Is kyphoplasty reliable for osteoporotic vertebral compression fracture with vertebral wall deficiency?

Abstract 

Background

Vertebral compression fractures are a common clinical manifestation of osteoporosis. The introduction of kyphoplasty has allowed minimally invasive treatment of these fractures. However, in patients with loss of vertebral wall integrity, balloon kyphoplasty is contraindicated due to the possibility of extruding wall fragments into the canal and cement extravasation. We evaluated the efficacy and safety of kyphoplasty in the treatment of vertebral compression fractures in patients with compromised vertebral walls using individualised surgical techniques to avoid cement extravasation.

Methods

Symptomatic vertebral fractures (59 fractures in 55 patients) were treated by kyphoplasty. In levels with compromised anterior vertebral walls, two distinct sequential applications of cement were performed to avoid anterior leakage. In levels that demonstrated posterior or lateral wall deficiencies, the cement was injected under live fluoroscopy to monitor lateral or posterior extravasation. Radiographic outcomes were evaluated by comparing pre- and postoperative anterior/middle vertebral body height and local kyphotic angle. Clinical outcomes were evaluated by comparing Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) values preoperatively, postoperatively, and at 3-, 6- and 12-month follow-ups.

Results

Symptomatic cement extravasation and complications after kyphoplasty were not observed. Vertebral height was restored and the mean kyphotic angle was improved. The mean VAS decreased significantly from pre-surgery to post-surgery, as did the ODI (p<0.05).

Conclusion

Kyphoplasty is a safe, clinically effective treatment for osteoporotic vertebral fracture with peripheral wall damage when using individualised surgical techniques to prevent bone cement leakage.

Keywords: Kyphoplasty, Osteoporotic vertebral compression fracture, Vertebral wall deficiency, Cement extravasation