[Preliminary experience with balloon kyphoplasty for the treatment of painful osteoporotic compression fractures].
OBJECTIVE
To describe the technique and to evaluate the safety and efficacy of percutaneous kyphoplasty as a new treatment in patients with painful osteoporotic vertebral body compression fractures of the lumbar and thoracic spine.


METHODS
In this prospective study balloon kyphoplasty was performed in 34 consecutive patients (25 females, 9 males; mean age 75 years) with 56 painful osteoporotic vertebral fractures (from T6-L5), of which 22 showed a posterior wall involvement and retropulsion on preoperative CT. The median duration of symptoms was 9.7 weeks. Symptomatic levels were identified by correlating the clinical presentation with MRI, conventional radiographs and CT including bone-densitometry. Pre- and postoperative examinations (radiographs, CT) as well as Karnofsky and visual analogy pain scores (Visual Analog Scale = VAS) were documented and compared to evaluate the success of the procedure.


RESULTS
The median Karnofsky score improved from 40 % (pre-) to 70 % (post-treatment). Simultaneously, median pain scores (VAS) decreased from 64 (pre-) to 21 (post-treatment) (p < 0.001). Perioperative morbidity included one transient L2 nerve root bruise. The procedure led to a partial restoration of the height of the vertebral body by reducing the median sagittal index from 11.5(3) to 5(3). In none of our patients, the procedure led to worsening of the fracture-induced narrowing of the spinal canal. Clinically asymptomatic cement leakage occurred in 10 cases, with leakage 4 times into the paraspinal space, 3 times into the spinal canal and 3 times into the disc space.


CONCLUSIONS
Balloon kyphoplasty is a safe and effective procedure. It is applicable even in fractures with posterior wall involvement since it is a low-pressure technique in contrast to vertebroplasty and restores vertebral body height partially. It results in immediate clinical improvement of mobility and pain relief. While short-term results are excellent, follow-up data have to be awaited for the final judgment of this method.
Wilhelm
K
K
Radiologische Universitätsklinik Bonn, Bonn. wilhelm@uni-bonn.de
Stoffel
M
M
Ringel
F
F
Rao
G
G
Rösseler
L
L
Urbach
H
H
Meyer
B
B
D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000601:surgery*; D006801:Humans; D017567:Karnofsky Performance Status; D007738:Kyphosis / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010024:Osteoporosis / Q000150:complications*; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D010147:Pain Measurement; D011446:Prospective Studies; D012449:Safety; D016103:Spinal Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013130:Spinal Stenosis / Q000209:etiology; D013904:Thoracic Vertebrae / Q000293:injuries*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D001843:Bone Cements