Abstract
Summary
Bone pain and spinal axial deformity are major concerns in aged patients suffering from osteoporotic vertebral compression fracture (VCF). Pain can be relieved by vertebroplasty or kyphoplasty procedures, in which the compressed vertebral body is filled with substitutes. We randomly assigned 100 patients with osteoporotic compression fracture at the thoraco-lumbar (T-L) junction into two groups: vertebroplasty and kyphoplasty; we used polymethylmethacrylate (PMMA) as the bone filler. Pain before and after treatment was assessed with visual analog scale (VAS) scores and vertebral body height and kyphotic wedge angle were measured from reconstructed computed tomography images. More PMMA was used in the kyphoplasty group than in the vertebroplasty group (5.56 ± 0.62 vs. 4.91 ± 0.65 mL, p < 0.001). Vertebral body height and kyphotic wedge angle of the T-L spine were also improved (p < 0.001). VAS pain scores did not differ significantly between the treatment groups. The duration of follow-up was 6 months. Two patients in the kyphoplasty group had an adjacent segment fracture. In terms of clinical outcome there was little difference between the treatment groups. Thus, owing to the higher cost of the kyphotic balloon procedure, we recommend vertebroplasty over kyphoplasty for the treatment of osteoporotic VCFs.
Introduction
Spinal axial deformities are major concerns in aged patients suffering from osteoporotic vertebral compression fracture. Pain may be relieved by vertebroplasty or kyphoplasty. We investigated the radiological and clinical outcomes of these procedures.
Methods
One hundred cases of VCF at the thoraco-lumbar junction were randomly assigned into two groups: vertebroplasty or kyphoplasty (50 cases each). We used polymethylmethacrylate as the bone filler. Pain before and after treatment was assessed with visual analog scale scores and vertebral body height and kyphotic wedge angle were measured from reconstructed computed tomography images.
Results
More PMMA was used in the kyphoplasty group than in the vertebroplasty group (5.56 ± 0.62 vs. 4.91 ± 0.65 mL, p < 0.001). Vertebral body height and kyphotic wedge angle of the T-L spine were also improved (p < 0.001). VAS pain scores did not differ significantly between the treatment groups. The duration of follow-up was 6 months. Two patients in the kyphoplasty group had an adjacent segment fracture.
Conclusions
In terms of clinical outcome there was little difference between the treatment groups. Thus, with the higher cost of the kyphotic balloon procedure, we recommend vertebroplasty over kyphoplasty for the treatment of osteoporotic VCFs.
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References
Galibert P, Deramond H, Rosat P, Le Gars D (1987) Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 33:166–168
Garfin SR, Yuan HA, Reiley MA (2001) New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 26:1511–1515
Lieberman IH, Dudeney S, Reinhardt MK, Bell G (2001) Initial outcome and efficacy of "kyphoplasty" in the treatment of painful osteoporotic vertebral compression fractures. Spine 26:1631–1638
Eck JC, Nachtigall D, Humphreys SC, Hodges SD (2008) Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature. Spine J 8:488–497
Gill JB, Kuper M, Chin PC, Zhang Y, Schutt R Jr (2007) Comparing pain reduction following kyphoplasty and vertebroplasty for osteoporotic vertebral compression fractures. Pain Physician 10:583–590
Karlsson MK, Hasserius R, Gerdhem P, Obrant KJ, Ohlin A (2005) Vertebroplasty and kyphoplasty: new treatment strategies for fractures in the osteoporotic spine. Acta Orthop 76:620–627
Taylor RS, Fritzell P, Taylor RJ (2007) Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J 16:1085–1100
Berlemann U, Ferguson SJ, Nolte LP, Heini PF (2002) Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg Br 84:748–752
Polikeit A, Nolte LP, Ferguson SJ (2003) The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine 28:991–996
Taylor RS, Taylor RJ, Fritzell P (2006) Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine 31:2747–2755
Mudano AS, Bian J, Cope JU, Curtis JR, Gross TP, Allison JJ, Kim Y, Briggs D, Melton ME, Xi J, Saag KG (2008) Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a population-based cohort study. Osteoporos Int 20(5):819–826
Ledlie JT, Renfro M (2003) Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg 98:36–42
Hulme PA, Krebs J, Ferguson SJ, Berlemann U (2006) Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine 31:1983–2001
Lavelle W, Carl A, Lavelle ED, Khaleel MA (2007) Vertebroplasty and kyphoplasty. Anesthesiol Clin 25:913–928
Lavelle W, Carl A, Lavelle ED, Khaleel MA (2007) Vertebroplasty and kyphoplasty. Med Clin North Am 91:299–314
Burton AW, Hamid B (2008) Kyphoplasty and vertebroplasty. Curr Pain Headache Rep 12:22–27
Rohlmann A, Zander T, Bergmann G (2006) Spinal loads after osteoporotic vertebral fractures treated by vertebroplasty or kyphoplasty. Eur Spine J 15:1255–1264
Hiwatashi A, Sidhu R, Lee RK, deGuzman RR, Piekut DT, Westesson PL (2005) Kyphoplasty versus vertebroplasty to increase vertebral body height: a cadaveric study. Radiology 237:1115–1119
Hiwatashi A, Moritani T, Numaguchi Y, Westesson PL (2003) Increase in vertebral body height after vertebroplasty. AJNR Am J Neuroradiol 24:185–189
McKiernan F, Faciszewski T, Jensen R (2003) Reporting height restoration in vertebral compression fractures. Spine 28:2517–2521 discussion 2513
Teng MM, Wei CJ, Wei LC, Luo CB, Lirng JF, Chang FC, Liu CL, Chang CY (2003) Kyphosis correction and height restoration effects of percutaneous vertebroplasty. AJNR Am J Neuroradiol 24:1893–1900
Verlaan JJ, van Helden WH, Oner FC, Verbout AJ, Dhert WJ (2002) Balloon vertebroplasty with calcium phosphate cement augmentation for direct restoration of traumatic thoracolumbar vertebral fractures. Spine 27:543–548
Theodorou DJ, Theodorou SJ, Duncan TD, Garfin SR, Wong WH (2002) Percutaneous balloon kyphoplasty for the correction of spinal deformity in painful vertebral body compression fractures. Clin Imaging 26:1–5
Fourney DR, Schomer DF, Nader R, Chlan-Fourney J, Suki D, Ahrar K, Rhines LD, Gokaslan ZL (2003) Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg 98:21–30
Barr JD, Barr MS, Lemley TJ, McCann RM (2000) Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 25:923–928
Crandall D, Slaughter D, Hankins PJ, Moore C, Jerman J (2004) Acute versus chronic vertebral compression fractures treated with kyphoplasty: early results. Spine J 4:418–424
McKiernan F, Faciszewski T, Jensen R (2004) Quality of life following vertebroplasty. J Bone Joint Surg Am 86-A:2600–2606
Kim SH, Kang HS, Choi JA, Ahn JM (2004) Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol 45:440–445
Fribourg D, Tang C, Sra P, Delamarter R, Bae H (2004) Incidence of subsequent vertebral fracture after kyphoplasty. Spine 29:2270–2276
Harrop JS, Prpa B, Reinhardt MK, Lieberman I (2004) Primary and secondary osteoporosis' incidence of subsequent vertebral compression fractures after kyphoplasty. Spine 29:2120–2125
Shindle MK, Gardner MJ, Koob J, Bukata S, Cabin JA, Lane JM (2006) Vertebral height restoration in osteoporotic compression fractures: kyphoplasty balloon tamp is superior to postural correction alone. Osteoporos Int 17:1815–1819
Cotten A, Boutry N, Cortet B, Assaker R, Demondion X, Leblond D, Chastanet P, Duquesnoy B, Deramond H (1998) Percutaneous vertebroplasty: state of the art. Radiographics 18:311–320 discussion 320–313
Acknowledgements
This study was supported by the grant from Chung-Shan Medical University Hospital (CS08110). The authors thank Che-Hung Liu, B.S. and Yi-Chun Chang, B.S. for technical assistance in manuscript preparation.
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Liu, J.T., Liao, W.J., Tan, W.C. et al. Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int 21, 359–364 (2010). https://doi.org/10.1007/s00198-009-0952-8
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DOI: https://doi.org/10.1007/s00198-009-0952-8