Abstract
Severe osteoporotic vertebral compression fractures (OVCFs) were considered as relative or even absolute contraindication for vertebroplasty and kyphoplasty and these relevant reports are very limited. This study aimed to evaluate and compare the efficacy of vertebroplasty with high-viscosity cement and conventional kyphoplasty in managing severe OVCFs. 37 patients of severe OVCFs experiencing vertebroplasty or kyphoplasty were reviewed and divided into two groups, according to the procedural technique, 18 in high-viscosity cement percutaneous vertebroplasty (hPVP) group and 19 in conventional percutaneous kyphoplasty (cPKP) group. The operative time, and injected bone cement volume were recorded. Anterior vertebral height (AVH), Cobb angle and cement leakage were also evaluated in the radiograph. The rate of cement leakage was lower in hPVP group, compared with cPKP group (16.7% vs 47.4%, P = 0.046). The patients in cPKP group achieved more improvement in AVH and Cobb angle than those in hPVP group postoperatively (37.2 ± 7.9% vs 43.0 ± 8.9% for AVH, P = 0.044; 15.5 ± 4.7 vs 12.7 ± 3.3, for Cobb angle, P = 0.042). At one year postoperatively, there was difference observed in AVH between two groups (34.1 ± 7.4 vs 40.5 ± 8.7 for hPVP and cPKP groups, P = 0.021), but no difference was found in Cobb angle (16.6 ± 5.0 vs 13.8 ± 3.8, P = 0.068). Similar cement volume was injected in two groups (2.9 ± 0.5 ml vs 2.8 ± 0.6 ml, P = 0.511). However, the operative time was 37.8 ± 6.8 min in the hPVP group, which was shorter than that in the cPKP group (43.8 ± 8.2 min, P = 0.021). In conclusion, conventional PKP achieved better in restoring anterior vertebral height and improving kyphotic angle, but PVP with high-viscosity cement had lower rate of cement leakage and shorter operative time with similar volume of injected cement.
Highlights
Severe osteoporotic vertebral compression fractures (OVCFs) were considered as relative or even absolute contraindication for vertebroplasty and kyphoplasty and these relevant reports are very limited
The inclusion criteria were as follow: 1. age above 65 years; 2. single-level OVCFs involving T10-L5 and absence of spinal cord or nerve compression symptoms; 3. fractured vertebrae collapsed to less than one third of its original height; 4. osteoporosis diagnosed by dual-energy X-ray absorptiometry, and bone mineral density (BMD) was less than 2.5 SD; 5. acute back pain associated with vertebral fracture and visual analogue scale (VAS) ≥ 5; Patients were excluded if meeting to the following criteria: traumatic fracture, bone metastases, infectious diseases, tuberculosis, and a history of vertebroplasty and other thoracic or lumbar surgeries
The rate of cement leakage was 16.7% (3 of patients) in the high-viscosity cement percutaneous vertebroplasty (hPVP) group, which was lower than 47.4% (9 of patients) in the conventional percutaneous kyphoplasty (cPKP) group
Summary
Severe osteoporotic vertebral compression fractures (OVCFs) were considered as relative or even absolute contraindication for vertebroplasty and kyphoplasty and these relevant reports are very limited. Conventional PKP achieved better in restoring anterior vertebral height and improving kyphotic angle, but PVP with high-viscosity cement had lower rate of cement leakage and shorter operative time with similar volume of injected cement. Percutaneous vertebroplasty (PVP) has achieved satisfactory outcome in relieving pain and improving life quality for patients with OVCFs. severe OVCFs, the vertebral body collapsed to less than one-third of its original height, were regarded as contraindication for technical difficulties[3,4]. Reports that explicitly investigate the efficacy and safety of these modifications in severe OVCFs are limited This retrospective study presents the clinical and radiological outcomes of patients with severe OVCFs, who received PVP with high-viscosity cement and conventional PKP, in order to evaluate and compare efficacy and safety of conventional PKP and high-viscosity cement PVP in managing severe OVCFs
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