Postoperative Clinical Outcomes of Balloon Kyphoplasty Treatment: Would Adherence to Indications and Contraindications Prevent Complications?

Abstract

Study Design: We retrospectively assessed the postoperative clinical outcomes of balloon kyphoplasty (BKP).Purpose: To evaluate the risk factors for complications and to reconfirm the indications and contraindications for BKP.Overview of Literature: In Japan, BKP is indicated for cases of osteoporotic vertebral fractures when pain is not improved even after an adequate period of conservative treatment. Contraindications to BKP include pedicle fracture, fracture of a flat vertebra, or fracture of the posterior wall of the vertebral body diagnosed on computed tomography.Methods: Seventy-five patients who underwent BKP in our institution participated in this study; 49 provided follow-up data. Those with complications and persistent pain were assigned to the “eventful” group; the others, to the “uneventful” group. We evaluated risk factors for complications and persistent pain, including the presence or absence of severe posterior wall injury/pedicle fracture, the shape of the vertebral body, and the time period from onset of pain to BKP.Results: The incidences of severe posterior wall injury, pedicle fracture, and flattened vertebral body did not differ significantly between the uneventful and eventful groups. However, there was a significant difference in disease duration between those with and those without adjacent vertebral fractures (AVFs): The incidence of AVF was lower among patients with disease of less than 8 weeks’ duration.Conclusions: Disease duration is a possible risk factor for developing AVF, whereas other characteristics were not risk factors for complications after BKP. Although it has been suggested that BKP treatment in the early phase after injury results in a good outcome, the indications should be determined according to prognosis that is based on findings obtained with tools such as imaging examinations.

Radiographic Factors for Adjacent Vertebral Fractures and Cement Loosening Following Balloon Kyphoplasty in Patients with Osteoporotic Vertebral Fractures

“…Factors such as age, sex, bone density, time to surgery, pre-existing vertebral fracture, vertebral wedge angle, and posterior wall injury were assessed as potential risk factors for adjacent vertebral body fractures in this study and were evaluated in previous reports. While sex, time to surgery, and vertebral wedge angle were reported in a previous study as factors associated with adjacent vertebral body fractures, these factors were not associated with adjacent vertebral fractures in other studies and in this present study 26 - 30 ) . Therefore, these three factors might not be significant factors associated with adjacent vertebral fractures.…”

“…The incidence of secondary vertebral fractures after BKP in this study was comparable to previous reports [23][24][25] . Several previous studies have already identified factors associated with adjacent vertebral fractures [26][27][28][29][30] . Thoracolumbar fracture levels have been reported as a risk factor for adjacent vertebral fractures after BKP 28,29) .…”

Management of Osteoporosis and Spinal Fractures: Contemporary Guidelines and Evolving Paradigms

“…A retrospective radiographic study published in 2020 by Lu X et al 53 in 112 acute VCFs (72 treated with kyphoplasty and 40 with non-operative treatments) in 101 subjects followed for mean 21.5 months found that vertebral augmentation may be associated with increased creep deformity of the adjacent vertebra and the progression of segmental kyphosis. However, Momomura et al 46 in 2020 reported no significant differences in incidence of severe posterior wall injury,…”

“…44 CM&R 2022 : 2 (June) Osteoporotic spinal fractures augmentation, and no consensus on the long-term pain relief or patient satisfaction over nonsurgical management. 46 These were all based on two initial randomized clinical trials (INVEST and Australian Trial) and a subsequent Cochrane review of six trials where the effect of augmentation on disability, mortality, or quality of life were inconsistent. Beall et al 47 published a metaanalysis in 2018 where kyphoplasty had significantly better outcomes in terms of pain reduction compared with nonsurgical management based on Level I and II studies.…”

Comparison of Outcomes between Minimally Invasive Lateral Approach Vertebral Reconstruction Using a Rectangular Footplate Cage and Conventional Procedure Using a Cylindrical Footplate Cage for Osteoporotic Vertebral Fracture

“…Minimally invasive treatment methods such as balloon kyphoplasty have been developed to overcome OVF. However, contraindications to balloon kyphoplasty include pedicle fracture and fracture of the posterior wall of the vertebral body diagnosed on computed tomography (CT); these cases require reconstructive surgery [ 4 ].…”