Kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fractures

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Abstract

Background

The incidence of osteoporotic vertebral compression fractures increases with advancing age and is associated with significant healthcare expenditure. Patients who have sustained fractures from osteoporosis are at increased risk of additional fractures because of loss of bone strength caused by osteoporosis. Vertebroplasty is a minimally invasive vertebral augmentation procedure to relieve pain; it stabilizes the vertebral body. Kyphoplasty is a minimally invasive method for correction and augmentation of osteoporotic vertebral fractures.

Materials and methods

This study included two groups of patients suffering from painful osteoporotic vertebral compression fractures: the first group comprised 26 patients with 33 vertebral compression fractures treated by percutaneous vertebroplasty between April 2007 and October 2008. The results of this group were compared with those of another group of 18 patients (24 vertebrae) who were treated by kyphoplasty between November 2008 and July 2011. The visual analog scale (VAS) and the Oswestry Disability Index (ODI) were applied for the assessment of patients preoperatively and postoperatively.

Results

In the vertebroplasty group, the mean VAS score improved from 7.8 to 2.4 according to VAS and from 69 to 15 according to ODI. Cement leakage was noted in four patients (15.4%), without clinical consequence. Ten vertebrae (30.3%) revealed a mean improvement in vertebral height of 11% (8–14%). No patient showed progression of vertebral angles of the augmented vertebrae during the follow-up period. In the kyphoplasty group, the mean pain score improved from 8 to 2.1 according to VAS and from 71 to 17 according to ODI. Cement leakage was noted in two patients (11.11%), without clinical consequence. No thoracolumbar back pain was reported after kyphoplasty. Nineteen vertebrae (79.16%) revealed a mean improvement in vertebral height of 22% (range, 18–38%). No patient showed progression of vertebral angles of the augmented vertebrae during the follow-up period.

Conclusion

Both vertebroplasty and kyphoplasty resulted in significant improvement in VAS pain scores. Vertebroplasty, although less expensive than kyphoplasty, had a statistically greater risk for cement leakage and adjacent vertebral fracture.

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