Balloon Kyphoplasty: Cement Augmentation in Acute Osteoporotic Thoraco-Lumbar Fractures

Abstract

Background
Several techniques have been developed for simpler and safer procedures during the last 2 decades. Techniques of vertebral body augmentation have been developed in an effort to treat these refractory cases. The injection of low-viscosity poly-methylemethacrylate (PMMA) under high pressure poses a potential risk for neural compromise and pulmonary embolism by uncontrolled leakage. Therefore, balloon kyphoplasty and vertebroplasty using a large cannula low pressure injection of PMMA in a high-viscosity state has been introduced. Percutaneous kyphoplasty (PKP) is a recently developed, minimally invasive surgical approach for the treatment of osteoporotic vertebral compression fractures (OVCF).
Objective
Our objective is directed towards the study of the role of kyphoplasty in the management of osteoporotic thoracolumbar fractures, following the analysis of clinical and radiographic outcomes. Our objective is to evaluate the efficacy and safety of kyphoplasty in the treatment of acute vertebral osteoporotic compression fractures and to validate the hypothesis that kyphoplasty will help diminish pain, disability and improve the quality of life (QoL). The goal of this study was to determine the safety and effectiveness of kyphoplasty in improving vertebral body height, decreasing pain, and improving affected functions.
Patients and Methods
A prospective analysis of 30 patients (10 males and 20 females), being treated with kyphoplasty, was performed at our institution, after a clinical follow-up of 6 months. The patients had vertebral compression fractures (VCFs) at levels T7 to L4 due to osteoporosis arising from primary and secondary etiological factors. There were 41 VCFs in these 30 patients. The median age was 69 years (range 53-87 years). Subjects were excluded if they had associated spinal stenosis, neurologic deficit, an active infection, and severe comorbidities, such as uncorrected coagulopathy.
Results
According to the pain scores, 26 (87%) patients showed a drastic post-operative improvement whereas, in 2 cases, significant improvement was noted after a follow-up in 3 months. On the other hand, 2 (7%) patients showed a deteriorated pain score. 24 (80%) patients showed constant improvement over a period of 6 months. 7 patients (23%) showed further improvement after the 6 months clinical follow-up.
Conclusion
All PMMA extravasations were asymptomatic; the cement was observed at a close vicinity to the treated vertebrae. We treated 41 fractures with balloon kyphoplasty (BKP); however, the failure of balloon distension occurred in 6 fractures (14%), which were managed with conventional vertebroplasty; Therefore, the exact cause behind the failure of the procedure is still unclear.