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
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Article info
Publication history
Accepted:
September 28,
2009
Identification
Copyright
© 2009 Published by Elsevier Inc. All rights reserved.
