Long-term follow-up study of osteoporotic vertebral compression fracture treated using balloon kyphoplasty and vertebroplasty

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Long-term follow-up study is required for verifying whether the clinical outcomes of kyphoplasty and vertebroplasty are altered. The authors' findings showed only subtle differences between these operations within a 5-year period. However, they still suggest the use of vertebroplasty over kyphoplasty in view of the treatment costs. In their previous study, the authors performed a short-term prospective comparison between vertebroplasty and kyphoplasty. Vertebroplasty was recommended instead of kyphoplasty for the treatment of vertebral compression fractures (VCFs) because of the subtle differences between this procedure and kyphoplasty and the treatment costs. To determine whether these clinical outcomes persist in the long term, they continued to observe the patients from their short-term study over a longer-term period.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>One hundred cases of VCF were assigned randomly to either the kyphoplasty or the vertebroplasty group. In cement augmentation, the authors used polymethylmethacrylate as bone filler. Pain was assessed by using a visual analog scale (VAS). For each patient, vertebral body height and wedge angle were measured from reconstructed CT images.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The duration of the follow-up period was 5 years. Vertebral body height, kyphotic wedge angle, and VAS score were not evidently altered. Eight patients in the kyphoplasty group had an adjacent fracture after the procedure, whereas 7 patients in the vertebroplasty group had an adjacent fracture after the procedure. These adjacent fractures occurred within 1 year of surgery in both treatment groups except in 1 kyphoplasty-treated patient in whom the adjacent fracture was noted 16 months after treatment. Three patients in the vertebroplasty group had a nonadjacent fracture, and 4 patients in the kyphoplasty group had a nonadjacent fracture. The link between angular correction and the occurrence of adjacent fracture was statistically significant in the vertebroplasty group.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Excessive angular correction is a critical concern in the risk of adjacent fracture after vertebroplasty. Given the subtle differences between vertebroplasty and kyphoplasty observed over the course of 5 years, vertebroplasty remains the preferred option in view of the costs.</jats:p></jats:sec>

Pain, Quality of Life, and Safety Outcomes of Kyphoplasty for Vertebral Compression Fractures: Report of a Task Force of the American Society for Bone and Mineral Research

“…Similarly, there was no significant difference in risk of incident adjacent radiographic vertebral fracture occurring up to 12 months (6.0% versus 7.0%; RR = 0.91; 95% CI, 0.39 to 2.15; n = 278; k = 3), 24 months (16.0% versus 14.0%; RR = 1.14; 95% CI, 0.45 to 2.91; n = 100; k = 1), or 60 months (16.0% versus 14.0%; RR = 1.14; 95% CI, 0.45 to 2.91; n = 100; k = 1) (Fig. ) . There was no significant difference in risk of incident clinical vertebral fracture at 1 month (4.7% versus 8.9%; RR = 0.53; 95% CI, 0.24 to 1.15; k = 1), or 12 months (16.3% versus 22.9%; RR = 0.77; 95% CI, 0.53 to 1.11; k = 2) (Supporting Table 11), or, in one quasi‐randomized study, at 2 years (18.2% versus 14.3%; RR = 1.27; 95% CI, 0.48 to 3.36; n = 86)…”

Low Volume Vertebral Augmentation with Cortoss® Cement for Treatment of High Degree Vertebral Compression Fractures and Vertebra Plana

“…Using a balloon bilaterally creates a larger relatively circular defect from 1.0 - 1.5 cm in size within the already softened and fractured osteoporotic vertebra. The addition of hard PMMA cement in large, inert masses potentially changes the mechanics of the collapsed vertebra by filling multiple microfractures with a larger and more rigid mass of PMMA within the balloon [2-6]. These masses potentially create pressure that leads to further endplate fractures.…”

“…There is a significant percentage of balloon cases where the balloon ruptures, sending higher volumes and higher pressure cement into the vertebra [2-6]. In vertebra plana and fractures with high degree collapse, pressure from the large mass of PMMA on one or both sides can fracture the cortical borders of the collapsed vertebra or, more importantly, the endplate, thereby putting pressure on the adjacent vertebrae [2-6]. This creates stronger forces on already weakened bone at the involved vertebra as well as at the adjacent vertebrae.…”

“…There is recent literature suggesting vertebral augmentation or balloon kyphoplasty are effective in high degree collapse; however, note that there are higher risks of both intraspinal and intradiscal leakage of cement [2]. All of these reports used polymethylmethacrylate (PMMA) cement, which is an inert hydrophobic polymer, with or without balloon kyphoplasty, for use in partially (30-50%) collapsed vertebral bodies [3].…”

Balloon Kyphoplasty under Three-dimensional Radiography Guidance

“…PBKP is usually performed under 2D radiography guidance using single- or bi-plane fluoroscopy or CT guidance. 5,13,14) Single- or bi-plane fluoroscopy images cannot provide information regarding the Z axis. 2D images could be accurate enough to determine the appropriate trajectory if an expert spine surgeon were to perform PBKP.…”