treatment. During balloon kyphoplasty a balloon system is introduced into the fractured vertebral body to achieve bitranspedicular augmentation, after which low-viscosity bone cement is injected into the vertebral body, where it sets very quickly. In general the patient can be fully mobilized 24–48 h after the procedure and in most cases the symptoms are then considerably attenuated; many patients are actually free of pain. Published studies and our own experience indicate that balloon kyphoplasty is a safe method of treating painful vertebral compression fractures sustained in various ways and that complications are rare with this procedure.     

Vertebroplasty and Kyphoplasty in Spinal Trauma

Abstract Kyphoplasty and vertebroplasty have become recognized procedures for the treatment of vertebral fractures, especially in patients with osteoporosis. In most cases of osteoporotic spinal vertebral fracture in elderly patients, polymethylmethacrylate (PMMA) cement is used to fill the defect and stabilize the vertebral body. The techniques of vertebroplasty and kyphoplasty differ in the possibility of realignment and reconstruction of the vertebral body and spinal column. Long-term results in terms of integration of the cement and bioreactivity of the vertebral body are still lacking; so, these procedures are still no options in the treatment of younger patients. Vertebroplasty and kyphoplasty show different success in the management of fresh traumatic spine fractures. The acute traumatic vertebral fracture has to be classified sensitively, to find the right indication for cement augmentation. Mild acute compression fractures can be treated by vertebroplasty or kyphoplasty, severe compression and burst fractures by combination of internal fixation and kyphoplasty. The indications for use of biological or osteoinductive cement in spinal fracture management must still be regarded as restricted owing to the lack of basic biomechanical research data. Such cement should not be used except in clinical studies.     

Higher incidence of new vertebral fractures following percutaneous vertebroplasty and kyphoplasty--fact or fiction?

New vertebral fractures after percutaneous vertebroplasty or kyphoplasty are said to result from biomechanical changes induced by cementation. Fact or fiction? The reported incidences for new vertebral fractures after cementation or after conservative therapy vary widely. This is mainly due to differences in their design, more specifically as to the duration of followup. Therefore a systematic review of the literature was performed, searching for comparable publications to assess the potential risk of new vertebral fractures following vertebroplasty and kyphoplasty versus conservative treatment. Studies were only included if they granted a standardized one-year radiological follow-up, so improving comparability. However, a high degree of heterogeneity was still seen among the results, which made it impossible to state that cement augmentation is as safe as conservative treatment with respect to new fractures. In other words, it was impossible to separate facts from fiction with the studies available to-day. The combined odds ratio of vertebroplasty and kyphoplasty versus conservative treatment, namely 0.96, gave a hint that there might be little difference. Large scale randomized studies will be necessary.     

Wirbelkörperfrakturen und Osteoporose

Due to the increasing aging population, osteoporotic vertebral fractures, including traumatic fractures, yet even more frequent causes of pain and disability. Conservative treatment remains a mainstay of the treatment of osteoporotic vertebral fractures. Minimally invasive treatment strategies, e.g. vertebroplasty/kyphoplasty, assume greater importance in cases where conservative treatment fails. The treatment of complex vertebral fractures can be surgically challenging in the case of osteoporosis; however, cement augmentation of pedicle screws, additional cement augmentation of the fractured vertebra as well as anterior stabilization are possible approaches to treat these fractures with satisfactory results.     

Percutaneous vertebral augmentation: an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty.

BACKGROUND CONTEXT: Osteoporotic vertebral compression fractures (VCFs) are being increasingly treated with minimally invasive bone augmentation techniques such as kyphoplasty and vertebroplasty. Both are reported to be an effective means of pain relief; however, there may be an increased risk of developing subsequent VCFs after such procedures. PURPOSE: The purpose of this study was to compare the effectiveness and complication profile of kyphoplasty and vertebroplasty in a single patient series. STUDY DESIGN/SETTING: A clinical series of 36 patients with VCFs treated by vertebral augmentation procedures was retrospectively analyzed for surgical approach, volume of cement injected, cement extravasation (symptomatic and asymptomatic), the occurrence of subsequent adjacent level fracture, and pain relief. PATIENT SAMPLE: Thirty-six patients with 46 VCFs underwent either kyphoplasty or vertebroplasty after failing conservative therapy. The mean patient age was not significantly different between the kyphoplasty group (70; range, 46-83) and vertebroplasty group (72; range, 38-90) (p=.438). OUTCOME MEASURES: Outcomes were assessed by using self-report measures (a comparative pain rating scale) and physiologic measures (pre- and postoperative radiographs). METHODS: Thirty-six patients with VCFs underwent 46 augmentation procedures (17 patients had 20 fractures treated via kyphoplasty, and 19 patients had 26 fractures treated via vertebroplasty). Seventeen patients in this series underwent kyphoplasty using standard techniques involving bone void creation with balloon tamps, followed by cement injection. Nineteen patients underwent a percutaneous vertebroplasty procedure using a novel cannulated, fenestrated bone tap developed to direct cement anteriorly into the vertebral body to avoid backflow of cement onto neural elements. RESULTS: Pain improvement was seen in >90% of patients in both groups. Mean cement injection per vertebral body was 4.65 mL and 3.78 mL for the kyphoplasty and vertebroplasty groups, respectively (p=.014). Ninety-five percent of the kyphoplasty procedures were performed bilaterally, whereas only 19% of the vertebroplasty procedures required bilateral augmentation (p<.001). There was no cement extravasation resulting in radiculopathy, or myelopathy in either group. Asymptomatic cement extravasation was seen in 5 of 46 (11%) of the total series (3/20 [15%] and 2/26 [7.7%] of kyphoplasty and vertebroplasty, respectively) (p=.696). Within a 3-month period, there were 5 new adjacent level fractures seen in 3 patients who underwent a kyphoplasty procedure (5/20 [25%]) and none in the vertebroplasty group (p<.05). CONCLUSIONS: Vertebroplasty appears to offer a comparable rate of postoperative pain relief as kyphoplasty while using less bone cement more often via a unilateral approach and without the attendant risk of adjacent level fracture.     

Cement augmentation in fracture treatment.

Surgical treatment of fractures close to joints, especially in osteoporotic patients, is often associated with problems to obtain adequate strength of the bone-implant construct as well as sufficient purchase for screws in the weak bone. One way to address this increasing problem is through the development of new metal implants specifically designed for fixation of fractures in osteopenic bone. An alternative strategy is to develop methods for augmentation of the weak bone that surrounds the metal implant. In most instances augmentation is achieved by using injectable cement to reinforce the bone. Conventional PMMA provides good strength but due to several drawbacks it has never gained general acceptance for fracture augmentation. More recently several injectable cements based on calcium-phosphate, calcium-sulphate or bioglass has been developed for augmentation of fractures in the extremities as well as for vertebral compressive fractures in the spine. On the basis of biomechanical studies and the clinical experience so far, cement augmentation will enable faster rehabilitation, as the strength of the cement makes it possible to allow full weight-bearing earlier than conventional metal implants alone. More clinical studies are needed in order to refine the surgical technique, develop cement types aimed for fracture treatment and define the most appropriate indications and limitations of augmentation for fracture repair. The purpose of this article is to review the possible use of augmentation as a technique in the treatment of fractures in the extremities as well as in the spine.     

Spinal loads after osteoporotic vertebral fractures treated by vertebroplasty or kyphoplasty

Vertebroplasty and kyphoplasty are routine treatments for compression fractures of vertebral bodies. A wedge-shaped compression fracture shifts the centre of gravity of the upper body anteriorly and generally, this shift can be compensated in the spine and in the hips. However, it is still unclear how a wedge-shaped compression fracture of a vertebra increases forces in the trunk muscle and the intradiscal pressure in the adjacent discs. A nonlinear finite element model of the lumbar spine was used to estimate the force in the trunk muscle, the intradiscal pressure and the stresses in the endplates in the intact spine, and after vertebroplasty and kyphoplasty treatment. In this study, kyphoplasty represents a treatment with nearly full fracture reduction and vertebroplasty one without restoration of kyphotic angle although in reality kyphoplasty does not guarantee fracture reduction. If no compensation of upper body shift is assumed, the force in the erector spine increases by about 200% for the vertebroplasty but by only 55% for the kyphoplasty compared to the intact spine. Intradiscal pressure increases by about 60 and 20% for the vertebroplasty and kyphoplasty, respectively. In contrast, with shift compensation of the upper body, the increase in muscle force is much lower and increase in intradiscal pressure is only about 20 and 7.5% for the vertebroplasty and kyphoplasty, respectively. Augmentation of the vertebral body with bone cement has a much smaller effect on intradiscal pressure. The increase in that case is only about 2.4% for the intact as well as for the fractured vertebra. Moreover, the effect of upper body shift after a wedge-shaped vertebral body fracture on intradiscal pressure and thus on spinal load is much more pronounced than that of stiffness increase due to cement infiltration. Maximum von Mises stress in the endplates of all lumbar vertebrae is also higher after kyphoplasty and vertebroplasty. Cement augmentation has only a minor effect on endplate stresses in the unfractured vertebrae. The advantages of kyphoplasty found in this study will be apparent only if nearly full fracture reduction is achieved. Otherwise, differences between kyphoplasty and vertebroplasty become small or vanish. Our results suggest that vertebral body fractures in the adjacent vertebrae after vertebroplasty or kyphoplasty are not induced by the elevated stiffness of the treated vertebra, but instead the anterior shift of the upper body is the dominating factor.     

Use of a screw-syringe injector for cement delivery during kyphoplasty: technical report

OBJECTIVE: Percutaneous kyphoplasty is postulated to have several advantages over percutaneous vertebroplasty for the treatment of vertebral compression fractures and is gaining increased popularity. However, cement delivery with the KyphX kit (Kyphon, Inc., Santa Clara, CA), the only commercially available device for percutaneous kyphoplasty, is relatively problematic. This kit uses a series of "bone filler device" (BFD) tubes. Each BFD must be loaded manually with cement, which is then injected into the kyphoplasty cavity by manually depressing an inner stylet. The high profile of the BFD cannulas and their stylets requires frequent repositioning of the image intensifier tube and table. Because each accommodates only a small volume, the BFDs must be exchanged frequently. This delivery method also places the operator's hands directly in the field of radiation. We sought to overcome these limitations. METHODS: Dissatisfied with the shortcomings of the BFDs, we substituted the EZflow screw-syringe injector (Parallax Medical, Mountain View, CA) we use to deliver cement during conventional percutaneous vertebroplasty. This amalgam of the KyphX kit and the screw-syringe injector has been used for kyphoplasty treatment of 26 thoracolumbar compression fractures in 17 patients. RESULTS: The screw-syringe injector allows controlled volumetric delivery of large boluses of high-viscosity cement without having to refill the reservoir. It minimizes radiation exposure and does not require repositioning of the x-ray tubes. It may theoretically allow decompression should cement extrusion occur. Also, it delivers cement to the interstices of bony trabeculae outside the kyphoplasty cavity, thus combining the mechanical benefits of percutaneous kyphoplasty and percutaneous vertebroplasty. CONCLUSION: The use of a screw-syringe injector has several merits over the customary means of cement delivery during kyphoplasty.     

Extended kyphoplasty indications for stabilization of osteoporotic vertebral compression fractures

OBJECTIVES: Percutaneous vertebroplasty with polymethylmethacrylate allows minimally invasive stabilization of osteoporotic vertebral fractures. Fracture reduction is, however, not possible and the risk of uncontrolled epidural cement leakage with burst fractures is increased. Kyphoplasty, in contrast, allows a degree of fracture reduction and provides an extended spectrum of indications through open approaches, which enable spinal decompression and augmentation of incomplete burst fractures. METHODS. In kyphoplasty a contrast-filled balloon is inflated in the vertebra until a cavern is created. A degree of reposition may be achieved depending on fracture age. Augmentation is performed with high-viscosity polymethylmethacrylate under low pressure. In cases of neural compression, interlaminary spinal decompression and kyphoplasty through the posterior wall is performed. With anterior spinal procedures, kyphoplasty can be performed without extending the approach. RESULTS: Vertebral augmentation was performed by percutaneous, interlaminary, and anterior approaches for incomplete burst fractures. Four representative cases are presented from a collective of 120 augmentations. CONCLUSIONS: Percutaneous kyphoplasty, supplemented by open approaches, enables augmentation of osteoporotic incomplete burst fractures.     

Degeneration und Osteoporose der Wirbelsäule

Reduced bone quality due to osteoporosis poses a fundamental problem in spine surgery instrumentation. The consequences observed most often are insufficient implant anchoring and adjacent fractures. In cases of manifest osteoporosis, several modern anchoring possibilities are at our disposal that, to differing degrees, increase the stability of the instrumentation. Cement augmentation of a fractured vertebra by means of kyphoplasty or vertebroplasty verifiably leads to significantly better pain reduction than conservative treatment does, at least in the short-term postoperative course. A difference between these two techniques has not yet been substantiated. The rate of adjacent fractures occurring after cement augmentation is not higher than in conservatively treated patients.     

The biomechanical effects of kyphoplasty on treated and adjacent nontreated vertebral bodies

It remains unclear whether adjacent vertebral body fractures are related to the natural progression of osteoporosis or if adjacent fractures are a consequence of augmentation with bone cement. Experimental or computational studies have not completely addressed the biomechanical effects of kyphoplasty on adjacent levels immediately following augmentation. This study presents a validated two-functional spinal unit (FSU) T12-L2 finite element model with a simulated kyphoplasty augmentation in L1 to predict stresses and strains within the bone cement and bone of the treated and adjacent nontreated vertebral bodies. The findings from this multiple-FSU study and a recent retrospective clinical study suggest that changes in stresses and strains in levels adjacent to a kyphoplasty-treated level are minimal. Furthermore, the stress and strain levels found in the treated levels are less than injury tolerance limits of cancellous and cortical bone. Therefore, subsequent adjacent level fractures may be related to the underlying etiology (weakening of the bone) rather than the surgical intervention.     

气囊扩张椎体后凸成形术的初步报告

目的:初步评价气囊扩张后突成形术治疗骨质疏松性椎体压缩骨折的手术操作、安全性、及疗效。方法:观察21例骨质疏松患者,30节椎体,新鲜骨折24椎节,陈旧性骨折6椎节,均有局部腰背疼痛,无神经症状。C-arm透视下,两侧同时经皮穿刺,气囊扩张骨折复位后,骨水泥灌注入椎体。随访4～7月。记录患者局部止痛的疗效,骨折的复位,及并发症等情况。结果:完全止痛14例,部分止痛7例,24节新鲜骨折气囊扩张的复位率是28.2％,6节陈旧性骨折复位率是2.1％。并发症2例,骨水泥外漏到椎间隙。其他椎体再次骨折2例,余无疼痛复发及椎体高度丢失。结论:气囊扩张后突成形术能恢复脊柱的稳定性,部分矫正脊柱后突,止痛疗效好,创伤小,并发症少,值得推广。     

Spinal Body Reconstruction in Osteoporosis

Abstract The treatment of osteoporotic vertebral body fractures often requires a well-thought-out therapeutic strategy. Most of the patients are at older age and multimorbid, so that therapy should be as gentle as possible. On the other hand, an early surgical stabilization to avoid immobilization of the patients often is necessary. Kyphoplasty and vertebroplasty are established minimal invasive procedures in the therapy of osteoporotic vertebral fractures. In literature the outcome after cement augmentation is quite good and the complication rate, especially in kyphoplasty, is low. In cases of a total collapse of the vertebral body, in older fractures with kyphotic deformity or in cases of instability, a posterior instrumentation with an anterior column support is needful. Due to the fact that there is no comparative long-term evidence-based data in literature concerning the different implants, general recommendations cannot be given. To avoid implant failure we propose an additional instrumentation of the adjacent vertebral bodies within the posterior stabilization and—if procurable—we always do an anterior column support with an expandable titanium cage. Furthermore, a pedicle screw system which allows cement augmentation of the screws after placement of the screws could be helpful to elevate the stability of the instrumentation. Further clinical examinations have to be carried out.     

Initial outcome and efficacy of "kyphoplasty" in the treatment of painful osteoporotic vertebral compression fractures.

STUDY DESIGN: An Institutional Review Board-approved Phase I efficacy study of inflatable bone tamp usage in the treatment of symptomatic osteoporotic compression fractures. OBJECTIVES: To evaluate the safety and efficacy of inflatable bone tamp reduction and cement augmentation, "kyphoplasty," in the treatment of painful osteoporotic vertebral compression fractures. SUMMARY OF BACKGROUND DATA: Osteoporotic compression fractures can result in progressive kyphosis and chronic pain. Traditional treatment for these patients includes bed rest, analgesics, and bracing. Augmentation of vertebral compression fractures with polymethylmethacrylate, "vertebroplasty," has been used to treat pain. This technique, however, makes no attempt to restore the height of the collapsed vertebral body. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps into the vertebral body. Once inflated, the bone tamps restore the vertebral body back toward its original height while creating a cavity that can be filled with bone cement. PATIENTS AND METHODS: Seventy consecutive kyphoplasty procedures were performed in 30 patients. The indications included painful primary or secondary osteoporotic vertebral compression fractures. Mean duration of symptoms was 5.9 months. Symptomatic levels were identified by correlating the clinical data with MRI findings. Perioperative variables and bone tamp complications or issues were recorded and analyzed. Preoperative and postoperative radiographs were compared to calculate the percentage height restored. Outcome data were obtained by comparing preoperative and latest postoperative SF-36 data. RESULTS: At the completion of the Phase I study there were no major complications related directly to use of this technique or use of the inflatable bone tamp. In 70% of the vertebral bodies kyphoplasty restored 47% of the lost height. Cement leakage occurred at six levels (8.6%).SF-36 scores for Bodily Pain 11.6-58.7, (P = 0.0001) and Physical Function 11.7-47.4, (P = 0.002) were among those that showed significant improvement. CONCLUSIONS: The inflatable bone tamp was efficacious in the treatment of osteoporotic vertebral compression fractures. Kyphoplasty is associated with early clinical improvement of pain and function as well as restoration of vertebral body height in the treatment of painful osteoporotic compression fractures.     

Vertebro-/Kyphoplasty History, Development, Results

Abstract Many investigations prove the significant analgetic effect of vertebral augmentation. The reasons for the decrease in pain are found in the stabilization of fracture fragments as well as the toxic-thermic effect of polymethylmethacrylate (PMMA), used in the majority of cases. The techniques, primarily in use since 1984, can be divided in vertebro- and kyphoplasty. Vertebroplasty is the direct injection of PMMA into the trabecular vertebral body, while kyphoplasty uses an inflatable bone tamp to create a cavity which is filled with highly viscous cement allowing a certain degree of vertebral height restoration. Both techniques are used percutaneously. Indications for augmentation are painful osteoporotic vertebral fractures, metastatic osteolyses, and painful or destabilizing vertebral hemangiomas. In this article, an overview of the techniques and the history of their development is provided. The materials used for augmentation, the possibilities, limits, and complications of the techniques are discussed.     

Sandwich Vertebral Fracture in the Study of Adjacent-level Fracture After Vertebral Cement Augmentation

The literature is inconclusive on the development of adjacent-level vertebral fracture after initial cement augmentation. A preliminary hypotheses is that cement injection exaggerates force transmission to the adjacent vertebral bodies, thereby predisposing those levels to future fractures. A sandwich vertebra is an intact vertebral body located between 2 previously cemented vertebrae. The purpose of this study was to determine whether the risk of adjacent-level fracture increased due to load shift after a cement injection procedure. The authors retrospectively investigated the rate of adjacent-level fracture after sandwiching compared with conservative treatment and determined the potential causative factors of sandwich vertebral fracture. Age, sex, weight, height, body mass index, follow-up period, and location of sandwich level (T10-L2 or nonT10-L2 junction) were assessed. Surgical variables, including surgical procedure (vertebroplasty or balloon kyphoplasty), surgical approach (through uni- or bilateral pedicle), volume of cement injected into the painful vertebrae, cement leakage into the intervertebral disk, cumulative number of treated levels, and pre- and postoperative kyphotic angulation of the sandwich region, were also analyzed. Nine of 42 sandwiched levels developed fatigue fractures, whereas 11 of 71 patients treated with conservative therapy sustained new vertebral fractures adjacent to the treated levels. Only preoperative kyphotic angulation was the variable positively associated with sandwich vertebral fracture at follow-up (P=.021). Although subjected to double load shifts, the sandwich vertebra was not prone to structural failure. Thus, cement augmentation protocol does not increase the incidence of adjacent vertebral fracture.     

Percutaneous vertebral augmentation.

BACKGROUND CONTEXT: With the aging of the population, painful osteoporotic compression fractures are becoming more common. PURPOSE: To review the physiologic implications of these injuries as well as treatment options and outcomes, especially with reference to newer, percutaneous "augmentation" procedures, that is, vertebroplasty and kyphoplasty. STUDY DESIGN/SETTING: A literature review. METHODS: No direct, randomized studies comparing vertebroplasty, kyphoplasty and standard, nonoperative care are available. RESULTS: The growing literature suggests a role for kyphoplasty and vertebroplasty in the management of patients with intractable pain or progressive vertebral collapse after vertebral compression fracture. Both procedures likely offer similar rates of pain relief. Kyphoplasty, although more expensive, may allow fracture reduction. The void created with the balloon tamp allows a more viscous cement to be applied, thereby decreasing the risk of extravasation. CONCLUSIONS: More study is required to understand the ideal role of these new techniques in the management of spinal osteoporosis and associated fractures. However, for carefully selected cases, current data suggest that the complication rates are low and pain relief can be profound.     

Is kyphoplasty reliable for osteoporotic vertebral compression fracture with vertebral wall deficiency?

Background

Vertebral compression fractures are a common clinical manifestation of osteoporosis. The introduction of kyphoplasty has allowed minimally invasive treatment of these fractures. However, in patients with loss of vertebral wall integrity, balloon kyphoplasty is contraindicated due to the possibility of extruding wall fragments into the canal and cement extravasation. We evaluated the efficacy and safety of kyphoplasty in the treatment of vertebral compression fractures in patients with compromised vertebral walls using individualised surgical techniques to avoid cement extravasation.

Methods

Symptomatic vertebral fractures (59 fractures in 55 patients) were treated by kyphoplasty. In levels with compromised anterior vertebral walls, two distinct sequential applications of cement were performed to avoid anterior leakage. In levels that demonstrated posterior or lateral wall deficiencies, the cement was injected under live fluoroscopy to monitor lateral or posterior extravasation. Radiographic outcomes were evaluated by comparing pre- and postoperative anterior/middle vertebral body height and local kyphotic angle. Clinical outcomes were evaluated by comparing Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) values preoperatively, postoperatively, and at 3-, 6- and 12-month follow-ups.

Results

Symptomatic cement extravasation and complications after kyphoplasty were not observed. Vertebral height was restored and the mean kyphotic angle was improved. The mean VAS decreased significantly from pre-surgery to post-surgery, as did the ODI (p < 0.05).

Conclusion

Kyphoplasty is a safe, clinically effective treatment for osteoporotic vertebral fracture with peripheral wall damage when using individualised surgical techniques to prevent bone cement leakage.