J Korean Neurosurg Soc.  2014 Sep;56(3):211-217. 10.3340/jkns.2014.56.3.211.

Early Vertebroplasty versus Delayed Vertebroplasty for Acute Osteoporotic Compression Fracture : Are the Results of the Two Surgical Strategies the Same?

• Son S
• Lee SG
• Kim WK
• Park CW
• Yoo CJ

• KMID: 2339959
• DOI: http://doi.org/10.3340/jkns.2014.56.3.211

Abstract

OBJECTIVE
In Korea, early vertebroplasty (EVP) or delayed vertebroplasty (DVP, which is performed at least 2 weeks after diagnosis) were performed for the treatment of acute osteoporotic compression fracture (OCF) of the spine. The present study compared the outcomes of two surgical strategies for the treatment of single-level acute OCF in the thoracolumbar junction (T12-L2).
METHODS
From 2004 to 2010, 23 patients were allocated to the EVP group (EVPG) and 27 patients to the DVP group (DVPG). Overall mean age was 68.3+/-7.9 and minimum follow-up period was 1.0 year. Retrospective study of clinical and radiological results was conducted.
RESULTS
No significant differences in baseline characteristics were observed between the two groups. As expected, mean duration from onset to vertebroplasty and mean duration of hospital stay were significantly longer in the DVPG (17.1+/-2.1 and 17.5+/-4.2) than in the EVPG (3.8+/-3.3 and 10.8+/-5.1, p=0.001). Final clinical outcome including visual analogue scale (VAS), Oswestry Disability Index, and Odom's criteria did not differ between the two groups. However, immediate improvement of the VAS after vertebroplasty was greater in the EVPG (5.1+/-1.3) than in the DVPG (4.0+/-1.0, p=0.002). The proportion of cement leakage was lower in the EVPG (30.4%) than in the DVPG (59.3%, p=0.039). In addition, semiquantitative grade of cement interdigitation was significantly more favorable in the EVPG than in the DVPG (p=0.003). Final vertebral body collapse and segmental kyphosis did not differ significantly between the two groups.
CONCLUSION
Our findings suggest that EVP achieves a better immediate surgical effect with more favorable cost-effectiveness.

Keyword

Osteoporosis; Spine; Compression fracture; Vertebroplasty

MeSH Terms

Follow-Up Studies
Fractures, Compression*
Humans
Korea
Kyphosis
Length of Stay
Osteoporosis
Retrospective Studies
Spine
Vertebroplasty*

Figure

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  Fig. 1 Lateral plain radiograph of the lumbar spine showing measured factors. The height of the vertebral body was defined as the average of the three area heights of the vertebral body [(a+b+c)/3]. The compression ratio was calculated using the following equation : The compression ratio (%)= Segmental kyphotic angle (x) was determined at the intersection of lines drawn at the level of the inferior plateau of the upper adjacent body and the superior plateau of the lower adjacent body.

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  Fig. 2 Mean duration from onset to diagnosis and from diagnosis to surgery in the two groups. DVPG : delayed vertebroplasty group, EVPG : early vertebroplasty group.

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  Fig. 3 Sequential changes of the mean visual analogue scale in the two groups. DVPG : delayed vertebroplasty group, EVPG : early vertebroplasty group.

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  Fig. 4 Sequential changes of the mean Oswestry Disability Indexs in the two groups. DVPG : delayed vertebroplasty group, EVPG : early vertebroplasty group.

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  Fig. 5 Sequential changes of the mean compression ratios (%) in the two groups. DVPG : delayed vertebroplasty group, EVPG : early vertebroplasty group.

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  Fig. 6 Sequential changes of the mean segmental angles (°) in the two groups. DVPG : delayed vertebroplasty group, EVPG : early vertebroplasty group.

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