Abstract
Background
Few studies have compared the surgical outcomes of vertebroplasty (VP) and kyphoplasty (KP) in the treatment of osteoporotic vertebral compression fractures (VCFs) with intravertebral clefts.
Methods
A retrospective study was conducted to review patients with a single-level osteoporotic VCF treated by VP or KP. Intravertebral clefts were assessed by preoperative computed tomography (CT) and magnetic resonance scans. All enrolled patients were followed up for 12 months. Clinical outcomes, radiological findings and complications were evaluated.
Results
A total of 53 patients were available for data analysis. Most of the fractures (75.5 %) occurred in the region of the thoracolumbar junction (T10–L2). Twenty-four patients received VP and 29 patients received KP. Patients in both group had significant pain relief after surgery (P < 0.01). Compared with VP group, there was a significant lower visual analogue scale (VAS) score in KP group at the 6- (P = 0.04) and 12-month follow-up (P = 0.02), but the decreased values of VAS score had no significant correlation with the magnitude of deformity correction. Restoration of vertebral body height and reduction in kyphotic angle were achieved in both groups, and the magnitude of correction was more significant in KP group (P < 0.01). Cement leakage rate in VP group (66.7 %) was higher than that in KP group (20.7 %), and there was a significant difference (P < 0.01).
Conclusions
Intravertebral clefts occur primarily at the thoracolumbar junction and can be detected easily by CT and magnetic resonance imaging scans. Both VP and KP are effective in the treatment of clefts, but patients in KP group tend to have a better pain relief at the medium and long-term follow-up. However, the better pain relief effect of KP cannot be attributed to the higher magnitude of deformity correction.
Similar content being viewed by others
References
Maldague BE, Noel HM, Malghem JJ (1978) The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology 129(1):23–29
Brower AC, Downey EF Jr (1981) Kummell disease: report of a case with serial radiographs. Radiology 141(2):363–364
Van Eenenaam DP, El-khoury GY (1993) Delayed post-traumatic vertebral collapse (Kummell’s disease): case report with serial radiographs, computed tomographic scans, and bone scans. Spine 18(9):1236–1241
Lane JI, Maus TP, Wald JT, Thielen KR, Bobra S, Luetmer PH (2002) Intravertebral clefts opacified during vertebroplasty: pathogenesis, technical implications, and prognostic significance. Am J Neuroradiol 23(10):1642–1646
Hasegawa K, Homma T, Uchiyama S, Takahashi H (1998) Vertebral pseudarthrosis in the osteoporotic spine. Spine 23(20):2201–2206
Kumpan W, Salomonowitz E, Seidl G, Wittich GR (1986) The intravertebral vacuum phenomenon. Skeletal Radiol 15(6):444–447
Linn J, Birkenmaier C, Hoffmann RT, Reiser M, Baur-Melnyk A (2009) The intravertebral cleft in acute osteoporotic fractures: fluid in magnetic resonance imaging-vacuum in computed tomography? Spine 34(2):E88–E93. doi:10.1097/BRS.0b013e318193ca06
Wang HJ, Chen BB, Yu CW, Hsu CY, Shih TT (2007) Alteration of disc vacuum contents during prolonged supine positioning: evaluation with MR image. Spine 32(23):2610–2615. doi:10.1097/BRS.0b013e318158cb49
Swartz K, Fee D (2008) Kummell’s disease: a case report and literature review. Spine 33(5):E152–E155. doi:10.1097/BRS.0b013e3181657f31
Klazen CA, Lohle PN, de Vries J, Jansen FH, Tielbeek AV, Blonk MC, Venmans A, van Rooij WJ, Schoemaker MC, Juttmann JR, Lo TH, Verhaar HJ, van der Graaf Y, van Everdingen KJ, Muller AF, Elgersma OE, Halkema DR, Fransen H, Janssens X, Buskens E, Mali WP (2010) Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 376(9746):1085–1092. doi:10.1016/S0140-6736(10)60954-3
Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 373(9668):1016–1024. doi:10.1016/S0140-6736(09)60010-6
Van Meirhaeghe J, Bastian L, Boonen S, Ranstam J, Tillman JB, Wardlaw D (2013) A Randomized trial of balloon kyphoplasty and non-surgical management for treating acute vertebral compression fractures: vertebral body kyphosis correction and surgical parameters. Spine. doi:10.1097/BRS.0b013e31828e8e22
Krauss M, Hirschfelder H, Tomandl B, Lichti G, Bar I (2006) Kyphosis reduction and the rate of cement leaks after vertebroplasty of intravertebral clefts. Eur Radiol 16(5):1015–1021. doi:10.1007/s00330-005-0056-6
Wiggins MC, Sehizadeh M, Pilgram TK, Gilula LA (2007) Importance of intravertebral fracture clefts in vertebroplasty outcome. Am J Roentgenol 188(3):634–640. doi:10.2214/AJR.06.0542
Ha KY, Lee JS, Kim KW, Chon JS (2006) Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts. J Bone Joint Surg Br 88(5):629–633. doi:10.1302/0301-620x.88b5.17345
Kim YJ, Lee JW, Kim KJ, Chung SK, Kim HJ, Park JM, Kang HS (2010) Percutaneous vertebroplasty for intravertebral cleft: analysis of therapeutic effects and outcome predictors. Skeletal Radiol 39(8):757–766. doi:10.1007/s00256-009-0866-8
Wang G, Yang H, Chen K (2010) Osteoporotic vertebral compression fractures with an intravertebral cleft treated by percutaneous balloon kyphoplasty. J Bone Joint Surg Br 92(11):1553–1557. doi:10.1302/0301-620X.92B11.24671
Wu AM, Ni WF, Weng W, Chi YL, Xu HZ, Wang XY (2012) Outcomes of percutaneous kyphoplasty in patients with intravertebral vacuum cleft. Acta Orthop Belg 78(6):790–795
Yang H, Wang G, Liu J, Ebraheim NA, Niu G, Hiltner L, Lee AH, Tang T (2010) Balloon kyphoplasty in the treatment of osteoporotic vertebral compression fracture nonunion. Orthopedics 33(1):24. doi:10.3928/01477447-20091124-28
Garfin SR, Yuan HA, Reiley MA (2001) New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 26(14):1511–1515
Bhalla S, Reinus WR (1998) The linear intravertebral vacuum: a sign of benign vertebral collapse. Am J Roentgenol 170(6):1563–1569. doi:10.2214/ajr.170.6.9609175
Tanigawa N, Komemushi A, Kariya S, Kojima H, Shomura Y, Omura N, Sawada S (2007) Relationship between cement distribution pattern and new compression fracture after percutaneous vertebroplasty. Am J Roentgenol 189(6):W348–W352. doi:10.2214/ajr.07.2186
Stabler A, Schneider P, Link TM, Schops P, Springer OS, Durr HR, Reiser M (1999) Intravertebral vacuum phenomenon following fractures: CT study on frequency and etiology. J Comput Assist Tomogr 23(6):976–980
Nieuwenhuijse MJ, van Rijswijk CS, van Erkel AR, Dijkstra SP (2012) The intravertebral cleft in painful long-standing osteoporotic vertebral compression fractures treated with percutaneous vertebroplasty: diagnostic assessment and clinical significance. Spine 37(11):974–981. doi:10.1097/BRS.0b013e318238bf22
Pradhan BB, Bae HW, Kropf MA, Patel VV, Delamarter RB (2006) Kyphoplasty reduction of osteoporotic vertebral compression fractures: correction of local kyphosis versus overall sagittal alignment. Spine 31(4):435–441. doi:10.1097/01.brs.0000200036.08679.1e
Dong R, Chen L, Tang T, Gu Y, Luo Z, Shi Q, Li X, Zhou Q, Yang H (2013) Pain reduction following vertebroplasty and kyphoplasty. Int Orthop 37(1):83–87. doi:10.1007/s00264-012-1709-0
Xing D, Ma JX, Ma XL, Wang J, Xu WG, Chen Y, Song DH (2013) A meta-analysis of balloon kyphoplasty compared to percutaneous vertebroplasty for treating osteoporotic vertebral compression fractures. J Clin Neurosc Off J Neurosurg Soc Australas. doi:10.1016/j.jocn.2012.05.038
Jung JY, Lee MH, Ahn JM (2006) Leakage of polymethylmethacrylate in percutaneous vertebroplasty: comparison of osteoporotic vertebral compression fractures with and without an intravertebral vacuum cleft. J Comput Assist Tomogr 30(3):501–506
Weisskopf M, Ohnsorge JA, Niethard FU (2008) Intravertebral pressure during vertebroplasty and balloon kyphoplasty: an in vitro study. Spine 33(2):178–182. doi:10.1097/BRS.0b013e3181606139
Phillips FM, Todd Wetzel F, Lieberman I, Campbell-Hupp M (2002) An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty. Spine 27(19):2173–2178. doi:10.1097/01.brs.0000025689.39941.26
Conflict of interest
The authors do not have any possible conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
Ling-De Kong and Pan Wang have contributed equally to this work.
Rights and permissions
About this article
Cite this article
Kong, LD., Wang, P., Wang, LF. et al. Comparison of vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures with intravertebral clefts. Eur J Orthop Surg Traumatol 24 (Suppl 1), 201–208 (2014). https://doi.org/10.1007/s00590-013-1374-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-013-1374-z