Treatment Of Vertebral Compression Fractures Research Articles

A Prospective Randomized FDA-IDE Trial Comparing Cortoss With PMMA for Vertebroplasty

Randomized, controlled, prospective (AAOS therapeutic level I) trial conducted under Food and Drug Administration Investigational Device Exemption hypothesized noninferiority of a novel bioactive composite material to polymethylmethacrylate (PMMA). To determine the safety and efficacy of a new, nonresorbable bioactive composite (Cortoss) compared with PMMA, the standard treatment of vertebral compression fractures (VCFs). Vertebroplasty with PMMA, the widely adopted treatment for VCFs nonresponsive to conservative care, provides effective, immediate pain relief, but the material has received criticism for its properties. A new bioactive composite material designed specifically for vertebroplasty showed promising results in animals and nonrandomized clinical studies and was subsequently compared with PMMA in a randomized study. This study represents the first prospective study evaluating vertebroplasty comparing PMMA with another material with 24-month follow-up. Using 2:1 randomization, vertebroplasty was performed with Cortoss on 162 patients and PMMA on 94 patients. Inclusion criteria were painful osteoporotic VCFs with a visual analogue scale pain score of at least 50 mm on a 100-mm scale and at least 30% disability as measured by the Oswestry Disability Index. Evaluations at pretreatment, treatment day, and 7 posttreatment intervals out to 24 months included pain, disability, neurological status, adverse events, quality of life, patient satisfaction, analgesic use, and independently reviewed radiographs. Noninferiority of Cortoss relative to PMMA was observed, with Cortoss-treated patients experiencing significant pain relief at 3 months (P = 0.0395) and better maintenance or improvement in function at 24 months (P = 0.0299). Incidence of serious device-related adverse events was 4.3% in both groups; none were life threatening. Vertebroplasty using either Cortoss or PMMA provides effective, immediate, and lasting pain relief and prevents further loss of function. Both materials performed comparably at most time points; Cortoss demonstrated better results for pain reduction at 3 months and for function at 24 months.

Hypovitaminosis D as a risk factor of subsequent vertebral fractures after kyphoplasty

Over the past 20 years, methods of minimally invasive surgery have been developed for the treatment of vertebral compression fractures. Balloon kyphoplasty and vertebroplasty are associated with a recurrent fracture risk in the adjacent levels after the surgical procedure. In certain patient categories with impaired bone metabolism, the risk of subsequent fractures after kyphoplasty is increased. To determine the incidence of recurrent fractures after kyphoplasty and explore whether the status of bone metabolism and 25-hydroxyvitamin D (25(OH)D) levels affect the occurrence of these fractures. Prospective longitudinal clinical study. Forty female postmenopausal women with primary osteoporosis and acute symptomatic vertebral compression fractures. Identification of new vertebral fractures and documentation of indicators of bone metabolism. A total of ninety-eight kyphoplasties were performed in 40 female patients. Balloon kyphoplasty was performed on all symptomatic acute vertebral compression fractures. Age, body mass index, history of tobacco use, number of initial vertebral fractures, intradiscal cement leakage, history of nonspinal fractures, use of antiosteoporotic medications, bone mineral density, bone turnover markers, and 25(OH)D levels were assessed. All participants were evaluated clinically and/or radiographically. Follow-up period was 18 months. The mean population age was 70.6 years (range, 40-83 years). After initial kyphoplasty procedure, nine patients (11 levels) (22.5% of patients; 11.2% of levels) developed a postkyphoplasty vertebral compression fracture. Cement leakage was identified in seven patients (17.5%). The patients without recurrent fractures after kyphoplasty demonstrated higher levels of 25(OH)D (22.6±5.51 vs. 14.39±7.47; p=.001) and lower N-terminal cross-linked telopeptide values (17.11±10.20 vs. 12.90±4.05; p=.067) compared with the patients with recurrent fractures. Bone metabolism and 25(OH)D levels seem to play a role in the occurrence of postkyphoplasty recurrent vertebral compression fractures.

Life expectancy following diagnosis of a vertebral compression fracture

The life expectancy of vertebral compression fracture (VCF) patients was evaluated as a function of their treatment. Compared to non-operated patients, the kyphoplasty and vertebroplasty patient cohort had 115% and 44% greater adjusted life expectancy, respectively. Kyphoplasty patients had a 34% greater adjusted life expectancy than vertebroplasty patients. Balloon kyphoplasty and vertebroplasty are minimally invasive procedures for the treatment of painful VCFs. This comparative effectiveness study characterized the life expectancy of VCF patients as a function of their treatment. Life expectancy of VCF patients in the 100% U.S. Medicare dataset (2005-2008) was estimated using a parametric Weibull survival model (adjusted for comorbidities), and compared between operated and non-operated patients as well as between kyphoplasty and vertebroplasty patients. A total of 858,978 patients with a newly diagnosed VCF were identified, including 119,253 kyphoplasty patients (13.9%) and 63,693 vertebroplasty patients (7.4%). Adjusted life expectancy was 85% greater for operated than non-operated patients (p < 0.001; 95% confidence interval: 82-89%). Compared to non-operated patients, the kyphoplasty and vertebroplasty patient cohort had 115% (p < 0.001; 95% confidence interval: 111-119%) and 44% (p < 0.001; 95% confidence interval: 42-47%) greater adjusted life expectancy, respectively. Kyphoplasty patients had a 34% greater adjusted life expectancy than vertebroplasty patients (p < 0.001; 95% confidence interval: 31-36%). Across all gender-age groups, the median life expectancy predicted by the parametric Weibull model was 2.2-7.3 years greater for operated than non-operated patients. Statistically significant and substantial differences in life expectancy were observed between the treated and non-treated cohorts in the Medicare population. Among the treated cohorts, patients in the vertebroplasty group experienced less of a survival benefit than those who received kyphoplasty. The results will be a useful basis for future cost effectiveness studies of VCF treatments for the Medicare population.

Improved percutaneous vertebroplasty for osteoporotic vertebral compression fractures

Objective To evaluate the curative efficacy of improved percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF) in comparison with conventional PVP and percutaneous kyphoplasty (PKP). Methods Between June 2007 and July 2010,97 senior OVCF patients were surgically treated and followed up in our department.They were 36 men and 61 women,with an average age of 68.3 years (ranging from 56 to 89 years).Altogether 124 vertebral bodies were treated,including 73 thoracic vertebrae and 51 lumbar vertebrae.Seventy-four patients had a single vertebra fractured,19 had 2 vertebrae fractured and 4 had 3 vertebrae fractured.The patients received improved PVP,conventional PVP and PKP respectively.The visual analogue scale (VAS) scores and the cobb angles of the injured vertebra before operation,one week and 6 months after operation and the postoperative cement leakage as well were compared between the 3 groups of patients. Results The patients obtained an average follow-up of 13 months (from 7 to 20 months).Mild radicular symptoms were observed in 3 patients.No spinal injury,infection or vascular embolism occurred.There was a significant difference between the preoperative and postoperative VAS scores in all the 3 groups( P ＜ 0.05) but there was no significant difference among the 3 groups regarding the VAS score at the same time point ( P ＞ 0.05). PKP and improved PVP were significantly better than conventional PVP in correction of the cobb angle ( P ＜ 0.05).Moreover,PKP and improved PVP resulted in significantly fewer events of cement leakage than conventional PVP ( P ＜ 0.05). Conclusions Compared with conventional PVP,improved PVP makes a significant improvement in correction of vertebral kyphosis and reduction of cement leakage while it can also rapidly relieve pain in patients with OVCF.Improved PVP is as therapeutically effective as PKP,but much less expensive than PKP. Key words: Spinal fractures; Osteoporosis; Vertebroplasty

Abstract No. 183: Radiofrequency targeted vertebral augmentation (RF-TVA) for osteoporotic compression fractures

RF-TVA employs a novel system containing a steerable osteotome for site-specific cavity creation and radiofrequency (RF) modulation of cement viscosity delivered using a hydraulic delivery system. We report a prospective study of patients with acute osteoporotic vertebral compression fractures (VCF) with this system. Between May 2009 and January 2011, 20 patients with 1-3 painful VCFs (confirmed by MRI and pain concordant with index level) who were to receive kyphoplasty treatment were enrolled. Inclusion criteria included age between 50-90, Visual Analogue Pain (VAS) score >4, a moderate (21-40%) or greater Oswestry Disability Index (ODI) score, and 20-90% vertebral compression. VAS and ODI scores were recorded pre-procedure, at discharge, one week, one month, and three months after the procedure. ODI scores were recorded at the same time points except at discharge. Each procedure was performed using this Vertebral Augmentation System. A trocar was placed via a unipedicular approach. . Using a remotely controlled delivery system RF energy was applied tothe PMMA cement as it passed into the delivery cannula. Average patient age was 79.7 ±9.85 years. The mean percentage of collapse was 28 ±13. %. A majority of patients had associated diseases, the most common ones being hypertension (N=14) and coronary artery diseases (N=9). All surgeries were performed within 42 days (av. 13 days) of the patient's reported date of injury. The average procedure time was 18.6 ± 8.95 minutes. No procedure related complications were encountered. No patients required bilateral procedures. The improvement in mean VAS scores from pre-procedure to discharge was 3.4 (p<0.0001). At 1 week, 1 month and 3 months, the improvement in mean VAS score was 3. After three months, the improvement in average ODI scores was significant (34.14%, p < 0.0001). Radiofrequency targeted vertebral augmentation (RF-TVA) is a safe and effective method for treatment of vertebral compression fractures. The use of RF energy, to warm cement immediately prior to entering the patient, results in the unique combination of consistently high viscosity cement useable over an extended working time.

Abstract No. 184: Comparative analysis of cement extravasation in radiofrequency targeted vertebral augmentation, balloon kyphoplasty and high viscosity cement vertebroplasty

Targeting and control of cement delivery is the goal of minimally invasive (MI) treatment of vertebral compression fractures (VCF). In vitro studies have shown high-viscosity cements to significantly decrease the incidence of leakage compared with low-viscosity cements. This study compares the incidence and pattern of cement leakage in cases treated with high-viscosity cement vertebroplasty (VP) (DePuy), standard BKP (Medtronic) and Radiofrequency Targeted Vertebral Augmentation (RF-TVA) (StabiliT System, DFine), novel unipedicular vertebral augmentation procedure that combines an ultra-high viscosity cement delivered into targeted site specific cavities. Retrospective analysis of postoperative radiographs of VCF patients treated with the three MI cement augmentation techniques were analyzed for the incidence and location of cement leakage. 112 consecutive patients with 159 treated levels were included in this review; 66 VP levels, 46 BKP levels and 47 RF-TVA levels, ranging from T3 to L5. In the VP group, 33 leakages in 66 levels (50% per level) were observed (17 discal, 11 venous, 4 paravaertebral and 1 epidural). In the BKP group 31 leakages in 46 levels (67% per level) were observed (15 discal, 11 venous, 3 paravaertebral and 2 epidural). In the RF-KP group 16 leakages in 47 levels (34% per level) were observed, (8 discal, 5 venous, 3 paravaertebral and non epidural). All leakages were asymptomatic. These detailed analyses demonstrate targeted cement augmentation using RF-TVA technique may provide up to 50% reduction in leakage rate when compared to VP with high viscosity cement and standard BKP. These results may be related to targeted cement delivery as a result of the unique combination of controlled delivery of radiofrequency activated (ultra- high viscosity) cement at an optimized delivery rate into multiple site specific channels created using a navigational osteotome. Uni-pedicular access and remote controlled cement delivery further decreases procedural invasiveness and physician radiation exposure.

Abstract No. 6: Cost-benefit analysis of treatments for vertebral compression fractures

Vertebral compression fractures (VCFs) can be treated by nonsurgical management or by minimally invasive surgical treatment including vertebroplasty and balloon kyphoplasty. The purpose of the present study was to characterize the cost to society for treating VCF diagnosed patients by nonsurgical management, vertebroplasty, or kyphoplasty. We hypothesized that surgical treatments for VCFs using vertebroplasty or kyphoplasty would be a cost-effective alternative to nonsurgical management for the Medicare patient population.

Abstract No. 190: Interim results from a investigational device exemption trial evaluating the osseofix spinal implant for treatment of vertebral compression fractures

Abstract No. 190: Interim results from a investigational device exemption trial evaluating the osseofix spinal implant for treatment of vertebral compression fractures

Nursing of PVP and PKP in the treatment of osteoporotic vertebral compression fractures

Objective To explore the effect and reasonable nursing methods of percutancous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures.Methods Totally 156 patients with osteoporotic vertebral compression fractures were randomly selected in the third hospital of Hebei Medical University from December 2004 to December 2010.According to the surgical methods,all the patients were divided into two groups:PVP group ( n =89) and PKP group ( n =67 ).The hospital stay,hospitahzation costs,bed time,postoperative recovery time,VAS scores before and after treatment,cement leakage rate of both PVP group and PKP group were analyzed.Results Group PVP:hospital stay (4.85 ±0.81)d,bedtime (1.48 ±0.68)d,postoperative recovery time (2.36 ±0.84)d,VAS scores after treatment (2.19 ± 0.77) ; Group PKP:hospital stay (4.71 ± 0.77 ) d,bed time ( 1.53 ± 0.52) d,postoperative recovery time (2.40 ±0.64)d,VAS scores after treatment (2.26 ±0.63 ).There were no significant differences in the aspects of the hospital stay,bed time,postoperative recovery time,VAS scores after treatment between PVP group and PKP group (t =0.702,0.355,0.491,0.348,respectively; P ＞0.05).Group PVP:hospitalization costs (1.30 ±0.19) ten thousand yuan; Group PKP:hospitalization costs (4.79 ±0.22) ten thousand yuan,there was significant difference in the hospitalization costs(t =79.163,P＜0.01).There was significant difference in the aspects of cement leakage rate between PVP group and PKP group (30.34％ vs 13.43％ ;x2 =6.153 1,P＜0.05).Conclusions Both PVP and PKP can effectively ease the pain in patients with osteoporotic vertebral compression fractures.Hospitalization costs is lower in PVP group than that in PKP group.However,cement leakage rate is higher. Key words: Osteoporosis; Vertebroplasty; Fractures,compreasion

Balloon Kyphoplasty in the Treatment of Vertebral Compression Fractures in Cancer Patients

Patients with cancer are at increased risk of painful vertebral compression fractures (VCFs). The Cancer Patient Fracture Evaluation (CAFE) trial was the first randomised controlled study to compare the safety and effectiveness of balloon kyphoplasty (BKP – a minimally invasive procedure) with non-surgical fracture management in the treatment of VCFs in patients with cancer. Data from the CAFE trial demonstrated that BKP is a safe and effective treatment option that quickly reduces pain and improves physical function and vertebral body height in patients with cancer and painful VCFs. Data from peer-reviewed published studies support the CAFE trial findings.

Comparative clinical results of vertebroplasty using jamshidi® needle and bone void filler for acute vertebral compression fractures.

ObjectivePercutaneous vertebroplasty (PVP) is an effective treatment modality for management of osteoporotic compression fracture. However physicians sometimes have problems of high pressure in cement delivery and cement leakage when using Jamshidi® needle (JN). Bone void filler (BVF) has larger lumen which may possibly diminish these problems. This study aims to compare the radiologic and clinical outcome of JN and BVF for PVP.MethodsOne hundred twenty-eight patients were treated with PVP for osteoporotic vertebral compression fracture (VCF) where 46 patients underwent PVP with JN needle and 82 patients with BVF. Radiologic outcome such as kyphotic angle and vertebral body height (VBH) and clinical outcome such as visual analog scale (VAS) scores were measured after treatment in both groups.ResultsIn JN PVP group, mean of 3.26 cc of polymethylmethacrylate (PMMA) were injected and 4.07 cc in BVF PVP group (p<0.001). For radiologic outcome, no significant difference in kyphotic angle reduction was observed between two groups. Cement leakage developed in 6 patients using JN PVP group and 2 patients using BVF group (p=0.025). No significant difference in improvement of VAS score was observed between JN and BVF PVP groups (p=0.43).ConclusionFor the treatment of osteoporotic VCF, usage of BVF for PVP may increase injected volume of cement, easily control the depth and direction of PMMA which may reduce cement leakage. However, improvement of VAS score did not show difference between two groups. Usage of BVF for PVP may be an alternative to JN PVP in selected cases.

An ex vivo biomechanical comparison of a novel vertebral compression fracture treatment system to kyphoplasty

BackgroundVertebral compression fracture repair aims to relieve pain and improve function by restoring vertebral structure and biomechanics, but is still associated with risks arising from polymethylmethacrylate cement extravasation. The Kiva® Vertebral Compression Fracture Treatment System, a stacked coil implant made of polyetheretherketone and delivered over a guide-wire, is a novel device designed to provide height restoration and mechanical stabilization, while improving cement containment and minimizing disruption of cancellous bone. The objective of this study was to determine whether the Kiva system is as effective as balloon kyphoplasty at restoring mechanical properties in osteoporotic vertebral compression fractures. MethodsWedge fractures were created in the middle vertebra of fourteen osteoporotic three-vertebra spine segments and then repaired with either the Kiva or kyphoplasty procedure. Height, stiffness and displacement under compression of the spine segments were measured for four conditions: intact, fractured, augmented, and post-cyclic eccentric loading (50,000cycles, 200–500N, 30mm anterior lever arm). FindingsNo significant differences were seen between the two procedures for height restoration, stiffness at high or low loads, or displacement under compression. However, the Kiva System required an average of 66% less cement than kyphoplasty to achieve these outcomes (mean 2.6 (SD 0.4) mL v. mean 7.5 (SD 0.8) mL 0; P<0.01). Extravasations and excessive posterior cement flow were also significantly lower with Kiva (0/7 v. 4/7; P<.05). InterpretationKiva exhibits similar biomechanical performance to balloon kyphoplasty, but may reduce the risk of extravasation through the containment mechanism of the implant design and by reducing cement volume.

Vertebral Compression Fracture Treatment with Vertebroplasty and Kyphoplasty: Experience in 407 Patients with 1,156 Fractures in a Tertiary Cancer Center

Painful vertebral compression fractures (VCFs), whether pathologic or osteoporotic, are a source of morbidity in cancer patients. At our tertiary cancer center, over the past decade we have used vertebroplasty (VP) and kyphoplasty (KP) to treat painful VCFs. More data are needed on the treatment of VCFs in cancer patients with these techniques. We retrospectively reviewed the medical records of cancer patients with painful VCFs that had been treated at our institution between January 1, 2001 and May 31, 2008. Information was collected on demographic and clinical characteristics, features of the fractures, procedural details, and complications. Pre- and post-procedural pain and related symptoms were assessed using a subset of patients who had responded to the Brief Pain Inventory and the Edmonton Symptom Assessment Scale. A total of 407 cancer patients had 1,156 fractures that had been treated with VP or KP during 536 surgical procedures. Patients had an average of 2.8 fractures (range, 1-10). The majority of patients had pathologic fractures due to multiple myeloma (43%) or osteoporotic fractures (35%). Most fractures occurred in the thoracolumbar region. Adjacent-level fractures occurred in 18% of patients. Surgery provided significant relief from pain and several related symptoms. Symptomatic, serious complications requiring open surgery occurred in two cases (<0.01%) in our series. Our single-center experience revealed that a large number of cancer patients suffer from painful VCFs. The use of VP or KP in treating painful VCFs in cancer patients has good efficacy and an acceptably low complication rate.

Gestione delle fratture vertebrali toraco-lombari da osteoporosi

Vertebral osteoporotic fractures represent a frequent event in elder patients. Sometimes the fracture is an occasional finding in asymptomatic patients, but in many cases it causes not only pain but also a series of events that lead to serious inability, up to a shortening of life. For these reasons it is really important to evaluate carefully, either clinically or radiographically, the elder patient who complains of back pain. The conservative treatment of vertebral compression fractures due to osteoporosis is still very useful but can lead to an unsatisfactory result because of persistent pain and kyphosis. With the correct indications vertebroplasty and kyphoplasty can lead to a successful treatment of this pathology, avoiding the risk of immobilization.

Vertebral augmentation treatment of painful osteoporotic compression fractures with the Kiva VCF Treatment System

Background Vertebral compression fractures (VCFs) can cause significant pain and functional impairment, and their cumulative effect can lead to progressive morbidity. This single-arm, prospective feasibility trial, conducted at 4 clinical sites, was undertaken to evaluate the clinical outcomes associated with the use of an innovative vertebral augmentation device, the Kiva VCF Treatment System (Benvenue Medical, Santa Clara, California), in the management of symptomatic VCFs associated with osteoporosis. Methods Vertebral augmentation treatment was performed for persistent back pain symptoms in 57 patients (mean age, 71.9 ± 10.4 years), including 46 women, with radiologically confirmed VCFs; 36 of these patients (63%) had reached 12 months of follow-up at this data analysis. There were 51 one-level cases, 5 two-level cases, and 1 three-level case, representing 64 treated levels. Back pain severity and condition-specific functional impairment were evaluated with a standard 100-mm visual analog scale and the Oswestry Disability Index (ODI), respectively, before device implantation as well as at 6 weeks, 3 months, and 12 months. Results Marked clinical improvements were realized in back pain severity and functional impairment through 12 months of follow-up. The mean back pain score on the visual analog scale improved from 79.3 ± 17.2 before treatment to 21.9 ± 21.3, 21.9 ± 24.6, and 23.2 ± 23.3 at 6 weeks, 3 months, and 12 months, respectively. The mean decrease at 12 months was 49.9 ± 30.3 mm, or approximately 66% ( P < .0001). Similarly, the mean ODI score improved from 68.1% ± 16.9% before treatment to 27.4% ± 17.2%, 23.8% ± 18.7%, and 23.3% ± 15.5% at 6 weeks, 3 months, and 12 months, respectively, representing a mean change of 39.2 ± 19.6 percentage points, or approximately 63%, at 12 months. Overall clinical success rates based on a 30% improvement in pain severity or greater and maintenance or improvement in the ODI were 91%, 88%, and 89% at 6 weeks, 3 months, and 12 months, respectively. The vertebral augmentation procedure required injection of a mean of 2.2 ± 0.12 mL of cement per vertebral body. There were 5 levels (8%) where cement extravasation was identified radiographically, and none were related to clinical symptoms. Conclusions These pilot findings are encouraging, suggesting robust and durable clinical improvement after this novel vertebral augmentation procedure in patients with painful VCFs.

Investigation of polymethylmethacrylate pulmonary embolus in a patient ten years following vertebroplasty

Percutaneous vertebroplasty (PV) is a procedure commonly used for the treatment of vertebral compression fractures, and the number of procedures has been steadily increasing over the past decade. We report a case of an 81 year old female with a history of breast cancer that developed two vertebral body compression fractures and was subsequently treated with PV. The patient developed a subsegmental pulmonary polymethylmethacrylate (PMMA) embolus as a complication of the procedure. Ten years following the procedure, she remained asymptomatic with the PMMA embolus being discovered incidentally during workup for a suspected chronic obstructive pulmonary disease (COPD) exacerbation. In reviewing the case, we describe the typical presentation of a pulmonary PMMA embolus and consider methods to decrease the incidence of this complication.

Comparison of Unipedicular and Bipedicular Balloon Kyphoplasty for Treatment of Vertebral Compression Fractures: A Prospective Randomized Study

Comparison of Unipedicular and Bipedicular Balloon Kyphoplasty for Treatment of Vertebral Compression Fractures: A Prospective Randomized Study

Life Expectancy Following Diagnosis of a Vertebral Compression Fracture

The life expectancy of vertebral compression fracture (VCF) patients was evaluated as a function of their treatment. Compared to non-operated patients, the kyphoplasty and vertebroplasty patient cohort had 115% and 44% greater adjusted life expectancy, respectively. Kyphoplasty patients had a 34% greater adjusted life expectancy than vertebroplasty patients. Balloon kyphoplasty and vertebroplasty are minimally invasive procedures for the treatment of painful VCFs. This comparative effectiveness study characterized the life expectancy of VCF patients as a function of their treatment. Life expectancy of VCF patients in the 100% U.S. Medicare dataset (2005–2008) was estimated using a parametric Weibull survival model (adjusted for comorbidities), and compared between operated and non-operated patients as well as between kyphoplasty and vertebroplasty patients. A total of 858,978 patients with a newly diagnosed VCF were identified, including 119,253 kyphoplasty patients (13.9%) and 63,693 vertebroplasty patients (7.4%). Adjusted life expectancy was 85% greater for operated than non-operated patients (p < 0.001; 95% confidence interval: 82–89%). Compared to non-operated patients, the kyphoplasty and vertebroplasty patient cohort had 115% (p < 0.001; 95% confidence interval: 111–119%) and 44% (p < 0.001; 95% confidence interval: 42–47%) greater adjusted life expectancy, respectively. Kyphoplasty patients had a 34% greater adjusted life expectancy than vertebroplasty patients (p < 0.001; 95% confidence interval: 31–36%). Across all gender–age groups, the median life expectancy predicted by the parametric Weibull model was 2.2–7.3 years greater for operated than non-operated patients. Statistically significant and substantial differences in life expectancy were observed between the treated and non-treated cohorts in the Medicare population. Among the treated cohorts, patients in the vertebroplasty group experienced less of a survival benefit than those who received kyphoplasty. The results will be a useful basis for future cost effectiveness studies of VCF treatments for the Medicare population.

Hospital Outcomes of VCF Treatment with Kyphoplasty and Vertebroplasty in the United States

Previous research determined that vertebral compression fracture (VCF) patients admitted to a hospital in 2005 with no treatment plan had a greater likelihood of better outcomes when they were treated with kyphoplasty.

Comparison of percutaneous vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures

Objective To investigate and compare the efficacy, safety, and cost effectiveness in the treatment of painful osteoporotic vertebral compression fractures ( OVCFs ) with percutaneous vertebroplasty (PVP) and kyphoplasty(PKP). Methods Seventy-two patients (96 vertebrae) with painful OVCFs were treated by PVP (n ＝34) or PKP (n ＝38) under radiological monitoring. After bone biopsy needle into the compressed vertebra, bone cement (polymethylmethacrylate) was injected in PVP group, and that was inserted followed by the inflation of vertebra to create cavities in PKP group. The fluoroscopy time, total amount of bone cement injected, and cost were recollected respectively. The score of visual analogue scale point( VAS, 10-point scale)was determined at before the procedures, and 24 hours, one week, and one month after the procedures. Pain relief and complications were observed. The Cobb angle and vertebral heights of the anterior, middle, and posterior border were measured pre-and post-operative. Results The two procedures were technically successful in all patients. The follow-up ranged from 1. 0 to 34. 0 months [mean time, (8. 9 ±3.2) months]. The Mean fluoroscopy time of treating per vertebra in PVP group was ( 11. 1 ± 10. 6 ) min, which was significant shorter than that ( 23.5 ± 13. 0) min in PKP group( P ＜0. 05 ).The mean total cost per patient was (5127. 2 ± 502.3 ) yuan in PVP group, which were strikingly lower than that(32 301.4 ±3204. 6) yuan in PKP group (P ＜0. 05). (3)There was no significant difference( P ＞0. 05 ) in average cement volumes in PVP group [ (4. 9 ± 1.1 ) ml]and PKP group [ (5.4 ± 1.7 ) ml]. Pain relief of was observed in 94. 1％ (32/34) of PVP group and in 92. 1％ (35/38) of PKP group. The score of VAS at pre-operation was (8. 3 ±0. 4 vs 7.9 ±0. 8) ,and at post-operative 24 h (2. 9 ±0. 9 vs 2. 8 ± 1. 2),1 week (2.6 ± 0. 9 vs 2.6 ± 1. 1 ), and 1 month (2.6 ± 0. 9 vs 2. 5 ± 1.3 ) were no difference at PKP and PVP group(P ＜0.05). There was significant difference between pre- and post-operative time point in each group. The Cobb angle, anterior and middle height of vertebra was corrected in both PVP and PKP group. In PVP group, the preoperative Cobb angle, anterior and middle height of vertebra was (24. 2 ± 3.8 )°,( 19. 1 ± 1.4) mm, (25. 2 ± 1.0) mm, which was significant different ( P ＜ 0. 05 ) from that of ( 19.4 ±3.9)°, (21.0 ± 1.5) mm, (27.0 ± 1.2) mm at pre-operation. In PKP group,there was significant difference (P ＜ 0. 05 ) in the preoperative Cobb angle, anterior and middle height of vertebra [(25. 1 ±5.0)°vs(10.7 ±2.8)°, (19.5 ± 1.5) mm vs (24.3 ± 1.9) mm, (25.4 ± 1.1) mm vs (29.7 ±1.3) mm, respectively]. As to the above index, the overall correcting effect in PKP was much better than that in PVP( P ＜0. 05 ). Cement leakage occurred in 9 cases in PVP group and 3 cases in PKP group ( P ＜0. 05 ) but no symptoms. There were no major complications during operation in the two groups. Conclusion PVP and PKP are effective and safe in the treatment of painful OVCFs but PVP is more cost effective than PKP. Key words: Percutaneous vertebroplasty; Spine; Osteoporosis; Fracture,compression