Balloon kyphoplasty for the treatment of pathological vertebral compressive fractures
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Previous clinical studies have shown the safety and effectiveness of balloon kyphoplasty in the treatment of pathological vertebral compression fractures (VCFs). However, they have not dealt with the impact of relatively common comorbid conditions in this age group, such as spinal stenosis, and they have not explicitly addressed the use of imaging as a prognostic indicator for the restoration of vertebral body height. Neither have these studies dealt with management and technical problems related to surgery, nor the effectiveness of bone biopsy during the same surgical procedure. This is a prospective study comparing preoperative and postoperative vertebral body heights, kyphotic deformities, pain intensity (using visual analogue scale) and quality of life (Oswestry disability questionnaire) in patients with osteoporotic vertebral compression fractures (OVCFs) and osteolytic vertebral tumors treated with balloon kyphoplasty.
Thirty-two consecutive patients, 27 OVCFs (49 vertebral bodies [VBs]) and 5 patients suffering from VB tumor (12 VBs) were treated by balloon kyphoplasty. The mean age was 68.2 years. All patients were assessed within the first week of surgery, and then followed up after one, three and six months; all patients (27 OVCFs and 5 tumor patients) were followed up for 12 months, 17 patients (14 OVCFs and 3 tumors) were followed up for 18 months and 9 patients (8 OVCFs and 1 tumor) were followed up for 24 months (mean follow up 18 months). The correction of kyphosis and vertebral heights were measured by comparing preoperative and postoperative radiographic measurements.
Thirty-one patients (96.9%) exhibited significant and immediate pain improvement: 90% responded within 24 h and 6.3% responded within 5 days. Daily activities improved by 53% on the Oswestry scale. In the OVCF group, kyphosis correction was achieved in 24/27 patients (89.6%) with a mean correction of 7.6°. Anterior wall height was restored in 43/49 VBs (88%) (mean increment of 4.3 mm), and mid vertebral body height was restored in 45/49 VBs (92%) (mean increment of 4.8 mm). Edema (high intensity signal) on short tau inversion recovery (STIR) was evidenced in all OVCF patients who experienced symptoms for less than nine months and was associated with correction of deformity. Cement leakage was the only technical problem encountered; it occurred in 5/49 VBs (10.2%) of the osteoporotic group and 1/12 VBs (8.3%) of the tumor group but had no clinical consequences. The incidence of leakage to the anterior epidural space was 2%. Spinal stenosis was present in three patients (11.1%) who responded successfully to subsequent laminectomy. Retrieval of tissue samples for biopsy was successful in 10/15 cases (67%). New fractures occurred in the adjacent level in 2/27 OVCF patients (7.4%).
Associated spinal stenosis with OVCF should not be overlooked; STIR MRI is a good predictor of deformity correction with balloon kyphoplasty. The prevalence of a new OVCF in the adjacent level is low.
KeywordsKyphoplasty PMMA Osteoporotic vertebral compression fractures Spinal stenosis Laminectomy STIR MRI Biopsy
- 4.Cotten A, Dewatre F, Cortet B, Assaker R, Leblond D, Duquesnoy B, Chastanet P, Clarisse J (1996) Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 200:525–530PubMedGoogle Scholar
- 7.Gaitanis I, Voronov L, Ghanayem A, Carandang G, Havey R, Zindrick M, Phillips F, Hadjipavlou A, Patwardhan A (2004) Effect of balloon kyphoplasty on the restoration of spinal alignment in the treatment of vertebral compression fractures. Orthopedic Research Society, San Francisco, CA, March 7–10, 2004Google Scholar
- 12.Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P (2000) Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 39(12):1410–1414Google Scholar
- 13.Hadjipavlou A, Crow W, Borowski A, Mader J, Adesokan A, Jensen R (1998) Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis. Am J Orthop 27:188–197Google Scholar
- 14.Hadjipavlou AG, Arya S, Crow WN, Maggio WW, Lander P, Nardone EM (1996) Percutaneous transpedicular biopsy of the spine. J Interv Radiol 11:103–108Google Scholar
- 15.Hyde J, Cohen D, Feinberg J (2002) Secondary osteoporotic compression fractures after kyphoplasty (Abstract). Eur Spine J 11(Suppl 1):S21Google Scholar
- 20.Ledlie J, Renfro M (2003) Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain and activity levels. J Neurosurg 98:36–42Google Scholar
- 26.Lyritis GP, Mayasis B, Tsakalakos N, Lambropoulos A et al. (1989) The natural history of the osteoporotic vertebral fracture. Clin Rheumatol 2(8 Suppl):66–69Google Scholar
- 30.Riggs BL, Melton LJ 3rd (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17 [Suppl 5]:505S–511SGoogle Scholar
- 32.Silvermann SL (1992) The clinical consequences of vertebral compression fractures. Bone 13 [Suppl 1]:261–267Google Scholar
- 33.Sinaki M (1988) Exercise and physical therapy. In: Riggs L, Melton J (eds) Osteoporosis: etiology, diagnosis and management, Raven, NY, pp 401Google Scholar