Clinical and radiographic evaluation of balloon kyphoplasty using VCFX for osteoporotic vertebral compression fracture

Objective

In response to the major concerns of cement leakage and associated neurological injuries with regards to percutaneous vertebroplasty, balloon kyphoplasty (BK) was devised and introduced in 1998. This study retrospectively evaluated the clinical outcomes and radiological findings of the first 100 patients receiving BKs because of osteoporotic vertebral compression fractures (VCFs) at our institute.

Materials and Methods

A total of 100 patients (85 female and 15 male) with 130 osteoporotic VCFs undergoing BKs from January 2007 to July 2009 were enrolled. BK using VCFX (Central Medical Technologies, Taiwan) and associated polymethylmethacrylate augmentation was performed on these patients with symptomatic VCFs that responded poorly to conservative therapy. All patients received preoperative magnetic resonance imaging to determine which level needed BK. Radiographies were used for preoperative and postoperative imaging studies. A Huskisson’s visual analog scale was used to compare the clinical result of pain relief before and after surgery.

Results

The rupture of 20 (15.4%) balloons was noted during the operations. Nineteen (14.6%) cement leakages were found postoperatively, 7 cement leakages with balloon rupture and 12 with balloon integrity. No neurological complications occurred for either balloon rupture or integrity postoperatively. The visual analog scale scores improved from 87 preoperatively to 32 at final follow-up visit. Eighty-six patients returned to their preinjury activities of daily living and achieved better quality of life than their preoperative status. The average restoration of the fractured vertebral body height was 36.5%. The average correction of the sagittal alignment was 7.2°.

Conclusions

BK is an effective and low-risk method to treat painful osteoporotic VCFs. However, balloon rupture with Telebrex contrast medium extravasation is troublesome and can obscure the visual field of intraoperative fluoroscopy influencing the following injection of bone cement.