[The evaluation of balloonkyphoplasty for osteoporotic vertebral fractures. An interdisciplinary concept].
BACKGROUND
Patients with osteoporotic vertebral compression fractures frequently complain of pain and a loss of function and mobility. Such fractures are associated with an increased mortality. The common treatment with bed rest, bracing or osteosynthesis does not lead to satisfying results. With two new surgical techniques, vertebroplasty and kyphoplasty, an internal stabilisation of osteoporotic vertebral fractures is possible.


METHODS
All patients were treated by kyphoplasty. With a minimal invasive dorsal approach, an inflatable bone tamp is placed in the fractured vertebral body. This tamp can restore the vertebral body height and create a cavity, which is filled with bone cement under low pressure. The advantage of kyphoplasty compared to vertebroplasty is the restoration of the vertebral height and a decreased cement leakage rate. We performed a prospective, interdisciplinary study with a follow-up of 12 months. We treated 192 vertebral fractures in 102 patients. Augmentation was performed with polymethylmethacrylate in 138 cases and with a new injectable calcium phosphate-cement in 54 vertebral bodies. Outcome data were obtained with two different spine-scores and by the radiomorphometric evaluation of x-rays before and after treatment.


RESULTS
We noticed a significant improvement in pain and function in 89% of the patients. All patients showed a regain of vertebral height of on average 17%. In 7% of all treated vertebral bodies, we noticed cement leakage, which was, however, far below the rates published for vertebroplasty (20-70%). There were two complications, bleeding due to an unknown coagulopathy and a violation of the myelon by malpunction.


CONCLUSIONS
Kyphoplasty is a reliable and minimally invasive method for stabilizing fractured osteoporotic vertebral bodies. Improvement of pain and function and a regain in height of the treated vertebral body can be accomplished.
Hillmeier
J
J
Abteilung für Unfall- und orthopädische Chirurgie des St.-Vincenz-Krankenhauses Limburg. j.hillmeier@st-vincenz.de
Grafe
I
I
Da Fonseca
K
K
Meeder
P J
PJ
Nöldge
G
G
Libicher
M
M
Kock
H J
HJ
Haag
M
M
Kasperk
C
C
D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000009:adverse effects / Q000627:therapeutic use*; D002130:Calcium Phosphates / Q000009:adverse effects / Q000627:therapeutic use*; D002404:Catheterization / Q000379:methods*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009192:Myelography; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000601:surgery*; D019904:Polymethyl Methacrylate / Q000009:adverse effects / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D001843:Bone Cements; D002130:Calcium Phosphates; D019904:Polymethyl Methacrylate; C020243:calcium phosphate