Kyphoplasty for treatment of osteoporotic vertebral fractures: a prospective non-randomized study

Abstract

Background: Minimally invasive augmentation techniques of vertebral bodies have been advocated to treat osteoporotic vertebral body compression fractures (VBCFs). Kyphoplasty is designed to address both fracture-related pain as well as kyphotic deformity usually associated with fracture. Previous studies have indicated the potential of this technique for reduction of vertebral body height, but there has been little investigation into whether this has a lasting effect. The current study reports on our experience and the one-year results in 27 kyphoplasty procedures (24 patients) for osteoporotic VBCFs.

Results: All but one patient experienced pain relief following the procedure (on VAS 1-10)--with a lasting effect over the follow-up period in 25 cases. An average vertebral kyphosis reduction of 47.7% was achieved with no loss of reduction after one year. The potential for reduction was statistically related to the pre-operative amount of kyphosis, the level treated, and the age of the fracture, but not to the age of the patient. During follow-up, one fracture adjacent to a treated level was observed. Pain relief was not related to the amount of reduction.

Conclusion: Kyphoplasty is an effective treatment of VBCFs in terms of pain relief and durable reduction of deformity. Whether spinal realignment results in an improved long-term clinical outcome remains to be investigated.

Fig. 1A–G

Representative case (no. 20, KH). A Pre-operative situation with severely painful fractures of T12 and L1. Kyphotic deformity of T12=28°. B Treatment of T12 with kyphoplasty and conventional vertebroplasty of L1. Important correction of T12 with 18° immediately postoperative, and absolute disappearance of the pain. C Acute recurrence of pain after 1 week; a fracture of the adjacent vertebra (T11) was observed ( arrows) on the X-ray. D The patient was treated successfully with a conventional vertebroplasty on T11 and T10 that was injected in a prophylactic sense. E–G The course was uneventful with mild pain. The follow-up X-rays after 2 years show a stable situation with no sintering of the reinforced bones and no loss of the initial reduction