Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral body compression fractures: clinical and radiological outcomes

Spine J. 2022 Dec 5;S1529-9430(22)01038-5. doi: 10.1016/j.spinee.2022.11.015. Online ahead of print.

Abstract

Background context: Osteoporotic vertebral body compression fracture are the commonest fractures amongst the other osteoporotic fracture sites. These fragility fractures are the result of low energy mechanical forces that that would not ordinarily result in fracture. Percutaneous vertebroplasty and balloon kyphoplasty has been widely used as minimally invasive procedures to treat painful vertebral compression fractures.

Purpose: Aim of the present study was to evaluate radiological, clinical and functional outcome of patients with osteoporotic vertebral body fractures treated with Balloon Kyphoplasty and Vertebroplasty.

Study design: Prospective cohort study PATIENT SAMPLE: 40 patients (Male:15, Female: 25) with average age of 56 +/- 8 years diagnosed with osteoporotic vertebral body compression fracture on clinical and radiological evaluation with no neurological deficit and no other associated fractures were included.

Outcome measures: Operative time, cost for the procedure, gain in vertebral body height, reduction in pain, ability to perform daily routine activities, risk of cement leakage and any other systemic complications were evaluated and compared in both the study groups.

Methods: All the patients underwent conventional Xray, MRI (to rule out acute from chronic fracture, to check compromise of spinal canal and calculate collapse in vertebral body height), Visual analog scaling for severity of pain and difficulty in daily routine activities by Oswestry disability index preoperatively. Post operative clinal, functional, radiological outcome and complications were compared in patients treated with percutaneous vertebroplasty and balloon kyphoplasty.

Result: There was significant difference in intraoperative time period and procedure cost for the patients treated with Vertebroplasty(50.75min, 25k) in comparison to balloon kyphoplasty (71.95, 50k) with p value being < .001 There was significant difference between preoperative and postoperative study parameters in both the study groups but there was no significant difference in post operative study parameters amongst both the study groups with p values >.05 for different parameters, 0.381(Gain in vertebral height), 0.108 (pain relief), 0.846(Oswestry disability index) and 0.197(risk of cement leakage) CONCLUSION: Our study suggested that percutaneous vertebroplasty requires less operative time and is more economical than balloon kyphoplasty. Increase in intraoperative time increases the risk of infection. Though the cases of Intraoperative operative cement leakage were more in percutaneous vertebroplasty but is was not significant. However the final radiological, clinical, functional outcome and overall complications were found to be similar in both the groups. Balloon kyphoplasty provided no added benefit over percutaneous vertebroplasty. A study with larger sample size will be needed to warrant one surgical procedure superior to other in the treatment of osteoporotic vertebral body compression fracture.

Keywords: Balloon kyphoplasty; Cement leakage; Compression fractures; Osteoporosis; Percutaneous vertebroplasty; vertebral body height.