PERCUTANEOUS KYPHOPLASTY VERSUS HYBRID KYPHOPLASTY WITH SUPPLEMENTARY INSTRUMENTATION FOR MANAGEMENT OF OSTEOPOROTIC AND PATHOLOGIC VERTEBRAL FRACTURES.

Abstract

Background. Balloon kyphoplasty has been established as an effective minimal invasive method to treat vertebral fractures of osteoporotic and pathologic etiology.

Objectives. Comparative analysis of the clinical and radiographic outcomes of balloon kyphoplasty for treatment of osteoporotic and pathologic vertebral fractures.

Study design. Prospective comparative study.

Materials-Methods. Twenty five patients (14 women and 11 men) aged (average + SD) 73 + 8 years (range 52–83 years) with vertebral fracture were treated with kyphoplasty and were sampled into three groups: 14 patients (Group A) suffered from osteoporotic fractures and underwent percutaneous kyphoplasty, 5 patients (Group B) suffered from fractures caused from malignancy were treated with percutaneous kyphoplasty, and 6 patients (Group C, hybrid) who underwent combined operation (open kyphoplasty plus instrumented fusion). These patients underwent 25 operations to treat 38 vertebral fractures located between T11 and L5. Preoperative and postoperative radiographs were compared to calculate the changes of vertebral body height ratio (AVBHr, PVBHr) and Gardner kyphotic deformity angle. Sagittal spine alignment was analyzed on whole spine standing radiographs. The VAS, the Oswestry Disability Index (ODI) and the SF-36 surveys were used to evaluate the clinical results. The average time of follow-up was 31.5 + 7 months (range 25–40 months). The average preoperatively SF-36 score (Domain Bodily pain) was 8+ 16, The VAS was 9+1.3 while the ODI was 28+ 17.

Results. The average SF-36 (Bodily Pain) score did not significantly differ among the groups and was improved postoperatively to (average, SD) 40+14. VAS improved postoperatively in an similar way in all three groups to 4+1.4 and the ODI was improved in all three groups to 49+ 17, without significant differences among groups. The AVBHr improved significantly only in group A (p=0.01), while there was no change in PVBHr in any group. The Gardner angle improved significantly in groups A (p=0.006) and C (p=0.05) respectively.

Discussion. The inflatable bone tamp placed percutaneous or open in combination with spinal instrumentation was efficacious in the treatment of osteoporotic and pathologic vertebral fractures. Kyphoplasty alone or as hybrid was associated with early clinical improvement of pain and function in the treatment of painful pathologic compression fractures, as well as with reduction of Gardner angle.