Efficacy of percutaneous vertebroplasty in the treatment of severe osteoporotic vertebral compression fractures

Abstract

Background: Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are two minimally invasive surgical procedures and have achieved satisfactory outcomes in the treatment of mild to moderate osteoporotic vertebral compression fractures (OVCF) .However, severe osteoporotic vertebral compression fractures (sOVCF),used to been regarded as relative or even absolute contraindication for PVP and PKP.To date, there is still no consensus on the optimal treatment strategy for sOVCF. Methods: A retrospective analysis was conducted on 37 patients (7 males and 30 females) with single-level sOVCF who underwent PVP surgery at the Affiliated Hospital from May 2019 to May 2022. The age of the patients ranged from 61 to 88 years (average, 74.16 ± 7.76 years). The height and height ratio of the injured vertebra and the local kyphotic angle (LKA) were compared before and after surgery. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy of the surgery and the improvement in patients' quality of life. Operative time, bone cement volume, complications, and adjacent vertebral fractures were also analyzed. Results: All patients successfully underwent surgery and were followed up for an average of 24.2 months. The height of the fractured vertebrae recovered from 5.79 ± 1.94 mm preoperatively to 14.21 ±3.72 mm at the final follow-up (P<0.05). The height ratio of the fractured vertebrae recovered from 22.79 ± 7.40% preoperatively to 56.10 ± 14.69%at the final follow-up (P<0.05). The LKA improved from 25.63° ± 12.96° preoperatively to 22.48° ± 12.06° at the final follow-up (P<0.05). The VAS and ODI scores decreased from 6.46 ± 1.30％ and 77.51 ± 4.38％preoperatively to 2.57 ± 1.24％ and 25.57 ± 3.24％ at the final follow-up, respectively(P<0.05). Cement leakage occurred in seven patients. Adjacent OVCF occurred in four patients. Conclusions: PVP proves to be a safe, cost-effective and minimally invasive alternative therapy for elderly patients with sOVCF that can restore the vertebral height and correct local kyphosis in properly selected patients.