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Abstract
Objective
We wanted to evaluate the efficacy of kyphoplasty for treating osteoporotic VCF and we wanted to determine the risk factors for additional VCF.
Summary of the Literature Review
Successful pain relief with performing kyphoplasty for VCF has been well documented. However, unsatisfactory reduction and additional VCF are remained problems for kyphoplasty.
Materials and Methods
Sixty-three patients who underwent kyphoplasty were followed up for more than 1 year. The degree of reduction of the collapsed vertebral height, the vertebral kyphotic angle, the regional Cobb's angle and the overall sagittal alignment, the visual analogue scale (VAS), the fracture configuration, the bone mineral density (BMD), the presence of intradiscal cement leakage and additional VCF were investigated. The risk factors for additional VCF were analyzed.
Results
In terms of deformity correction, the collapsed vertebral height were restored (67.3±15.6% to 82.5±11.8%), the vertebral kyphotic angle was improved (12.1±6.9。to 8.1±5.3。), the degree of the regional Cobb's angle was reduced (3.1±4.5。) and the overall sagittal balance was improved (1.7±5.3 cm to 0.5±3.9 cm) with clinical satisfaction (VAS: 6.9±1.3 points to 2.3±0.9 points). But less than 40% of the patients reached the expected reduction criteria (the vertebral height >90%, the vertebral kyphotic angle and regional Cobb's angle reduction >5。). Additional VCF occurred in 10 patients (15.9%). The average BMD in the additional VCF group was T-score of -3.8 and that for the no-additional VCF group was T-score of -3.0 (p=0.025). The degree of reduction under general anesthesia was twice more than that under local anesthesia. Eleven cases (17.5%) of intradiscal cement leakages were noticed, but this showed no relevance to the fracture configurations and additional VCF. The overall sagittal alignment and cement volume showed no relevance to additional VCF.
REFERENCES
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Table 1.
Radiographical and clinical results during following-up.
Table 2.
Comparative results between balanced and imbalanced group.
Table 3.
Comparative results according to anesthetic methods.
Table 4.
Fracture configuration and intradical cement leakage.
| Fracture configuration | Intradiscal cement leakage | p value | |
|---|---|---|---|
| None (52 cases) | Yes (11 cases) | ||
| Linear Fx. without endplate Fx. | 26 | 4 | |
| Comminuted Fx. with endplate Fx. | 17 | 4 | 0.425 |
| Kummell's nonunion | 19 | 3 | |
Table 5.
Suspected risk factors for additional VCF after kyphoplasty.
| Risk factors | No subsequent VCF. | Additional VCF | p value |
|---|---|---|---|
| Sex | 0.573* | ||
| Female | 46 | 8 | |
| Male | 7 | 2 | |
| Age (years) | 70.3±6.9 | 71.0±7.7 | 0.962* |
| Intradiscal cement leakage | 0.498 | ||
| None | 43 | 9 | |
| Leakage | 10 | 1 | |
| Tamp pressure (mmHg);average | 114.0±47.2 | 101.5±69.0 | 0.187* |
| Right | 113.2±51.3 | 103.0±71.5 | 0.238* |
| Left | 114.9±50.9 | 100.0±67.8 | 0.171* |
| Cement amount (ml);Total | 5.5±2.0 | 6.0±1.7 | 0.349* |
| Right | 2.7±1.1 | 3.2±0.8 | 0.101* |
| Left | 2.8±1.0 | 2.8±1.2 | 0.864* |
| Steroid | 0.180 | ||
| None | 52 | 9 | |
| Yes | 1 | 1 | |
| DM | 0.580 | ||
| None | 44 | 9 | |
| Yes | 9 | 1 | |
| Smoking | 0 | 0 | - |
| Thyroid disease | 0 | 0 | - |
| Anti-osteoporotic medication | 0.894 | ||
| < 6 months | 33 | 6 | |
| ≥ 6 months | 20 | 4 | |
| BMD (T-score) | -3.0±1.1 | -3.8±0.6 | 0.025* |
| ≥ -3.5 | 34 | 3 | |
| < -3.5 | 19 | 7 | 0.044 |
| Postoperative reduction state | |||
| Collapsed vertebral height (%) | 81.7±12.4 | 86.5±7.9 | 0.332* |
| Vertebral kyphosis angle (。) | 9.0±5.1 | *4.7±5.0 | 0.012* |
| Reduction degree of | |||
| regional Cobb's angle(。) | 3.3±4.3 | *2.2±5.7 | 0.304* |
| Overall sagittal alignment (mm) | -0.4±3.8 | -1.2±4.4 | 0.623* |
| Postoperative overall sagittal alignment | 1.000 | ||
| Balanced state | 42 | 8 | |
| Imbalanced state | 11 | 2 |
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