Percutaneous kyphoplasty versus conservative treatment of acute and subacute osteoporotic vertebral compression fractures: a randomized controlled study

Abstract

Objective To compare percutaneous kyphoplasty ( PKP ) and conservative treatment (CT) in terms of efficacy and safety for patients with osteoporotic vertebral compression fractures (OVCF) .Methods From July 2007 to July 2010, 164 patients with acute (within 2 weeks) or sub-acute (2 to 8 weeks) OVCF were enrolled in this study.They were randomly assigned into CT and PKP.In the PKP group, there were 47 men and 30 women, aged from 57 to 77 years (average, 67 years); In the CT group, there were 43 men and 44 women, aged from 60 to 82 years (average, 67 years).Improvement of symptoms, vertebral height restoration, correction of kyphosis, bone cement leakage, pain, physical and psychological outcomes were observed.Visual analog scale (VAS), SF-36 form and the Dallas questionnaire were adopted to evaluate the physiological and psychological changes.Results The patients obtained an average follow-up of 9 months (from 6 to 12 months) .A considerable degree of pain relief was obtained in both groups at postoperation and 3-month follow-up ( P ＜ 0.05 ).There was no significant difference between the 2 groups in VAS scores at preoperation and the last follow-up ( P ＞ 0.05 ), but a significant difference at 24 hours postoperation ( P ＜ 0.05) .In the PKP group, the average anterior vertebral body height was restored by 27.9% ( P ＜ 0.05) and the average vertebral kypbosis correction was 12.6° ( P ＜ 0.05).There were no significant differences between the 2 groups in postoperative scores in Health Survey Short Form (standard physical components and standard psychological components), Dallas Pain Questionnaire (activities of daily living, work and play, anxiety aod depression, social interests), Barthel index, Mini-Mental State Examination ( P ＞ 0.05) .Conclusions PKP is advantageous over CT in immediately relieving pain following an acute or subacute OVCF, better restoring the vertebral body height and correcting the kyphosis,early rehabilitation and lower complications.Although CT can relieve symptoms after 3 to 6 months, it is not as good as PKP in restoring the vertebral body height and correcting the kyphosis. Key words: Osteoporosis; Spinal fractures; Vertebroplasty