Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty
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The majority of the 700,000 osteoporotic vertebral compression fractures (VCFs) that occur annually in the United States affect women. The total treatment costs exceed $17 billion and approximate the total costs of breast cancer ($13 billion) and heart disease ($19 billion). Balloon-assisted percutaneous vertebral augmentation with bone cement (kyphoplasty) reportedly reduces VCF-related pain and accelerates return of independent functional mobility. Kyphoplasty may decrease overall cost of VCF treatment costs by reducing use of posttreatment medical resources.
We evaluated complications, mortality, posthospital disposition, and treatment costs of kyphoplasty compared with nonoperative treatment using the Nationwide Inpatient Sample database.
We identified 5766 VCFs (71% female) in patients 65 years of age or older with nonneoplastic VCF as the primary diagnosis in nonroutine hospital admissions; 15.3% underwent kyphoplasty. Demographic data, medical comorbidities, and fracture treatment type were recorded. Outcomes, including complications, mortality, posthospital disposition, and treatment costs, were compared for each treatment type.
Women were more likely to be treated with kyphoplasty than were men. Patients undergoing kyphoplasty had comorbidity indices equivalent to those treated nonoperatively. Kyphoplasty was associated with a greater likelihood of routine discharge to home (38.4% versus 21.0% for nonoperative treatment), a lower rate of discharge to skilled nursing (26.1% versus 34.8%) or other facilities (35.7% versus 47.1%), a complication rate equivalent to nonoperative treatment (1.7% versus 1.0%), and a lower rate of in-hospital mortality (0.3% versus 1.6%). Kyphoplasty was associated with higher cost of hospitalization (mean $37,231 versus $20,112).
Kyphoplasty for treatment of VCF in well-selected patients may accelerate the return of independent patient function as indicated by improved measures of hospital discharge. The initially higher cost of treatment may be offset by the reduced use of posthospital medical resources.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Alosh H, Riley LH III, Skolasky RL. Insurance status, geography, race, and ethnicity as predictors of anterior cervical spine surgery rates and in-hospital mortality: an examination of United States trends from 1992 to 2005. Spine (Phila Pa 1976). 2009;34:1956–1962.
- Barr JD, Barr MS, Lemley TJ, McCann RM. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine. 2000;25:923–928. CrossRef
- Browne JA, Cook C, Pietrobon R, Bethel MA, Richardson WJ. Diabetes and early postoperative outcomes following lumbar fusion. Spine. 2007;32:2214–2219. CrossRef
- Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361:557–568. CrossRef
- Cahill KS, Chi JH, Day A, Claus EB. Prevalence, complications, and hospital charges associated with use of bone-morphogentic proteins in spinal fusion procedures. JAMA. 2009;302:58–66. CrossRef
- Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of mortality following clinical fractures. Osteoporosis Int. 2001;11:556–561. CrossRef
- Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999;353:878–882. CrossRef
- Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40:373–383. CrossRef
- Convertino VA, Bloomfield SA, Greenleaf JE. An overview of the issues: physiological effects of bed rest and restricted physical activity. Med Sci Sports Exerc. 1997;29:187–190.
- Cook C, Santos GC, Lima R, Pietrobon R, Jacobs DO, Richardson W. Geographic variation in lumbar fusion for degenerative disorders: 1990 to 2000. Spine J. 2007;7:552–557. CrossRef
- Cook C, Tackett S, Shah A, Pietrobon R, Browne J, Viens N, Richardson W, Isaacs R. Diabetes and perioperative outcomes following cervical fusion in patients with myelopathy. Spine. 2008;33:E254–E260. CrossRef
- Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ III. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 1993;137:1001–1005.
- Cooper C, Atkinson EJ, O’Fallon WM, Melton JL III. Incidence of clinically diagnosed vertebral fractures: a population based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res. 1992;7:221–227. CrossRef
- Cortet B, Cotten A, Boutry N, Flipo RM, Duquesnoy B, Chastanet P, Delcambre B. Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol. 1999;26:2222–2228.
- Cowan JA Jr, Dimick JB, Wainess R, Upchurch GR Jr, Chandler WF, LaMarca F. Changes in the utilization of spinal fusion in the United States. Neurosurgery. 2006;59:15–20. CrossRef
- Crandal D, Slaughter D, Hankins PJ, Moore C, Jerman J. Acute versus chronic vertebral compression fractures treated with kyphoplasty: early results. Spine J. 2004;4:418–424. CrossRef
- Daniels AH, Arthur M, Hart RA. Variability in rates of arthrodesis for patients with thoracolumbar spine fracture with and without associated neurologic injury. Spine. 2007;32:2334–2338. CrossRef
- Daniels AH, Arthur M, Hart RA. Variability in rates of arthrodesis procedures for patients with cervical spine injuries with and without associated spinal cord injury. J Bone Joint Surg Am. 2007;89:317–323. CrossRef
- Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613. CrossRef
- Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI. United States trends in lumbar fusion surgery for degenerative conditions. Spine. 2005;30:1441–1445. CrossRef
- Elixhauser A, Steiner C, Palmer L. Clinical Classifications Software (CCS), 2008. US Agency for Healthcare Research and Quality. Available at: http://hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed June 1, 2008.
- Fribourg D, Tang C, Sra P, Delamarter R, Bae H. Incidence of subsequent vertebral fracture after kyphoplasty. Spine. 2004;29:2270–2276. CrossRef
- Galibert P, Deramond H, Rosat P, LeGars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty [in French]. Neurochirurgie. 1987;33:166–168.
- Garfin SR, Buckley RA, Ledlie J. Balloon kyphoplasty for symptomatic vertebral body compression fractures results in rapid, significant, and sustained improvements in back pain, function, and quality of life for elderly patients. Spine. 2006;31:2213–2220. CrossRef
- Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine. 2001;26:1511–1515. CrossRef
- Gehlbach SH, Burge RT, Puleo E, Klar J. Hospital care of osteoporosis-related vertebral fractures. Osteoporos Int. 2003;14:53–60. CrossRef
- Grafe IA, DaFonseca K, Hillmeier J, Meeder PJ, Libicher M, Noldge G, Bardenheuer H, Pyerin W, Basler L, Weiss C, Taylor RS, Nawroth P, Kasperk C. Reduction of pain and fracture incidence after kyphoplasty: 1-year outcomes of a prospective controlled trial of patients with primary osteoporosis. Osteoporos Int. 2005;16:2005–2012. CrossRef
- Gray DT, Deyo RA, Kreuter W, Mirza SK, Heagerty PJ, Comstock BA, Chan L. Population-based trends in volumes and rates of ambulatory lumbar spine surgery. Spine. 2006;31:1957–1963. CrossRef
- Harrop JS, Prpa B, Reinhardt MK, Lieberman I. Primary and secondary osteoporosis’ incidence of subsequent vertebral compression fractures after kyphoplasty. Spine. 2004;29:2120–2125. CrossRef
- International Osteoporosis Foundation. 2002 Invest in Your Bones Report: Osteoporosis in the workplace: the social, economic, and human costs of osteoporosis on employees, employers, and governments. Available at: www.iofbonehealth.org/publications/workplace-report.html. Accessed August 11, 2009.
- Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol. 1997;18:1897–1904.
- Kado DM, Browner WS, Palermo L, Nevitt M, Genant HK, Cummings SR. Vertebral fractures and mortality in older women: a prospective study. Arch Intern Med. 1999;159:1215–1220. CrossRef
- Kalanithi PS, Patil CG, Boakye M. National complication rates and disposition after posterior lumbar fusion for acquired spondylolisthesis. Spine (Phila Pa 1976). 2009;34:1963–1969.
- Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361:569–579. CrossRef
- Kasperk C, Hillmeier J, Noldge G, Grafe IA, DaFonseca K, Raupp D, Bardenheuer H, Libicher M, Liegibel UM, Sommer U, Hilscher U, Pyerin W, Vetter M, Meinzer HP, Meeder PJ, Taylor RS, Nawroth P. Treatment of painful vertebral fractures by Kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study. J Bone Miner Res. 2005;20:604–612. CrossRef
- Lad SP, Patil CG, Lad EM, Hayden MG, Boakye M. National trends in vertebral augmentation procedures for the treatment of vertebral compression fractures. Surg Neurol. 2009;71:580–584; discussion 584–585.
- Ledlie JT, Renfro M. Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg. 2003;98(Suppl):36–42.
- Leech JA, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis. 1990;141:68–71.
- Leidig G, Minne HW, Sauer P, Wüster C, Wüster J, Lojen M, Raue F, Ziegler R. A study of complaints and their relation to vertebral destruction in patients with osteoporosis. Bone Miner. 1990;8:217–219. CrossRef
- Lieberman IH, Dudeny S, Reinhart MK, Bell G. Initial outcome and efficacy of ‘kyphoplasty’ in the treatment of painful osteoporotic vertebral compression fractures. Spine. 2001;26:1631–1637. CrossRef
- Mathis JM, Petri M, Naff N. Percutaneous vertebroplasty treatment of steroid-induced osteoporotic compression fractures. Arthritis Rheum. 1998;41:171–175. CrossRef
- Matthis C, Weber U, O’Neill TW, Raspe H. Health impact associated with vertebral deformities: results from the European Vertebral Osteoporosis Study (EVOS). Osteoporos Int. 1998;8:364–372. CrossRef
- Mehbod A, Aunoble S, LeHuec JC. Vertebroplasty for osteoporotic spine fracture: prevention and treatment. Eur Spine J. 2003;12(Suppl 2):S155–S162. CrossRef
- Melton LJ. Epidemiology of spinal osteoporosis. Spine. 1997;22:63S. CrossRef
- Mudano AS, Bian J, Cope JU, Curtis JR, Gross TP, Allison JJ, Kim Y, Briggs D, Melton ME, Xi J, Saag KG. Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a population-based cohort study. Osteoporos Int. 2009;20:819–826. CrossRef
- National Osteoporosis Foundation Disease facts. Available at: www.nof.org/osteoporosis/diseasefacts.htm. Accessed April 12, 20008.
- Patil PG, Turner DA, Pietrobon R. National trends in surgical procedures for degenerative cervical spine disease: 1990–2000. Neurosurgery. 2005;57:753–758. CrossRef
- Phillips FM. Minimally invasive treatments of osteoporotic vertebral compression fractures. Spine. 2003;28:S54. CrossRef
- Rao RD, Singrakhia MD. Painful osteoporotic vertebral fracture. J Bone Joint Surg Am. 2003;85:2010–2022.
- Riggs BL, Melton LJ III. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. 1995;17(Suppl 5):505S–511S. CrossRef
- Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Brunze M, Ziegler R, Leidig-Bruckner G. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int. 1998;8:261–267. CrossRef
- Shamji MF, Cook C, Pietrobon R, Tackett S, Brown C, Isaacs RE. Impact of surgical approach on complications and resource utilization of cervical spine fusion: a nationwide perspective to the surgical treatment of diffuse cervical spondylosis. Spine J. 2009;9:31–38. CrossRef
- Shamji MF, Cook C, Tackett S, Brown C, Isaacs RE. Impact of preoperative neurological status on perioperative morbidity associated with anterior and posterior cervical fusion. J Neurosurg Spine. 2008;9:10–16. CrossRef
- Ström O, Leonard C, Marsh D, Cooper C. Cost-effectiveness of balloon kyphoplasty in patients with symptomatic vertebral compression fractures in a UK setting. Osteoporos Int. 2009 Nov 19 [Epub ahead of print].
- Taylor RS, Fritzell P, Taylor RJ. Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J. 2007;16:1085–1100. CrossRef
- Theodorou DJ, Theodorou SJ, Duncan TD, Garfin SR, Wong WH. Percutaneous balloon kyphoplasty for the correction of spinal deformity in painful vertebral body compression fractures. Clin Imaging. 2002;26:1–5. CrossRef
- Truumees E. Osteoporosis. Spine. 2001;26:930–932. CrossRef
- Truumees E, Hilibrand A, Vaccaro AR. Percutaneous vertebral augmentation. Spine J. 2004;4:218–229. CrossRef
- Wang MC, Chan L, Maiman DJ, Kreuter W, Deyo RA. Wang MC. Complications and mortality associated with cervical spine surgery for degenerative disease in the United States. Spine. 2007;32:342–347. CrossRef
- Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty
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- 1. Department of Orthopaedic Surgery, Hahnemann University Hospital, Drexel University College of Medicine, 245 N 15th Street, Philadelphia, PA, 19102, USA
- 2. Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA