Vertebroplasty versus kyphoplasty: a comparative study of safety and cost-effectiveness and tips to improve outcomes of vertebroplasty

Abstract

Background Vertebroplasty (VP) has been found to be effective in treating persistent pain resulting from osteoporotic vertebral fractures. It brings rapid and significant pain relief but shows high rates of cement leakage (CL) and does not restore lost vertebral height. Kyphoplasty (KP) can partially restore vertebral height with minimal risk for CL but is very expensive, time consuming, and exposes surgeons to higher radiation risk. Patients and methods Thirty-one patients who underwent either VP or KP were included in the study. VP technique was refined to minimize complications and maximize outcome. VP was performed unipedicularly, whereas KP was performed usually bipedicularly (except for two patients). Pain relief and functional outcome were evaluated using the Visual Analogue Scale and the Oswestry Disability Index. Radiographs were used to evaluate CL, vertebral height restoration, and cemented vertebral body fraction. Results Twenty patients underwent VP and 11 patients underwent KP. The mean duration was 45.5 and 70.9 min for VP and KP, respectively. The mean number of C-arm images was 46 and 163 images for VP and KP, respectively. The mean reduction in Visual Analogue Scale was 7.2 and 7.6 points for VP and KP, respectively. The mean reduction in the Oswestry Disability Index was 66.3 and 72.1 points for VP and KP, respectively. The mean regain in vertebral height was 19.7 and 42.5% after VP and KP, respectively. Symptomatic adjacent level fractures occurred in two VP patients and one KP patient. Conclusion KP is more effective compared with VP in terms of vertebral height restoration, but is very expensive, time consuming, and entails more radiation exposure to surgeons compared with VP. Both techniques are equally effective as regards pain relief. CL can be minimized by refining VP technique.