Outcome of percutaneous balloon kyphoplasty in vertebral compression fractures

Abstract

Background:Incidence of vertebral compression fractures (VCFs) is increasing due to increase in human life expectancy and prevalence of osteoporosis. Vertebroplasty had been traditional treatment for pain, but it neither attempts to restore vertebral body height nor eliminates spinal deformity and is associated with a high rate of cement leakage. Balloon kyphoplasty involves introduction of inflatable balloon into the fractured body of vertebra for elevation of the end-plates prior to fixation of the fracture with bone cement. This study evaluates short term functional and radiological outcomes of balloon kyphoplasty. The secondary aim is to explore short-term complications of the procedure.Materials and Methods:A retrospective study of 199 kyphoplasty procedures in 135 patients from March 2009 to March 2012 were evaluated with short form-36 (SF-36) score, visual analogue scale (VAS), detailed neurological and radiological evaluations. The mean followup was 18 months (range 12–20 months). Statistical analysis including paired sample t-test was done with statistical package for social sciences.Results:Statistically significant improvements in SF-36 (from 34.29 to 48.53, an improvement of 14.24, standard deviation (SD) - 20.08 P < 0.0001), VAS (drop of 4.49, from 6.74 to 2.24, SD - 1.44, P < 0.0001), percentage restoration of lost vertebral height (from 30.62% to 16.19%, improvement of 14.43%, SD - 15.37, P < 0.0001) and kyphotic angle correction (from 17.41° to 10.59°, improvement of 6.82, SD - 7.26°, P < 0.0001) were noted postoperatively. Six patients had cement embolism, 65 had cement leak and three had adjacent level fracture which required repeat kyphoplasty later. One patient with history of ischemic heart disease had cardiac arrest during the procedure. No patients had neurological deterioration in the followup period.Conclusions:Kyphoplasty is a safe and effective treatment for VCFs. It improves physical function, reduces pain and corrects kyphotic deformity.

Cause Analysis of Open Surgery Used After Percutaneous Vertebroplasty and Kyphoplasty

“…Studies show the injected pressure and the dose are positively correlated with cement extravasation rate [ 7 ]. The average injected volume in this study was 7.8 ml, which was significantly higher than the optimal reported in the literature [ 16 ]. In addition, although leaked volume accounted for only 6% of injected volume, serious neurological symptoms appeared, which may be related to spinal canal stenosis and nerve root canal stenosis of elderly patients.…”

Percutaneous intervertebral bridging cementoplasty for adjacent multilevel osteoporotic thoracolumbar fractures with vertebral endplate-disc complex injury: technical note

“…The VAS and the kyphotic angle were decreased obviously and lasted postoperatively, which were similar to those reported in previous literatures 19 – 21 . In a clinical study, Saxena et al 20 demonstrated that the VAS dropped from 6.74 preoperatively to 2.24 postoperatively, and the kyphotic angle was decreased from a preoperative mean angle of 17.41° to a postoperative mean angle of 10.59°. Foo et al 21 reported an improvement of 5.0 in VAS and a decrease of 30.77% in kyphotic angle.…”

Influence of vertebral bone mineral density on total dispersion volume of bone cement in vertebroplasty

“…The rationale is that this approach can rapidly eliminate severe chest or back pain, allowing patients to recover normal function in a shorter time. [9–11] When PVP is done for VCFs, increasing amounts of bone cement have often needed to be injected into vertebrae, resulting in higher incidence of complications, including cement extravasation. [12,13] However, several studies have shown that a lower volume of bone cement could be injected while still achieving a satisfactory analgesic effect.…”