Kyphoplasty for Osteoporotic Vertebral Compression Fractures: Outcomes and Intradiscal Cement Leakage Type

Ahmadreza Reyhani  Yassavoly; Taravat  Yazdanian; Parisa  Azimi; Alireza  Bagheri; Zahra  Farahzadi; Guive  Sharifi

doi:10.18502/jost.v11i2.18884

Ahmadreza Reyhani Yassavoly Assistant Professor, Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Taravat Yazdanian Researcher, Neurological Clinical Research Institute and Healey and AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Parisa Azimi Assistant Professor, Department of Neurosurgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Alireza Bagheri Assistant Professor, Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Zahra Farahzadi Associate Professor, Department of Psychology, Tehran Central Branch, Islamic Azad University, Tehran, Iran
Guive Sharifi Professor, Department of Neurosurgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jost.v11i2.18884

Keywords: Kyphoplasty; Compression Fractures; Osteoporotic Fractures

Abstract

Background: Kyphoplasty (KP) has been widely applied to treat painful osteoporotic vertebral compression fractures (VCFs). However, knowledge about sequelae is still inadequate. This study aimed to assess outcomes following balloon KP in patients with osteoporotic VCFs.

Methods: A total of 251 patients were included and classified into two groups: group A included 31 patients with braces for one month after KP, and group B contained 220 patients without braces. Patients with intradiscal bone cement leakage were divided into two groups according to spinal X-ray imaging with Round- type (n = 2) and Spike-type (n = 9). Operating efficacy was evaluated via a comparison of the visual analog scale (VAS) and Oswestry Disability Index (ODI) before and after KP. Complications such as adjacent vertebral fractures (AVFs) and remote vertebral fractures (RVFs) were observed.

Results: 361 vertebral bodies, including 153 thoracic vertebrae (42.4%) and 208 lumbar vertebrae (57.6%) were treated. Mean age of patients was 73.3 [standard deviation (SD) = 6.4] years and 72.9% were women. Mean follow-up duration was 22.8 (SD = 13.2) months. Operation average time was 35.2 (SD = 9.3) minutes. Average intraoperative fluoroscopy was 23.6 (SD = 9.8) times. Average volume of bone cement injected into each vertebral body was 3.7 (SD = 0.9) ml. We observed 18 AVFs and nine RVFs within 1-31 months of surgery. The remote fracture was 0% in group A and 4.1% in group B, which was also a statistically significant difference (P < 0.05). The AVFs were 78% in group of Spike-type and 0% in group of Round-type, which shows a significant difference between the groups (P < 0.05). All groups had significantly improved VAS and ODI at each follow-up time.

Conclusion: KP is an effective treatment for the management of osteoporotic VCFs, but it seems that intra-disc leakage with Spike-type increases the risk of AVFs. We recommend patients wear braces for at least one month after KP to reduce pain and new fractures.