Comparison of Outcomes and Complications Among Various Surgical Treatments for Vertebral Compression Fractures: a Retrospective Study.

Abstract

BackgroundOsteoporosis with vertebral compression fractures is increasingly common in the elderly. As no studies have compared the safety and efficacy of surgical techniques for the treatment of such fractures, we retrospectively compared vertebroplasty, balloon kyphoplasty, and kyphoplasty with SpineJack or an intravertebral expandable pillar (IVEP). In this study, we retrospectively compared the safety and efficacy, including visual analog scale scores for pain, kyphotic angle, average body height, rate of cement leakage, and occurrence of adjacent vertebral compression fractures of each surgical intervention mentioned above at Shin-Kong Wu Ho-Su Memorial Hospital. All patients underwent surgical treatment under Dr. Wu. MethodsWe retrospectively analyzed 10 years of data of 354 patients with vertebral compression fractures, randomly dividing them into five groups. All these patients were diagnosed with fresh compression fracture, defined as signal changes on T1 phase by magnetic resonance imaging examination. Their visual analog scale scores for pain, kyphotic angle, average body height, rate of cement leakage, and occurrence of adjacent vertebral compression fractures were followed up for 1 year. ANOVA, the post hoc Bonferroni test, and Fisher’s exact probability test were used for statistical analyses.ResultsAll pain scores significantly improved 12 months postoperatively; however, there was no significant difference between the groups. Kyphoplasty with SpineJack significantly reduced the kyphotic angle, restoring the vertebral body height; adjacent compression fracture rate was highest in the vertebroplasty group (p=0.020). The method with the lowest cement leakage rate remains unidentified due to the small sample size; however, kyphoplasty with SpineJack, intravertebral expandable pillar, and vesselplasty resulted in lower rates than balloon kyphoplasty or vertebroplasty.ConclusionsVertebroplasty and kyphoplasty were excellent treatments for vertebral compression fractures, with no differences in pain relief. Kyphoplasty with SpineJack entailed a lower risk of cement extravasation, resulting in greater vertebral body height restoration and kyphotic reduction than other groups. While the safest method remains unclear, Kyphoplasty with SpineJack, intravertebral expandable pillar, and vesselplasty resulted in low rates of cement leakage. Kyphoplasty with intravertebral expandable pillar resulted in the lowest adjacent compression fracture rate.