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Percutaneous vertebral augmentation: an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty.
Spine J. 2007 Sep-Oct; 7(5):575-82.SJ

Abstract

BACKGROUND CONTEXT

Osteoporotic vertebral compression fractures (VCFs) are being increasingly treated with minimally invasive bone augmentation techniques such as kyphoplasty and vertebroplasty. Both are reported to be an effective means of pain relief; however, there may be an increased risk of developing subsequent VCFs after such procedures.

PURPOSE

The purpose of this study was to compare the effectiveness and complication profile of kyphoplasty and vertebroplasty in a single patient series.

STUDY DESIGN/SETTING

A clinical series of 36 patients with VCFs treated by vertebral augmentation procedures was retrospectively analyzed for surgical approach, volume of cement injected, cement extravasation (symptomatic and asymptomatic), the occurrence of subsequent adjacent level fracture, and pain relief.

PATIENT SAMPLE

Thirty-six patients with 46 VCFs underwent either kyphoplasty or vertebroplasty after failing conservative therapy. The mean patient age was not significantly different between the kyphoplasty group (70; range, 46-83) and vertebroplasty group (72; range, 38-90) (p=.438).

OUTCOME MEASURES

Outcomes were assessed by using self-report measures (a comparative pain rating scale) and physiologic measures (pre- and postoperative radiographs).

METHODS

Thirty-six patients with VCFs underwent 46 augmentation procedures (17 patients had 20 fractures treated via kyphoplasty, and 19 patients had 26 fractures treated via vertebroplasty). Seventeen patients in this series underwent kyphoplasty using standard techniques involving bone void creation with balloon tamps, followed by cement injection. Nineteen patients underwent a percutaneous vertebroplasty procedure using a novel cannulated, fenestrated bone tap developed to direct cement anteriorly into the vertebral body to avoid backflow of cement onto neural elements.

RESULTS

Pain improvement was seen in >90% of patients in both groups. Mean cement injection per vertebral body was 4.65 mL and 3.78 mL for the kyphoplasty and vertebroplasty groups, respectively (p=.014). Ninety-five percent of the kyphoplasty procedures were performed bilaterally, whereas only 19% of the vertebroplasty procedures required bilateral augmentation (p<.001). There was no cement extravasation resulting in radiculopathy, or myelopathy in either group. Asymptomatic cement extravasation was seen in 5 of 46 (11%) of the total series (3/20 [15%] and 2/26 [7.7%] of kyphoplasty and vertebroplasty, respectively) (p=.696). Within a 3-month period, there were 5 new adjacent level fractures seen in 3 patients who underwent a kyphoplasty procedure (5/20 [25%]) and none in the vertebroplasty group (p<.05).

CONCLUSIONS

Vertebroplasty appears to offer a comparable rate of postoperative pain relief as kyphoplasty while using less bone cement more often via a unilateral approach and without the attendant risk of adjacent level fracture.

Authors+Show Affiliations

Department of Neurosurgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 428 CSB, Charleston, SC 29425, USA. frankel@musc.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17905320

Citation

Frankel, Bruce M., et al. "Percutaneous Vertebral Augmentation: an Elevation in Adjacent-level Fracture Risk in Kyphoplasty as Compared With Vertebroplasty." The Spine Journal : Official Journal of the North American Spine Society, vol. 7, no. 5, 2007, pp. 575-82.
Frankel BM, Monroe T, Wang C. Percutaneous vertebral augmentation: an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty. Spine J. 2007;7(5):575-82.
Frankel, B. M., Monroe, T., & Wang, C. (2007). Percutaneous vertebral augmentation: an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty. The Spine Journal : Official Journal of the North American Spine Society, 7(5), 575-82.
Frankel BM, Monroe T, Wang C. Percutaneous Vertebral Augmentation: an Elevation in Adjacent-level Fracture Risk in Kyphoplasty as Compared With Vertebroplasty. Spine J. 2007 Sep-Oct;7(5):575-82. PubMed PMID: 17905320.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous vertebral augmentation: an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty. AU - Frankel,Bruce M, AU - Monroe,Timothy, AU - Wang,Chiang, Y1 - 2007/01/24/ PY - 2006/05/21/received PY - 2006/10/26/revised PY - 2006/10/29/accepted PY - 2007/10/2/pubmed PY - 2008/1/5/medline PY - 2007/10/2/entrez SP - 575 EP - 82 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 7 IS - 5 N2 - BACKGROUND CONTEXT: Osteoporotic vertebral compression fractures (VCFs) are being increasingly treated with minimally invasive bone augmentation techniques such as kyphoplasty and vertebroplasty. Both are reported to be an effective means of pain relief; however, there may be an increased risk of developing subsequent VCFs after such procedures. PURPOSE: The purpose of this study was to compare the effectiveness and complication profile of kyphoplasty and vertebroplasty in a single patient series. STUDY DESIGN/SETTING: A clinical series of 36 patients with VCFs treated by vertebral augmentation procedures was retrospectively analyzed for surgical approach, volume of cement injected, cement extravasation (symptomatic and asymptomatic), the occurrence of subsequent adjacent level fracture, and pain relief. PATIENT SAMPLE: Thirty-six patients with 46 VCFs underwent either kyphoplasty or vertebroplasty after failing conservative therapy. The mean patient age was not significantly different between the kyphoplasty group (70; range, 46-83) and vertebroplasty group (72; range, 38-90) (p=.438). OUTCOME MEASURES: Outcomes were assessed by using self-report measures (a comparative pain rating scale) and physiologic measures (pre- and postoperative radiographs). METHODS: Thirty-six patients with VCFs underwent 46 augmentation procedures (17 patients had 20 fractures treated via kyphoplasty, and 19 patients had 26 fractures treated via vertebroplasty). Seventeen patients in this series underwent kyphoplasty using standard techniques involving bone void creation with balloon tamps, followed by cement injection. Nineteen patients underwent a percutaneous vertebroplasty procedure using a novel cannulated, fenestrated bone tap developed to direct cement anteriorly into the vertebral body to avoid backflow of cement onto neural elements. RESULTS: Pain improvement was seen in >90% of patients in both groups. Mean cement injection per vertebral body was 4.65 mL and 3.78 mL for the kyphoplasty and vertebroplasty groups, respectively (p=.014). Ninety-five percent of the kyphoplasty procedures were performed bilaterally, whereas only 19% of the vertebroplasty procedures required bilateral augmentation (p<.001). There was no cement extravasation resulting in radiculopathy, or myelopathy in either group. Asymptomatic cement extravasation was seen in 5 of 46 (11%) of the total series (3/20 [15%] and 2/26 [7.7%] of kyphoplasty and vertebroplasty, respectively) (p=.696). Within a 3-month period, there were 5 new adjacent level fractures seen in 3 patients who underwent a kyphoplasty procedure (5/20 [25%]) and none in the vertebroplasty group (p<.05). CONCLUSIONS: Vertebroplasty appears to offer a comparable rate of postoperative pain relief as kyphoplasty while using less bone cement more often via a unilateral approach and without the attendant risk of adjacent level fracture. SN - 1529-9430 UR - https://www.unboundmedicine.com/medline/citation/17905320/Percutaneous_vertebral_augmentation:_an_elevation_in_adjacent_level_fracture_risk_in_kyphoplasty_as_compared_with_vertebroplasty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(06)01024-2 DB - PRIME DP - Unbound Medicine ER -