Balloon kyphoplasty for the treatment of painful spinal deformity resulting from osteoporotic vertebral compression fractures

Abstract

Purpose of study: Treatments for vertebral compression fractures (VCFs) have historically focused on pain control, but the kyphotic deformity as a result of VCF is also a cause of significant medical morbidity. The ideal treatment of VCFs should thus address both the fracture-related pain and associated spinal deformity. Balloon kyphoplasty is a recently developed minimally invasive procedure that aims to address both the pain and deformity resulting from the fracture. To date, there have been no reports on the effect of kyphoplasty on the sagittal alignment of the spine. The goals of this prospective study were to measure the effects of kyphoplasty on spinal deformity, activity levels and pain in patients with osteoporotic VCFs.Methods used: Sixty-one vertebral compression fractures between T6 and L5 were treated with balloon kyphoplasty in 29 patients (mean age, 71 years). The mean interval between fracture and kyphoplasty was 3.8 months. Clinical follow-up with measurement of pain scores and activity levels was obtained from patient questionnaires. Alterations in sagittal alignment were assessed by measuring Cobb angles in pre- and postkyphoplasty standing radiographs.of findings: Mean improvement in local sagittal alignment for the 28 patients treated with kyphoplasty was 8.8 degrees (range, 0 to 29 degrees). When separately analyzed, the mean improvement in sagittal alignment in treated thoracic fractures was 9.7 degrees, and the mean improvement in sagittal alignment in lumbar fractures was 7.9 degrees. If only fractures that were considered reducible (at least 5-degree improvement in sagittal alignment) were considered, 30 fractures in 17 patients showed an improvement in sagittal alignment of 14.2 degrees (range, 8 to 29 degrees). At the 1-week postoperative visit, 23 of 25 patients reported an improvement in pain. By 6 weeks after the procedure, 18 of 28 patients reported a return to prefracture activity, and 90% stated they would have another kyphoplasty for further fractures. Evaluation of intra- and postoperative radiographs revealed extravertebral cement leaks in 7 or 61 vertebral fractures treated, but no clinical consequences attributable to the bone tamp or cement occurred.Relationship between findings and existing knowledge: Prior studies have reported successful pain relief and vertebral body height restoration achieved with kyphoplasty in the treatment of osteoporotic VCFs. The effect on kyphoplasty on sagittal angulation, which we believe is more significant, has not previously been reported. The magnitude of correction of deformity achieved with kyphoplasty is comparable to that reported for open reduction and internal fixation of thoracolumbar fractures.Overall significance of findings: The results of this study indicate that kyphoplasty can rapidly provide pain relief and improve the kyphotic deformity resulting from osteoporotic VCFs. This study is the first to quantify the effects of kyphoplasty on sagittal angulation of the spine.Disclosures: Device or drug: KyphX bone tamp apparatus. Status: approved. Device or drug: polymethylmethacrylate in the spine. Status: not approved.Conflict of interest: Frank Phillips, consultant.