Early clinical outcome and complications related to balloon kyphoplasty

Abstract

The treatment of painful osteoporotic vertebral compression fractures using transpedicular cement augmentation has grown significantly over the last two decades. The benefits of balloon kyphoplasty compared to conservative treatment remain controversial and are discussed in the literature. The complication rates of vertebroplasty and kyphoplasty are considered to be low. The focus of this study was the analysis of acute and clinically relevant complications related to this procedure. In our department, all patients treated between February 2002 and February 2011 with percutaneous cement augmentation (372 patients, 522 augmented vertebral bodies) were prospectively recorded. Demographic data, comorbidities, fracture types, intraoperative data and all complications were documented. The pre- and postoperative pain-level and neurological status (Frankel-Score) were evaluated. All patients underwent a standardized surgical procedure. Two hundred and ninety-seven patients were treated solely by balloon kyphoplasty; 216 females (72.7%) and 81 males (27.3%). Average patient age was 76.21 years (±10.71, range 35–98 years). Average American Society Anestesiologists score was 3.02. According to the Orthopedic Trauma Association classification, there were 69 A 1.1 fractures, 177 A 1.2 fractures, 178 A 3.1.1 fractures and 3 A 3.1.3 fractures. Complications were divided into preoperative, intraoperative and postoperative events. There were 4 preoperative complications: 3 patients experienced persistent pain after the procedure. In one case, the pedicles could not be visualized during the procedure and the surgery was terminated. One hundred and twenty-nine (40.06%) of the patients showed intraoperative cement leaking outside the vertebras, one severe hypotension and tachycardia as reaction to the inflation of the balloons, and there was one cardiac arrest during surgery. Postoperative subcutaneous hematomas were observed in 3 cases, 13 patients developed a urinary tract infection, and 2 patients died during hospitalization. Twenty-four patients (8.1%) returned because of new pain events and 23 patients reported a new painful fracture. Balloon kyphoplasty is a save and effective procedure to treat patients with painful vertebral compression fractures. Rapid patient mobilization after kyphoplasty, as well as a prompt reintegration into the social environment, are possible. Compared to other surgical procedures, especially in patients with an average age of 75 years, balloon kyphoplasty seems to offer some advantages. However, the procedure still has a potential for serious complications and should be performed by well trained personnel.

Percutaneous balloon kyphoplasty in the treatment of painful vertebral compression fractures: Effect on local kyphosis and one-year outcomes in pain and disability

“…Within following 11 months the mean ODI ranged between 16% and 10%, signifying minimal disability. Aforementioned results are confirmed in literature [3,6,7,15,16]. However, in our study clinical outcome shows discrepancy with radiological results: reduction of LK was achieved in 51.7% of vertebrae, it succeeded in 66.7% of patients; amongst them only 37.5% had the kyphosis of all fractured vertebrae reduced.…”

“…In the next step, the created void is filled with injectable bone cement, most commonly polymethylmethacrylate (PMMA), which consecutively hardens stabilizing the shape of expanded vertebra [1,2,4,5]. After more than a decade of experience, the clinical benefits as well as radiographical results of BKP remain debated [4,[6][7][8][9][10][11][12][13][14][15][16]. The objective of this study was to analyse the effects of BKP on correction of local kyphosis, pain relief and patient's quality of life.…”

Evaluation and Management of Vertebral Compression Fractures

“…48 Kyphoplasty is most successful at restoring the height of the fractured vertebral body if it is performed within 3 months of the occurence of fracture or onset of pain. 22,23,43,49,50 Short-term results show that 85% to 100% of patients have good to moderate pain relief. 26, 48 Wardlaw et al found that kyphoplasty had improved functional recovery compared with nonsurgical treatment.…”

The Clinical Characteristics of Lower Lumbar Osteoporotic Compression Fractures Treated by Percutaneous Vertebroplasty : A Comparative Analysis of 120 Cases

“…Furthermore, fractures of the 5 th lumbar vertebra are quite uncommon, representing only 1.2% of overall spine fractures and 2.2% of thoraco-lumbar fractures9). On the other hand, according to the previous studies on percutaneous vertebroplasty (PVP) or kyphoplasty, the incidence of PVP at L3, L4 and L5 is about 9-13%, 5-9% and 2-5% respectively of all their thoraco-lumbar PVP or kyphoplasty procedures5,18,21,28,29). Therefore, the approximate incidence of PVP at L3 is near to the sum of incidence of PVP at L4 or L5.…”