J Korean Soc Spine Surg.  2003 Jun;10(2):127-136. 10.4184/jkss.2003.10.2.127.

Comparison of Outcome between Percutaneous Vertebroplasty and Kyphoplasty for Osteoporotic Painful Vertebral Compression Fracture: A Preliminary Report

• Na HY
• Cho HW
• Kim SK
• Lee SY

• KMID: 2003210
• DOI: http://doi.org/10.4184/jkss.2003.10.2.127

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To compare the outcome of percutaneous vertebroplasty (VP), with kyphoplasty, in the treatment of osteoporotic painful vertebral compression fractures (VCF). SUMMARY OF LITERATURE REVIEW: There is much controversy relating to the treatment of painful osteoporotic VCF. Recent analytical data exists on VP and kyphoplasty.
MATERIALS AND METHODS
A consecutive group of patients, undergoing VP and kyphoplasty at our institution, between July 2000 and November 2002, were retrospectively reviewed. A total of 23 patients underwent 25 VP procedures under local anesthesia, and 8 underwent 8 kyphoplasty procedures, 3 under general and 5 under local anesthesia. A radiological assessment was achieved by the percentage of height restored, using both the preoperative and postoperative radiographs. The Visual analog scale (VAS) scores, obtained pre and postoperatively were used for the clinical assessment. The activity levels were assessed preoperatively, after discharge and at the last follow up period, by the ambulatory stati.
RESULTS
The VP restored 27.62% (anterior*) and 30.26% (middle**) of the lost height. The kyphoplasty restored 35.52% (anterior*) and 53.43% (middle**) of the lost height (P=0.3334*, P=0.0264**). The postoperative pain was improved in all patients after both procedures. The postoperative VAS score was 3.826 after the VP and 2.875 after the kyphoplasty (P=0.5647). The activity levels were improved in all patients after both procedures.
CONCLUSIONS
The kyphoplasty was more efficient in restoring the middle vertebral body height than the VP in the treatment of osteoporotic painful VCF. However, both procedures showed similar clinical improvements in the pain and restoration of the anterior vertebral body height in the treatment of painful osteoporotic VCF. Both kyphoplasty and VP safely increased the vertebral body height, decreased the acute back pain and quickly returned geriatric patients to higher activity levels, resulting in an increased independence and quality of life.

Keyword

Osteoporosis; Vertebral compression fracture; Vertebroplasty; Kyphoplasty

MeSH Terms

Anesthesia, Local
Back Pain
Body Height
Follow-Up Studies
Fractures, Compression*
Humans
Kyphoplasty*
Osteoporosis
Pain, Postoperative
Quality of Life
Retrospective Studies
Vertebroplasty*
Visual Analog Scale

Figure

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  Fig. 1. Bar graph demonstrating distribution of the 33 fracture levels. The x-axis denotes the vertebral level treated; the y-axis repre-sents the number of fractures treated.

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  Fig. 2. Graph demonstrating the percentage height restored over time.

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  Fig. 3. Radiograph of 73-year-old female shows L2 compression fracture. The patient was undergone. After 2 weeks from a day of vertebroplasty, the patient had significant pain relief. After 12 months, from a day of vertebroplasty, % height restoration was slightly decreased and kyphosis was increased.

• 

  Fig. 4. Radiograph of 74-year-old female shows L1 compression fracture. The patient was undergone kyphoplasty. After 2 days from a day of kyphoplasty, the patient had significant pain relief and returned to fully ambulatory state. After 4 months, from a day of kyphoplasty, % height restoration of anterior and middle column was not decreased, and kyphosis was not advanced.

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  Fig. 5. Bar graphs showing the VAS score obtained over time.

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  Fig. 6. Graph demonstrating results of pre-and postoperative activity levels in all patients.

Reference

1). Belkoff SM., Mathis JM., Fenton DC, et al. An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture, Spine,. 26:151–156. 2001.

2). Chae In Jung. Percutaneous vertebroplasty for spine fracture. Journal of Korean Spine Surgery,. 7:328–330. 2000.

3). Cotton A., Dewatre F., Cortet B, et al. Percutaneous ver -tebroplasty for osteolytic metastasis and myeloma; effects of the percentage of lesion filling and the leakage of methylmethacrylate at clinical follow-up, Radiology,. 200:525–530. 1996.

4). Eck JC., Hodges SD., Humphreys SC. Vertebroplas -ty: A new treatment strategy for osteoporotic compression fractures, The American journal of orthopedics,. 31:123–127. 2002.

5). Galibert P. Note Preliminaire sur le traitement des angiomes vertebraux par vertebroplastie acrylique percutanee, Neurochirurgie,. 33:166–7. 1987.

6). Garfin SR., Yuan HA., Reiley MA. New technologies in spine; kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine,. 26:1511–1515. 2001.

7). Hardouin P., Fayada P., Leclet H., Chopin D. Kypho -plasty. Joint Bone Spine. 69(3):256–61. 2002.

8). Ledlie JT., Renfro M. Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels, Journal of Neurosurgery,. 98:36–42. 2003.

9). Lieberman IH., Dudeney S., Reinhardt MK, et al. Initial outcome and efficacy of “ kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures, Spine. 26:1631–1638. 2001.

10). Tohmeh AG., Mathis JM., Fenton DC, et al. Biomechan -ical efficacy of unipedicular versus bipedicular vertebro -plasty for the management of osteoporotic compression fractures, Spine,. 24:1772–1776. 1999.

11). Watts NB., Harris ST., Genant HK. Treatment of painful osteoporotic vertebral compression fractures with percutaneous vertebroplasty or kyphoplasty, Osteoporosis internal,. 12:S27–S31. 2001.