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Clinical Trial
. 2020 Apr 9:2020:8593516.
doi: 10.1155/2020/8593516. eCollection 2020.

Prophylactic Percutaneous Kyphoplasty Treatment for Nonfractured Vertebral Bodies in Thoracolumbar for Osteoporotic Patients

Fei Lei  1 , Wen He  2 , Xinggui Tian  1 , Zhongyang Li  3 , Lipeng Zheng  1 , Jianping Kang  1 , Daxiong Feng  1
Affiliations
Clinical Trial

Prophylactic Percutaneous Kyphoplasty Treatment for Nonfractured Vertebral Bodies in Thoracolumbar for Osteoporotic Patients

Fei Lei et al. Biomed Res Int. .

Abstract

Purpose: The occurrence of new vertebral compression fractures (VCFs) is a common complication after percutaneous kyphoplasty (PKP). Secondary VCFs after PKP occur predominantly in the thoracolumbar segment (T11 to L2). Prophylactic injections of cement into vertebral bodies in order to reduce new VCFs have rarely been reported. The main purpose of this study was to investigate whether prophylactically injecting cement into a nonfractured vertebral body at the thoracolumbar level (T11-L2) could reduce the occurrence of new VCFs.

Methods: From July 2011 to July 2018, PKP was performed in 86 consecutive patients with osteoporotic vertebral compression fractures (OVCFs) in the thoracolumbar region (T11-L2). All patients selected underwent PKP because of existing OVCFs (nonprophylactic group). Additionally, 78 consecutive patients with fractured vertebrae in the thoracolumbar region (T11-L2) with OVCFs underwent PKP and received prophylactic injections of cement into their nonfractured vertebrae in the thoracolumbar region (T11-L2) (prophylactic group). The visual analog scale (VAS) scores and incidence of new VCFs after PKP were compared between the two groups.

Results: The mean VAS scores improved from 8.00 ± 0.79 preoperatively to 1.62 ± 0.56 at the last follow-up in the nonprophylactic group and improved from 8.17 ± 0.84 to 1.76 ± 0.34 in the prophylactic group (P > 0.05). In the nonprophylactic group, 21 of 86 patients (24.4%) developed new VCFs within one year after PKP, of whom 15 patients (71.4%) developed VCFs within 3 months. In the prophylactic group, 8 of 78 patients (10.3%) developed new VCFs within one year, and 6 of these 8 patients (75%) developed new VCFs within 3 months. The incidence of new VCFs was significantly higher in the nonprophylactic group than that in the prophylactic group at one year (P = 0.018), but there were no statistically significant differences at three months (P = 0.847).

Conclusions: Prophylactic injections of cement into nonfractured (T11-L2) vertebral bodies reduced the incidence of secondary VCFs after PKP in patients with OVCFs, but there was no significant difference in local back pain (VAS) scores between the two groups.

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Conflict of interest statement

All authors declare that they have no conflict of interests.

Figures

Figure 1
Figure 1
The mean VAS scores at preoperatively, postoperatively, and one year after surgery.
Figure 2
Figure 2
Preoperative X-ray of a 69-year-old woman with OVCFs of the T11, 12, and L1 vertebral bodies (a, b). MRI (T1-weighted and STIR-weighted images) visualized each fractured vertebral body (e, f). The BMD values were -3.5 (T11), -3.3 (T12), and -3.6 (L1). The patient underwent PKP from T11 to L1 (c, d). Seventeen days after surgery, the patient complained of low back pain, and MRI showed a new vertebral body fracture in L2 (white arrow) (g, h). The patient elected to receive conservative treatment.
Figure 3
Figure 3
Preoperative X-ray of a 76-year-old woman with OVCF of the T12 and L1 vertebral bodies (a, b). MRI (T1-weighted and STIR-weighted images) visualized each fractured vertebral body (g, h). The BMD values were -3.9 (T12) and -3.4 (L1). The patient underwent PKP from T12 to L1, and T11 and L2 were treated with prophylactic PKP. X-rays were obtained after PKP (c, d). Twelve months after PKP, no evidence of new VCFs was observed (e, f).
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