Kyphoplasty for the treatment of incomplete osteoporotic burst fractures

Abstract

Kyphoplasty has become a standard procedure in the treatment of painful osteoporotic compression fractures. According to current guidelines, involvement of the posterior wall of the vertebral body is a relative contraindication. From February 2002 until January 2008, 97 patients with at least one AO classification A 3.1 fracture were treated by kyphoplasty. There was a structured follow-up for the medium-term evaluation of the patients' outcome. Ninety-seven patients (68 of whom were females and 29 of whom were males) with involvement of the vertebra's posterior margin averaging 76.1 +/- 12.36 (59-98) years were treated by kyphoplasty. The fractures of 75 patients were caused by falls from little height, 5 patients had suffered traffic accidents and in the case of 17 patients, no type of trauma was remembered. According to the AO classification, there were 109 A 3.1.1 and one A3.1.3 injuries. Prior to surgery, all patients were neurologically without pathological findings. Seventy-nine fractures were accompanied by a narrowing of the spinal canal [average of 15% (10-40)]. Overall, 134 vertebras were treated by Balloon kyphoplasty (81 x 1 segment, 22 x 2 segments, 3 x 3 segments). In 47.4% of the patients, cement leakage was observed after surgery. All patients with cement extravasation, however, were clinically unremarkable. Using the visual analog scale, patients stated that prior to surgery their pain averaged 8.1, whereas after surgery it significantly decreased and averaged 1.6 (p < 0.001). In geriatric patients with osteoporotic vertebral fractures with partial inclusion of the posterior wall of the vertebral body, kyphoplasty is an effective procedure with few complications.

Radiographic and safety details of vertebral body stenting: results from a multicenter chart review

“…Using a different unit for describing re-alignment but kyphotic angles, Maestretti et al reported Beck Index improvements of 0.14 in their traumatic BKP case series treated with calciumphosphate cement [17] and Krüger et al of about 0.07 in their series of osteoporotic incomplete burst fractures [18]. However, in the latter series the preoperative BI values were around 0.8, whilst those in the Maestretti series were 0.7 and hence better comparable with the extent of VB deformation in our series.…”

Percutaneous Dorsal Instrumentation of Vertebral Burst Fractures: Value of Additional Percutaneous Intravertebral Reposition—Cadaver Study

“…It has been shown that balloon kyphoplasty can be used in burst fractures in the elderly population [22]. The problem with using a balloon in burst fractures is the potential risk of pushing a posterior wall fragment further into the spinal canal.…”

Die Behandlung osteoporotischer Wirbelkörperfrakturen mit augmentierter Instrumentation

“…Die Beteiligung der Hinterwand im Rahmen von Berstungsbrüchen (Typ A3 nach Magerl) stellt aufgrund des erhöhten Risikos eines Zementaustritts in den Spinalkanal eine zumindest relative Kontraindikation zur Kyphoplastie dar [23]. Bei ausgeprägter Berstung des Wirbelkörpers empfiehlt sich auch hier die dorsale Stabilisierung [16]. Eine weitere Indikation zur dorsalen Stabilisierung stellen veraltete osteoporotische Wirbelkörperfrakturen mit posttraumatischer Kyphose dar, die durch Lagerung oder perkutane Maßnahmen nicht ausreichend lordosiert werden können.…”