Kyphoplasty increases vertebral height, decreases both pain score and opiate requirements while improving functional status

Abstract

Vertebral compression fractures can result from advanced osteoporosis, or less commonly from metastatic or traumatic insults to the vertebral column, and result in disabling pain and decreased functional capacity. Various vertebral augmentation options including kyphoplasty aim at preventing the sequelae of pain and immobility that can develop as the result of the vertebral fractures. The mechanism for pain relief following kyphoplasty is not entirely understood, and the restoration of a portion of the lost vertebral height is a subject of debate. We retrospectively reviewed radiographic imaging, pain relief, analgesic intake and functional outcomes in 67 consecutive patients who underwent single- or multilevel kyphoplasty with the primary goal of quantifying the restoration of lost vertebral height. We observed a mean of 45% of the lost vertebral height restored postprocedurally. Secondarily, kyphoplasty was associated with significant decreases in pain scores, daily morphine consumption and improvement in patient-reported functional measures.

Keywords: kyphoplasty; kyphosis; osteoporosis; percutaneous vertebral augmentation; vertebral compression fracture; vertebral height restoration.

Figure 1

Verbal response scale (VRS) pain scores, before and after kyphoplasty. Boxplots display the minimum, first quartile, median, third quartile, and maximum of each sample. To reduce over plotting, line widths varied in proportion to the number of patients with each pair of baseline and postkyphoplasty values; the thickest line represents n = 5.

Figure 2

Raw data on percent loss of vertebral height, before and after kyphoplasty. Arrows indicate change in the vertebral height from baseline to postkyphoplasty. There were two observations for which no change was observed; these are indicated by dots on the figure. Results are displayed by vertebral level.

Figure 3

Daily opioid requirements, before and after kyphoplasty. Results expressed in oral daily morphine equivalents (mg). Boxplots display the minimum, first quartile, median, third quartile, and maximum of each sample. To reduce over plotting, line widths varied in proportion to the number of patients with each pair of baseline and postkyphoplasty values; the thickest line represents n = 17.