Treatment Of Osteoporotic Vertebral Compression Fractures Research Articles

Vertebroplasty for osteoporotic spine fracture: prevention and treatment.

There is a relatively high prevalence of osteoporotic vertebral compression fractures (VCFs) in the elderly population, especially in women aged 50 or older. The result of these VCFs is increased morbidity and mortality in the short and long term. Medical treatment of these fractures includes bed rest, orthotics, analgesic medication and time. Percutaneous vertebroplasty (PVP) consists of percutaneous injection of biomaterial, such as methylmethacrylate, into the VCF to produce stability and pain relief. Biomechanical testing has shown that PVP can restore strength and stiffness of the vertebral body to the pre-fracture levels. Clinical results show immediate and maintained pain relief in 70-95% of the patients. Possible major complications include cement leakage into the spinal canal or into the venous system. Additionally, percutaneous vertebroplasty may alter the normal loading behavior of the adjacent vertebral body, and there is an increased risk of adjacent segment VCF. Kyphoplasty is a new technique, which introduces a balloon into the vertebral body transpedicularly to reduce the VCF while creating a cavity for the cement injection. This technique has the benefit of kyphosis reduction as well as less cement leakage. Research continues into the development of injectable biomaterials that are resorbable and allow for new bone formation. Vertebroplasty and kyphoplasty are safe and effective in the treatment of osteoporotic VCFs. They may allow for a faster return to function, and thus avoid the morbidity associated with medical treatment.

4:19 Clinical factors influencing the therapeutic results of percutaneous vertebroplasty in osteoporotic vertebral compression fractures

Purpose of study: A clinical study was conducted to find out possible clinical factors influencing long-term therapeutic results in osteoporotic vertebral compression fractures (VCFs) after percutaneous vertebroplasty (PVP) using pre-established protocols.Methods used: The authors analyzed various clinical factors affecting therapeutic results of PVP in 215 patients with 532 symptomatic osteoporotic VCFs, performed by a single operator (range of the age of fractures, 1 week to 3 years). The patients were interviewed by a third party to assess four different variables (relief of pain, change in activity, analgesic use, patient satisfaction) of treatment results. The relationship between 16 clinical factors and each different variable of the results were statistically analyzed (mean follow-up, 15 months).of findings: Pain relief was rated in 45 cases as good; in 86 cases, fair; in 72 cases, no change and in 13 cases, worse. The sooner the duration from fracture to PVP, the more severe back pain, positive bone scan, and the lower mean T score on BMD, the better pain relief. Change in activity was rated by 16 as good; by 29, fair; by 162, no change and by 7, worse. The longer the duration, the less severe back pain, negative bone scan, paravertebral leakage, the less improvement in activity. Twenty-eight rated the effect of analgesic use as good, 43 as fair, 128 as no change and 15 as worse. Women and patients with negative bone scans appeared to be less improved. With regard to patient satisfaction, 56 were very satisfied, 96 were somewhat satisfied, 39 were somewhat dissatisfied and 24 were very dissatisfied. The longer the duration, negative bone scan, the higher the mean T score and paravertebral leakage, the less patients were satisfied. There were no serious complications related to the surgical procedures.Relationship between findings and existing knowledge: PVP has been used successfully in the treatment of osteoporotic VCFs, and has become a popular management procedure. However, there are no reliable criteria for success of PVP in practice except for a few results from short-term follow-up in a small population of the patients. In our study, the efficacy of PVP was confirmed in osteoporotic VCFs, but PVP was rated lower in pain relief and satisfaction compared with the previous studies and not significant in terms of change in activity and analgesic use.Overall significance of findings: These disparities might be mainly caused by the wide range of fracture age. The favorable clinical factors appeared to be positive bone scan imaging, shorter age of fractures and severity of pain and osteoporosis. The unfavorable factors were female gender, negative bone scan, mild osteoporosis and leakage of methacrylate into the paravertebral space. Long-term therapeutic results of PVP management can be improved in terms of early return to usual activity, improvement in pain relief, analgesic use and patient satisfaction, especially in bedridden elderly patients presenting severe focal pain and severe osteoporosis. Revision of the pre-existing criteria for patient selection for PVP might be needed.Disclosures: Device or drug: polymethylmethacrylate. Status: approved.Conflict of interest: No conflicts.

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

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.