title: Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study.
abstract: 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.
authors.affiliation: Department of Medicine I, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. Christian.Kasperk@med.uni-heidelberg.de
authors.forename: Christian
authors.initials: C
authors.lastname: Kasperk
authors.forename: Jochen
authors.initials: J
authors.lastname: Hillmeier
authors.forename: Gerd
authors.initials: G
authors.lastname: Nöldge
authors.forename: Ingo A
authors.initials: IA
authors.lastname: Grafe
authors.forename: Katharina
authors.initials: K
authors.lastname: Dafonseca
authors.forename: Dorothea
authors.initials: D
authors.lastname: Raupp
authors.forename: Hubert
authors.initials: H
authors.lastname: Bardenheuer
authors.forename: Martin
authors.initials: M
authors.lastname: Libicher
authors.forename: Ute Monika
authors.initials: UM
authors.lastname: Liegibel
authors.forename: Ulrike
authors.initials: U
authors.lastname: Sommer
authors.forename: Ulrike
authors.initials: U
authors.lastname: Hilscher
authors.forename: Walter
authors.initials: W
authors.lastname: Pyerin
authors.forename: Marcus
authors.initials: M
authors.lastname: Vetter
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Meinzer
authors.forename: Peter-Jürgen
authors.initials: PJ
authors.lastname: Meeder
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
authors.forename: Peter
authors.initials: P
authors.lastname: Nawroth
mesh_terms: 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