Influence of operative timing on the early post-operative radiological and clinical outcome after kyphoplasty

Abstract

Purpose To clarify the relationship between operative timing and the early post-operative radiological and clinical outcome after kyphoplasty. Methods We conducted a retrospective cohort study including patients who underwent kyphoplasty of a single vertebra. Patients were divided into three groups (acute [< 2 weeks], subacute [2–6 weeks] or chronic [6–51 weeks]) based on the interval between fracture and surgery. The relative vertebral body height (VBH) and local kyphotic angle (LKA) of the fractured vertebra (measured on plain radiographs) as well as pain and use of analgesics were compared pre- and post-operatively (day 2) and between the groups. Results A total of 230 patients (100 with acute, 91 with subacute and 39 with chronic fractures) with fractures from T4 to L5 were included. In all groups, there was a significant post-operative improvement in the anterior (8.9–12.9%) and middle (10.7–13.4%) VBH (all groups: p < 0.001), LKA (acute: 3.8°, p < 0.001; subacute: 4.3°, p < 0.001; chronic: 1.7°, p = 0.046) and pain. The use of analgesics significantly decreased post-operatively in the acute and subacute groups, but did not significantly change in the chronic group. Patients from acute (p = 0.042) and subacute (p = 0.027) groups showed significantly better post-operative correction of the LKA than the chronic group. Conclusion Kyphoplasty is effective for vertebral height restoration as well as pain relief for both acute, subacute and chronic fractures. However, the achievable correction of the fracture-related local kyphosis decreases significantly after 6 weeks. Therefore, we recommend making a final decision about conservative vs. operative treatment within 6 weeks to ensure better height restoration in surgically treated patients.

Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Body Fractures With Deformation of Both Endplates With or Without Posterior Wall Involvement (OF 4): Short-Term Results from the Prospective EOFTT Multicenter Study

“…The duration between the patients' admission and the treatment decision was 4 ± 4 days (range: 0-26, median 2 days) and did not differ depending on surgical or conservative therapy choice (P = .376). At the day of treatment decision the mean OF-score was 8.2 ± 1.7 (range [4][5][6][7][8][9][10][11][12] and differed between conservative (7.6 ± 1.8) and surgical treated patients (8.4 ± 1.7, P = .029). Thereby a total of 15 patients were treated conservatively despite an OF score of more than 6 and 7 patients were treated surgically despite an OF score of less than 6.…”

“…Taking the recent literature into account stand-alone cement augmentation seems to be justified. Palmowski et al 4,12 reported of favorable clinical and radiological results with reduction potential and low reduction loss in the short run. Similarly, Gu et al 3 reported similar clinical results after both stand-alone kyphoplasty and hybrid stabilization.…”

Georg Schmorl prize of the German spine society (DWG) 2022: current treatment for inpatients with osteoporotic thoracolumbar fractures—results of the EOFTT study

“…Posterior stabilization was recommended in unstable fractures, such as OF type 3-5 fractures, depending on the clinical course. To date, several studies have evaluated the treatment of OVCFs using the OF score [2,[9][10][11][12], including the treatment of short-and long-segmental posterior stabilizations. Recently, OF classifications have gained an increased level of acceptance [13][14][15].…”