Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study.
This study investigates the effects of kyphoplasty on pain and mobility in patients with osteoporosis and painful vertebral fractures compared with conventional medical management.


BACKGROUND
Pharmacological treatment of patients with primary osteoporosis does not prevent pain and impaired activity of patients with painful vertebral fractures. Therefore, we evaluated the clinical outcome after kyphoplasty in patients with vertebral fractures and associated chronic pain for >12 months.


METHODS
Sixty patients with primary osteoporosis and painful vertebral fractures presenting for >12 months were included in this prospective, nonrandomized controlled study. Twenty-four hours before performing kyphoplasty, the patients self-determined their inclusion into the kyphoplasty or control group so that 40 patients were treated with kyphoplasty, whereas 20 served as controls. This study assessed changes in radiomorphology, pain visual analog scale (VAS) score, daily activities (European Vertebral Osteoporosis Study [EVOS] score), number of new vertebral fractures, and health care use. Outcomes were assessed before treatment and at 3 and 6 months of follow-up. All patients received standard medical treatment (1g calcium, 1000 IE vitamin D(3), standard dose of oral aminobisphosphonate, pain medication, physical therapy).


RESULTS
Kyphoplasty increased midline vertebral height of the treated vertebral bodies by 12.1%, whereas in the control group, vertebral height decreased by 8.2% (p = 0.001). Augmentation and internal stabilization by kyphoplasty resulted in a reduction of back pain. VAS pain scores improved in the kyphoplasty group from 26.2 +/- 2 to 44.2 +/- 3.3 (SD; p = 0.007) and in the control group from 33.6 +/- 4.1 to 35.6 +/- 4.1 (not significant), whereas the EVOS score increased in the kyphoplasty group from 43.8 +/- 2.4 to 54.5 +/- 2.7 (p = 0.031) and in the control group from 39.8 +/- 4.5 to 43.8 +/- 4.6 (not significant). The number of back pain-related doctor visits within the 6-month follow-up period decreased significantly after kyphoplasty compared with controls: mean of 3.3 visits/patient in the kyphoplasty group and a mean of 8.6 visits/patient in the control group (p = 0.0147).


CONCLUSIONS
The results of this study show significantly increased vertebral height, reduced pain, and improved mobility in patients after kyphoplasty. Kyphoplasty performed in appropriately selected osteoporotic patients with painful vertebral fractures is a promising addition to current medical treatment.
Kasperk
Christian
C
Department of Medicine I, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. Christian.Kasperk@med.uni-heidelberg.de
Hillmeier
Jochen
J
Nöldge
Gerd
G
Grafe
Ingo A
IA
Dafonseca
Katharina
K
Raupp
Dorothea
D
Bardenheuer
Hubert
H
Libicher
Martin
M
Liegibel
Ute Monika
UM
Sommer
Ulrike
U
Hilscher
Ulrike
U
Pyerin
Walter
W
Vetter
Marcus
M
Meinzer
Hans-Peter
HP
Meeder
Peter-Jürgen
PJ
Taylor
Rod S
RS
Nawroth
Peter
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology / Q000601:surgery*; D002484:Cementation; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*; D011446:Prospective Studies; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome