Kyphoplasty for osteoporotic vertebral fractures with posterior wall injury

Publication date: Available online 14 November 2017
Source:The Spine Journal
Author(s): Ahmed Shawky, Ali Ezzati, Ramachandran Govindasamy, Branko Krajnovic, Belal El-nady, Galal Zaki Said
BackgroundCement augmentation techniques are standard treatments for osteoporotic vertebral fractures. Compared to vertebroplasty, kyphoplasty is associated with lower rates of cement leak and better deformity correction, however, posterior wall fractures are relative, but not absolute, contraindications for both techniques and hence treatment practices vary among spine centers.PurposeThe primary aim of this study was to assess our center's incidence of posterior cement leakage in osteoporotic vertebral fractures with posterior wall injury treated by balloon kyphoplasty. Secondarily, physiologic results, pain relief, complication rates and non-posterior cement leakage were also evaluated.Study designThis is a prospective cohort study done in a high volume spine center in GermanyPatient SampleEighty two patients with 98 osteoporotic vertebral fractures with posterior wall cortical injury were studied from 2012-2016.Outcome MeasuresThe following were the outcome measures:(1) physiologic measures: standing plain x-rays (antero-posterior and lateral views). The following parameters were evaluatedo Cement leak behind the posterior vertebral body border,o Cobb angle for local sagittal deformity,o Vertebral wedge angle, ando Anterior vertebral height.(2) cement volume injected in each vertebra(3) self-report measures: Visual Analogue Scale (VAS)MethodsAll patients underwent balloon kyphoplasty using a bipedicular approach. Preoperative clinical and neurologic evaluations were done. Radiological evaluations included plain x-rays, CT scans and MRIs. The average follow up period was 18 months. The study received no funding from any organisation. None of the authors have a conflict of interest.ResultsNo cement leakage into the spinal canal occurred in any of the patients. Asymptomatic leakage into other sites was seen in 22 vertebrae (22.45%). There was significant improvement in Cobb angle, vertebral wedge angle, and anterior vertebral height in all cases. The mean preoperative visual analogue scale was 8.1, and this improved to 2.3 on third postoperative day.ConclusionBalloon kyphoplasty is a viable option for treatment of osteoporotic vertebral fractures even with posterior wall involvement.



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