Kyphoplasty for chronic painful osteoporotic vertebral compression fractures via unipedicular versus bipedicular approachment: A comparative study in early stage

Background

Osteoporotic compression fractures (OVCFs) commonly occur in aged people, and as much as one-third of these fractures progress to chronic pain. Kyphoplasty (KP) is proved to be efficacious for pain relief and vertebral height restoration in chronic OVCFs, but there is still no data available about the clinical and radiographical outcomes compared by unipedicular and bipedicular KP in treating chronic painful OVCFs.

Purpose

To assess the clinical and radiographical outcomes in treating chronic painful OVCFs compared by unipedicular and bipedicular KP.

Methods

Fifty-eight patients with a total of sixty-six chronic painful OVCFs were enroled in our study. They were randomly allocated into two groups: group I (n = 33) was treated with unipedicular KP and group II (n = 25) with bipedicular KP. The operation times for each group were recorded and compared. Preoperative and postoperative of visual analogue scores (VAS) and oswestry disability index (ODI) scores were compared 2 weeks after surgery within each group and between groups. The radiographic outcomes were evaluated by the restoration rate (RR) in the most compressed point of the vertebral bodies.

Results

Significant improvement on the VAS, ODI scores and RR was noted in each group (p < 0.001), and there is no significant difference existing in clinical outcomes between the two groups. The mean operation time for each vertebra in group I was significantly shorter than in group II (p < 0.001). But the RR in group II was higher than in group I (p = 0.041).

Conclusion

Both unipedicular kyphoplasty and bipedicular kyphoplasty can achieve satisfactory clinical and radiographic outcomes in treating the chronic painful OVCFs and the operation time is shorter in unipedicular kyphoplasty. However, the bipedicular kyphoplasty is more efficacious in height restoration.     

Risk factors for newly developed osteoporotic vertebral compression fractures following treatment for osteoporotic vertebral compression fractures

Background context

It has been reported that newly developed osteoporotic vertebral compression fractures (OVCFs) occur at a relatively high frequency after treatment. While there are many reports on possible risk factors, these have not yet been clearly established.

Pulmonary cement embolization after kyphoplasty: a case report and review of the literature

Background context

Kyphoplasty is performed for the treatment of osteoporotic compression fractures. A theoretical advantage of this technique is the reduced risk of embolization of cement.

Study design/setting

Case report of an incidental finding of cement pulmonary embolization after kyphoplasty of an osteoporotic vertebral compression fracture.

Methods/results

Here we report a patient who presented with an incidental finding of pulmonary embolization after kyphoplasty and review the relevant literature.

Conclusions

Patients who present with symptoms of respiratory distress after kyphoplasty should undergo workup for pulmonary embolism. Clinicians may consider routine postoperative chest radiographs after kyphoplasty to screen for embolic disease. Further research is necessary to identify the risk factors and possible long-term sequelae of cement embolization.     

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.     

Social implications of balloon kyphoplasty: prospective study from a single UK centre

Purpose

The incidence of osteoporotic fractures is increasing with an ageing population. This has potential consequences for health services, patients and their families. Treatment of osteoporotic vertebral compression fractures (OVCFs) has been limited to non-surgical measures so far. The social and functional consequences of balloon kyphoplasty, a recent development for the treatment of VCF, were assessed in this cohort study.

Methods

Data collected prospectively from 53 patients undergoing balloon kyphoplasty for symptomatic OVCF in our hospital’s spinal unit were compared with data from an historical age-matched group of 51 consecutive patients treated conservatively for symptomatic OVCF. Social functionality was recorded prior to the injury, and at 6-month and 1-year follow-up; mortality was recorded at 6 months and 1 year.

Results

The mortality rate in the balloon kyphoplasty group was 11 % (6/53) at 1 year post-OVCF, versus 22 % (11/51) in the conservatively treated controls. A drift to a lower level of social functionality (defined by a lower level of independence) was observed at 1 year in 21 % of patients in the balloon kyphoplasty group versus 53 % of patients in the conservatively treated group. A drift to a lower level of independence was noted in 67 % of the conservatively treated patients who started at a lower level of functionality versus 20 % drift in a similar group who were treated with balloon kyphoplasty.

Conclusions

The reduction in mortality and drift in social functionality at 1 year following treatment with balloon kyphoplasty suggests that it is a viable option for the management of OVCFs.     

Improvement in Pulmonary Function of Chronic Obstructive Pulmonary Disease (COPD) Patients With Osteoporotic Vertebral Compression Fractures (OVCFs) After Kyphoplasty Under Local Anesthesia

To investigate the changes in respiratory function of COPD patients with osteoporotic vertebral compression fractures (OVCFs) after kyphoplasty (KP). Pain scores, pulmonary function parameters (PFT), and local kyphotic angle (LKA) were measured in 31 older patients (25 women, 6 men) with OVCFs before, 3 days after and 3 months after kyphoplasty. The preoperative and postoperative (3 days, 3 months) PFT parameters were as follows: % pred FVC, 74.33 ± 12.35, 85.23.8 ± 13.23, and 84.86 ± 14.01; % pred FEV1, 60.23 ± 11.2, 60.02 ± 11.90, and 60.78 ± 12.70; FEV1/FVC ratio (%), 68.22 ± 16.74, 59.56 ± 13.23, and 60.77 ±12.28, % pred MVV 52.46 ± 14.37, 55.23 ± 15.68, and 62.12 ± 14.48, respectively. The preoperative mean VAS score was 8.01 ± 1.41 and significantly decreased to 2.52 ± 0.89 and 2.34 ± 0.78 at 3 days, 3 months after kyphoplasty, respectively. The preoperative local kyphotic angle degree was 21.96 ± 5.75°, significantly decreased to 13.48 ± 6.12° 3 days after KP, and maintained 3 month after KP. The decrease in the VAS scores correlated with the PFT parameters; however, there were no significant correlations between the PFT parameters and the LKA, the VAS scores and the LKA. Kyphoplasty under local anesthesia is a safety treatment for the COPD patients with OVCFS, and is able to improve the lung function impaired by OVCFs.Key words: Chronic obstructive pulmonary disease, Osteoporotic vertebral compression fractures, Kyphoplasty, Pain, Kyphosis, Pulmonary function Osteoporotic vertebral compression fractures (OVCFs), which are the most common complication of osteoporosis, especially in older women, are steadily increasing due to the aging population. Patients with OVCFs often suffer back pain and the collapse of the fractured vertebral body can lead to spinal kyphosis. Kyphosis has been linked to poor pulmonary function and an increased risk of mortality. Schlaich et al¹ reported that pulmonary function is reduced in patients with spinal osteoporotic fractures in that both their vital capacity (VC) and forced expiratory volume were significantly diminished. Harrison et al² reported reductions in vital capacity (VC) in OVCFs patients, with values ranging from 68% to 94% of predicted values. And the declines in pulmonary function were correlated with the degree of kyphosis.The prevalence of osteoporosis in older patients with chronic obstructive pulmonary disease (COPD) is reported to be much higher than that in the age-matched elderly patients.^3,4 The mechanisms of osteoporosis in COPD remain controversial. Less improvements in functional exercise capacity due to poor pulmonary function is associated with osteoporosis,⁵ and the pathogenic mechanisms in COPD is strongly interact with vitamin D deficiency.⁶Kyphoplasty is a minimally invasive procedure to restore vertebral body anatomy, and internally stabilize OVCFs.⁷ Unlike vertebroplasty (VP), before the injection of PMMA a balloon is inserted into the vertebral body, leading to compression of cancellous bone, creation of a cavity, and if possible, realignment of the endplate of the vertebral body. After removal of the bone tamp, the injected PMMA fixes and stabilizes the fracture. Kyphoplasty not only has the advantage of improving or restoring vertebral height and kyphotic deformities, but can also decrease cement leakage and reduce the occurrence of new fracture.⁸ In a latest research, 45 patients who suffered osteoporotic fractures with middle column compromise were treated by BKP, the mean VAS improved significantly from pre- to postoperation (P < 0.05), and this improvement was sustained at the final follow-up which the mean follow-up period was 20.2 months.⁹ Maestretti et al¹⁰ reported a long follow-up about 10 years of kyphoplasty showing very good clinical and radiologic results.Yang et al¹¹ reported KP could partially improve the impaired lung function in patients with OVCFS, Dong et al¹² reported an improvement of pulmonary function after both VP and KP. VP could improve restrictive ventilatory impairment in patients with moderate and severe COPD affected by OVCFs.¹³ There are few studies that evaluate the effect of deformity correction on the changes of respiratory function in COPD patients after KP. This study investigated the changes of respiratory function, spinal deformity, and pain scores in COPD patients with OVCFs after KP. It also attempted to find if the changes of pulmonary function are related to the spinal deformity correction and pain scores.     

Comparison of radiological and clinical results of balloon kyphoplasty according to anterior height loss in the osteoporotic vertebral fracture

Background context

Percutaneous kyphoplasty is effective for pain reduction and vertebral height restoration in patients with osteoporotic vertebral fractures. However, in cases of severely collapsed fractures involving the loss of more than 70% of the vertebral height, kyphoplasty is technically difficult to perform and the outcomes remain unknown.

Purpose

To compare the vertebral height restoration rate, kyphotic angle, and clinical results of patients who underwent kyphoplasty according to the degree of anterior vertebral height loss. In addition, to determine the feasibility and effects of kyphoplasty on severely collapsed osteoporotic vertebral fractures.

Study design/setting

A retrospective study.

Patient sample

A total of 129 patients (145 vertebrae) who underwent kyphoplasty for osteoporotic painful vertebral fracture and followed up for more than 1 year between September 2005 and August 2012 were recruited for the analysis.

Outcome measures

The patients' kyphotic angle, anterior vertebral height, and anterior vertebral height restoration ratio 1 year after surgery were compared. Pre- and postoperative pain around the fractured vertebra and the radiological and clinical results according to bone mineral density (BMD) were also compared.

Methods

Patients were divided into three groups for comparison, according to radiographic findings. Patients with an anterior height compression ratio more than 70% at the time of fracture comprised Group I, patients with a compression ratio of 50–70% comprised Group II, and those with a compression ratio of 30–50% comprised Group III.

Results

Group I showed a greater extent of anterior height restoration immediately after surgery compared with the other groups, which noticeably decreased over time. All three groups showed significant restoration of the anterior vertebral height between pre- and postoperative values. The anterior vertebral height 1 year after surgery did not differ between Group I and Group II but was significantly higher in Group III. There was no correlation between the BMD and restoration or decrease of anterior vertebral height over time. Pain around the fractured vertebra significantly decreased in all groups immediately and 1 year after surgery compared with preoperative levels, although the pain level 1 year after surgery did not differ significantly between the groups.

Conclusions

In patients with an anterior vertebral compression ratio more than 70% because of osteoporotic vertebral fracture, although the anterior height and kyphotic angle were significantly lower than those of patients with an anterior vertebral compression ratio of 30% to 50%, kyphoplasty significantly improved the degree of pain, restored the anterior vertebral height, and maintained the kyphotic angle. Therefore, kyphoplasty can be a useful approach in patients with an anterior vertebral compression ratio more than 70%.     

Balloon kyphoplasty versus percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures (OVCFs)

Summary

The study investigated whether kyphoplasty (KP) was superior to vertebroplasty (VP) in treating patients with osteoporotic vertebral compression fractures (OVCFs). KP may be superior to VP for treating patients with OVCFs based on long-term VAS and ODI but not short-term VAS. Further large-scale trials are needed to verify these findings due to potential risk of selection bias.

Introduction

This study aimed to assess whether KP was superior to VP in treating patients with OVCFs.

Methods

The Medline, Embase, and Cochrane databases and references within articles and proceedings of major meetings were systematically searched. Eligible studies included patients with OVCFs who received either KP or VP. Standard mean differences (SMDs) and relative risks (RRs) were used as measures of efficacy and safety in a random-effects model.

Results

Eleven studies enrolling 869 patients with OVCFs were identified as eligible for final analysis. Compared with VP, KP was associated with significant improvements in long-term (SMD, ?0.70; 95 % confidence interval [CI]: ?1.30, ?0.10; P?=?0.023) visual analog scale (VAS); short-term (SMD, ?1.50; 95 % CI: ?2.94, ?0.07; P?=?0.040) and long-term (SMD, ?1.03; 95 % CI: ?1.88, ?0.18; P?=?0.017) Oswestry Disability Indexes (ODIs); short-term (SMD, ?0.74; 95 % CI: ?1.42, ?0.06; P?=?0.032) and long-term (SMD, ?0.71; 95 % CI: ?1.19, ?0.23; P?=?0.004) kyphosis angles; and vertebral body height (SMD, 1.56; 95 % CI: 0.62, 2.49; P?=?0.001) and anterior vertebral body height (SMD, 3.04; 95 % CI: 0.53, 5.56; P?=?0.018). KP was also associated with a significantly longer operation time (SMD, 0.73; 95 % CI: 0.26, 1.19; P?=?0.002) and a lower risk of cement extravasation (RR, 0.68; 95 % CI: 0.48, 0.96; P?=?0.030) compared with VP. No significant differences were found in the short-term VAS, posterior vertebral body height, and adjacent-level fractures.

Conclusion

Acknowledging some risk of selection bias, KP displayed a significantly better performance compared with VP only in one of the two primary endpoints, that is, for ODI but not for short-term VAS. Further randomized studies are required to confirm these results.

     

Mechanism of formation of intravertebral clefts in osteoporotic vertebral compression fractures: An in vitro biomechanical study

BACKGROUND CONTEXT

Intravertebral clefts (IVCs) are vacuum-like cavities commonly associated with osteoporotic vertebral compression fractures (OVCFs). IVCs promote cement leakage during kyphoplasty, suggesting a physical link with the basivertebral foramen, although this is uncertain.

Recompression in new levels after percutaneous vertebroplasty and kyphoplasty compared with conservative treatment

Study design

A prospective clinical study assessing new vertebral compression fracture after previous treatment.

Objective

The purpose of this study was to investigate the incidence and associated risk factors of new symptomatic osteoporotic vertebral compression fractures (OVCFs) in patients treated by percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) versus conservative treatment, and to elucidate our findings.

Summary of background data

There are a lot of reports concerning the feasibility and efficacy of this minimally invasive procedure compared with conservative treatment, especially in pain soothing. However, it is still unclear whether the risk of subsequent fracture has increased among operative treatment patients in the long term.

Methods

From November 2005 to July 2009, 290 consecutive patients with 363 OVCFs were randomly selected for PVP/PKP or conservative treatment and evaluated with a mean follow-up of 49.4 months (36–80 months). Some parameters were characterized and statistically compared in this study. Telephone questionnaires, clinical reexamine, and plain radiographs were performed in the follow-up.

Results

Thirty-one of 290 (10.7 %) patients had experienced 42 newly developed symptomatic secondary OVCFs. Among 169 operation (53.3 % vertebroplasty, 46.7 % kyphoplasty) and 121 comparison patients, there is no significant statistical difference of new OVCFs incidence between the two groups calculated by patient proportion. However, in separate, the rate of secondary adjacent fractures calculated by vertebral refracture number is significantly higher than non-adjacent levels in PVP/PKP group but no significant statistical difference was observed in conservative group. The time interval of recompression after operative procedure was much shorter than that for comparison group (9.7 ± 17.8 versus 22.4 ± 7.99 months, p = 0.017). In addition, older age, gender, fracture times, location of original fracture segment, the amount of cement, cement leakage, operation modality (PVP or PKP),and initial number of OVCFs were documented, but these were not the influencing factors in this study (p > 0.05).

Conclusions

Patients who had experienced PVP/PKP were not associated with an increased risk of recompression in new levels. However, recompression in new levels of PVP/PKP group occurred much sooner than that of conservative group in the follow-up period. The incidence of new vertebral fractures observed at adjacent levels was substantially higher but no sooner than at distant levels in PVP/PKP group. No major risk factors involving new OVCFs have been found in this study and  augmentation for sandwich situation is not necessary.     

Predictors and prevalence of patients undergoing additional kyphoplasty procedures after an initial kyphoplasty procedure

Background context

Vertebral cement augmentation, including kyphoplasty, has been shown to be a successful treatment for pain relief for vertebral compression fracture (VCF). Patients can sustain additional symptomatic VCFs that may require additional surgical intervention.

Purpose

To examine the prevalence and predictors of patients who sustain additional symptomatic VCFs that were treated with kyphoplasty.

Study design

A retrospective review of patients who previously underwent kyphoplasty for VCFs and had additional VCFs that were treated with kyphoplasty.

Patient sample

A total of 256 patients underwent kyphoplasty for VCFs from 2000 to 2007 at a single medical center.

Outcome measures

The outcome measure of interest was the need for an additional kyphoplasty procedure for a symptomatic VCF.

Methods

Risk factors such as age, sex, smoking status, and steroid use were assessed, as well as bisphosphonate use. Sagittal spinal alignment via Cobb angles for thoracic, thoracolumbar, and lumbar regions was assessed.

Results

About 22.2% of the patients had an additional symptomatic VCF that was treated with a kyphoplasty procedure. Steroid use was the only significant risk factor for predicting patients with additional symptomatic VCFs who underwent additional kyphoplasty. The average time to the second VCF was 33 days. Adjacent-level VCFs were most common in the thoracic and thoracolumbar spine. Bisphosphonate use was not shown to be protective of preventing additional VCFs during this follow-up period.

Conclusion

This is the first single-center review of a large cohort of patients who underwent additional-level kyphoplasty for symptomatic VCFs after an index kyphoplasty procedure. Our results suggest that patients with a VCF who use chronic oral steroids should be carefully monitored for the presence of additional symptomatic VCFs that may need surgical intervention. Patients with prior thoracic VCFs who have additional back pain should be reevaluated for a possible adjacent-level fracture.     

Surgical treatment of clavicular fractures in Finland – A register based study between 1987 and 2010

Background

Clavicle fractures are among the most common upper extremity injuries. Traditionally most clavicle fractures have been treated non-surgically, but during recent decades the surgical treatment of clavicle fractures has increased. The purpose of this study was to assess the numbers and trends of surgically treated clavicle fractures in Finland between 1987 and 2010.

Methods

The study covered the entire adult (>18 years) population of Finland over the study period. Data on surgically treated clavicle fractures was collected from the Finnish National Hospital Discharge Register. We assessed the number and incidence of surgically treated clavicle fractures annually.

Results

A total of 7073 surgically treated clavicle fractures were identified in the register over the study period. Three-fourths of the surgically treated patients were men and one-fourth was women. The incidence of surgical treatment increased nearly ninefold from 1.3 per 100,000 person years in 1987 to 10.8 per 100,000 person years in 2010. The increase in the rate of surgical treatment was especially notable in men.

Conclusions

A striking increase in incidence of surgically treated clavicle fractures was seen from 1987 to 2010. Although the actual incidence of clavicle fractures is not known, we assume that the proportion of patients receiving surgical treatment has increased markedly without high-quality evidence. Since recent reports have suggested similar functional results between operative and conservative treatment critical evaluation of the treatment policy of clavicle fractures is warranted.     

编织囊袋扩张-椎体后凸成形术治疗周壁破损的骨质疏松性椎体压缩骨折

目的评估编织囊袋扩张-椎体后凸成形术治疗周壁破损的骨质疏松性椎体压缩骨折(OVCF)的初步临床效果。方法自2007年12月～2010年4月应用编织囊袋扩张-椎体后凸成形术治疗13例周壁破损的OVCF共15个椎体骨折。随访观察患者的VAS疼痛评分以及影像学改变情况。结果本组获随访3～6个月,平均4.5个月。术后患者疼痛均明显缓解,术后VAS评分、椎体前缘高度和伤椎后凸Cobb角改善显著。未出现骨水泥向椎体外渗漏。结论对于周壁破损的OVCF,编织囊袋扩张-椎体后凸成形术有效避免了骨水泥渗漏、显著缓解疼痛、有效恢复骨折椎体的高度,是一种安全有效的治疗方法。     

Aggravation of spinal cord compromise following new osteoporotic vertebral compression fracture prevented by teriparatide in patients with surgical contraindications

Summary

Patients with spinal cord deficits following new unstable osteoporotic compression fracture and surgical contraindications were considered to receive conservative treatment. Teriparatide was better than alendronate at improving bone mineral density and bone turnover parameters, as well as preventing aggravation of spinal cord compromise.

Introduction

This study compared the preventive effects of teriparatide and alendronate on aggravation of spinal cord compromise following new unstable osteoporotic vertebral compression fracture (OVCF) in patients with surgical contraindications.

Methods

This was a 12-month, randomized, open-label study of teriparatide versus alendronate in 49 patients with new unstable OVCF and surgical contraindications. Neurological function was evaluated using modified Japanese Orthopedic Association (mJOA) score (11-point scale, the maximum score of 11 implies normalcy). Visual analog scale (VAS) scores, kyphotic angles, anterior-border heights and diameters of the spinal canal of the fractured vertebrae, any incident of new OVCFs (onset of OVCF during follow-up), spine bone mineral density (BMD), and serum markers of bone resorption and bone formation were also examined at baseline and 1, 3, 6, and 12 months after initiation of the medication regimen.

Results

At 12 months, mean mJOA score had improved in the teriparatide group and decreased in the alendronate group. Mean concentrations of bone formation and bone resorption biomarkers, mean spine BMD, and mean anterior-border height and spinal canal diameter of the fractured vertebrae were significantly greater in the teriparatide group than in the alendronate group. Mean VAS score, mean kyphotic angle of the fractured vertebrae, and incidence of new OVCFs were significantly smaller in the teriparatide group than in the alendronate group.

Conclusions

In patients with neurological deficits following new unstable OVCF and with surgical contraindications, teriparatide was better than alendronate at improving the BMD and the bone turnover parameters, as well as preventing aggravation of spinal cord compromise.

     

Percutaneous kyphoplasty combined with the posterior screw-rod system in treatment of osteoporotic thoracolumbar fractures

Background:

The osteoporotic vertebral compression fractures (OVCF) have attracted more and more attention due to increase in life span globally and aging population. Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) have been popularized rapidly by virtue of their unique advantage in minimal invasiveness. We analysed our results in osteoporotic thoracolumbar fractures using percutaneous kyphoplasty and posterior screw rod system. To investigate the possibility of treatment of rupture of the posterior vertebral osteoporotic fractures by means of kyphoplasty combined with the posterior screw-rod system.

Materials and Methods:

Twenty six patients (65 years of age or older) with the single spine fractures included in study. The preoperative bone mineral density was measured by dual-energy X-ray. The PKP was done in all the cases. Decompression was done if neurological symptoms were present.

Results:

The results demonstrated osteoporosis with BMD T value ≤ −2.5; injured posterior vertebral body (3 cases) had shown the whole damage accompanied by neurological symptoms through X-ray or CT. After 2 days, the remaining patients of back pain symptoms were relieved or disappeared except for three cases of patients with decompression incision. VAS score and Cobb angle changed from preoperative 8.23 ± 0.17 and 28.7 ± 0.33° respectively to postoperative 3.77 ± 0.44 and 3.8 ± 0.2° respectively.

Conclusion:

Treatment of rupture of the posterior vertebral osteoporotic thoracolumbar fractures by means of kyphoplasty combined with posterior screw-rod system is a safe, effective procedure.     

Pain reduction following vertebroplasty and kyphoplasty

Purpose

To evaluate the clinical efficacy, especially the pain reduction, of vertebroplasty and balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures (OVCFs).

Methods

Eighty-six patients with OVCFs were treated with vertebroplasty or balloon kyphoplasty. All patients were followed up for seven–36 months. Visual analog scale (VAS), vertebral height, and local kyphotic angle were evaluated at pre-operation, postoperation, and final follow-up.

Results

The VAS pain score decreased significantly after surgery in both kyphoplasty and vertebroplasty groups (p < 0.001), and the improvement of VAS score had no significant difference between the two groups (p = 0.826). There was a significant difference in the improvement of vertebral height (p < 0.001) and local kyphotic angle (p < 0.001) between the two groups. Improvement of VAS score had no correlation with improvement of vertebral height (vertebroplasty: r = −0.029, p = 0.869; kyphoplasty: r = 0.175, p = 0.219) or local kyphotic angle (vertebroplasty: r = 0.159, p = 0.361; kyphoplasty: r = 0.144, p = 0.312) in either group.

Conclusion

Vertebroplasty and kyphoplasty are effective procedures for the reduction of pain in OVCFs, and they have the same efficient effect on pain reduction. Correction of vertebral height and local kyphosis may have minimal effect on pain reduction.     

Percutaneous balloon kyphoplasty of osteoporotic vertebral compression fractures with intravertebral cleft

Background:

Intravertebral cleft is a structural change in osteoporotic vertebral compression fractures (OVCF), which is the manifestation of ischemic vertebral osteonecrosis complicated with fracture nonunion and pseudoarthrosis and appears in the late stage of OVCF. Despite numerous studies on OVCF, few aim to evaluate the clinicoradiological characteristics and clinical significance of intravertebral cleft in OVCF. This study investigates clinicoradiological characteristics of intravertebral cleft in OVCF and the effect on the efficacy of percutaneous balloon kyphoplasty (PKP).

Materials and Methods:

PKP was performed on 139 OVCF patients without intravertebral cleft (group A) and 44 OVCF patients with intravertebral cleft (group B). The frequency distribution of the affected vertebral body, bone cement infusion volume, imaging manifestation, leakage rate and type, preoperative and postoperative height of the affected vertebral body, visual analog scale (VAS) and Oswestry disability index (ODI) score were evaluated.

Results:

Significant differences were found in the frequency distribution of the affected vertebral body and bone cement leakage type between the two groups (P < 0.05). However, differences in bone cement infusion volume and leakage rate (P > 0.05) were not detected. In both groups, the postoperative height of the affected vertebral body was significantly improved (P < 0.05). The restoration of vertebral body height in group B was more evident than that in group A (P < 0.05). The preoperative VAS and ODI scores in group B were significantly higher than those in group A (P < 0.05). After surgical treatment, pain relief and daily activity function in both groups were significantly improved (P < 0.05), and no significant difference in postoperative scores was detected between the two groups (P > 0.05).

Conclusion:

Intravertebral cleft exhibits specific clinical and imaging as well as bone cement formation characteristics. PKP can effectively restore the affected vertebral body height, alleviate pain, and improve daily activity function of patients.     

Reduction of pain and fracture incidence after kyphoplasty: 1-year outcomes of a prospective controlled trial of patients with primary osteoporosis

Previously, we reported significantly reduced pain and improved mobility persisting for 6 months after kyphoplasty of chronically painful osteoporotic vertebral fractures in the first prospective controlled trial. Since improvement of spinal biomechanics by restoration of vertebral morphology may affect the incidence of fracture, long-term clinical benefit and thereby cost-effectiveness, here we extend our previous work to assess occurrence of new vertebral fractures and clinical parameters 1 year after kyphoplasty compared with a conservatively treated control group. Sixty patients with osteoporotic vertebral fractures due to primary osteoporosis were included: 40 patients were treated with kyphoplasty, 20 served as controls. All patients received standard medical treatment. Morphological characteristics, new vertebral fractures, pain (visual analog scale), physical function [European Vertebral Osteoporosis Study (EVOS) score] (range 0–100 each) and back-pain-related doctors visits were re-assessed 12 months after kyphoplasty. There were significantly fewer patients with new vertebral fractures of the thoracic and lumbar spine, after 12-months, in the kyphoplasty group than in the control group (P=0.0084). Pain scores improved from 26.2 to 44.4 in the kyphoplasty group and changed from 33.6 to 34.3 in the control group (P=0.008). Kyphoplasty treated patients required a mean of 5.3 back-pain-related doctors visits per patient compared with 11.6 in the control group during 12 months follow-up (P=0.006). Kyphoplasty as an addition to medical treatment and when performed in appropriately selected patients by an interdisciplinary team persistently improves pain and reduces occurrence of new vertebral fractures and healthcare utilization for at least 12 months in individuals with primary osteoporosis.     

Incidence of unexpected positive histology in kyphoplasty

Objective

Kyphoplasty and vertebroplasty have become one of the most frequent surgical procedures in the treatment of vertebral compression fractures. Often, the cause of compression fractures is lowered bone mineral density as in osteoporosis. In the differential workup, also pathologic vertebral compression fractures need to be ruled out. Importantly, imaging techniques alone cannot safely differentiate between invasive lymphatic and osteoporotic vertebral fracture. Our goal was to identify the degree of unexpected positive histology in kyphoplasty for presumed osteoporotic vertebral compression fracture.

Methods

We retrospectively analyzed all kyphoplasties performed between 2007 and 2015 at our institution. The data were acquired by reviewing our medical documentation system. The data analysis was done using Microsoft Excel. The statistical analysis was done using the Chi-squared test.

Results

We performed 130 kyphoplasties/vertebroplasties. A biopsy was taken in 97 (74.6%) cases. In 10 (10.3%) cases, the histology revealed a pathological fracture. From these patients, only in 3 (30%) cases, a positive histology was not expected. Meaning that there was no history of cancer and the radiological findings presumed an osteoporotic fracture.

Conclusions

Therefore, we could demonstrate that the incidence of unexpected positive histology in vertebral compression fracture treated with kyphoplasty is significant (3.1%). As a conclusion, if a kyphoplasty is performed due to assumed osteoporotic vertebral compression fracture, a biopsy should be taken to safely rule out a pathological fracture caused by lymphatic bony invasion.