[A prospective two-year follow-up of thoracic and lumbar osteolytic vertebral fractures caused by multiple myeloma treated with balloon kyphoplasty].
OBJECTIVE
Balloon kyphoplasty is a minimally invasive procedure for the stabilization of osteoporotic and osteolytic vertebral fractures. The purpose of this prospective study was to evaluate this operative procedure in the treatment of osteolytic vertebral fractures with regard to the reduction of pain and functional improvement of the patients and further to evaluate the restoration of vertebral height postoperatively.


METHODS
In this study 26 patients (21 male, 5 female) with osteolytic vertebral fractures were treated with balloon kyphoplasty. In total, 59 vertebral fractures were treated with balloon kyphoplasty. Preoperatively conventional radiographs in lateral and a. p. views, CT and/or MRI were preformed. Pre- and postoperatively the clinical parameters using VAS (visual analogue scale) and the Oswestry score were evaluated. Radiographic scans were performed pre- and postoperatively and after 3, 6, 12 and 24 months. The vertebral height and endplate angles were measured.


RESULTS
The median pain scores (VAS) decreased from pre- to post-treatment significantly (p < 0.05) as also did the Oswestry score (p < 0.05). Balloon kyphoplasty led to a significant and sustained reduction of pain resulting in a significant functional improvement for the patients. A significant restoration of vertebral height and reduction of the kyphotic angle could be achieved with the balloon technique (p < 0.05). Furthermore, the minimal-invasive procedure was able to stabilize the spine also over a longer period of 24 months. A radiation therapy and/or chemotherapy could be performed without loss of time.


CONCLUSIONS
In the treatment of osteolytic vertebral fractures balloon kyphoplasty led to a quick and sustained reduction of pain and as well as a functional improvement for the patients. A restoration of the vertebral height and reduction of the kyphotic angle was especially attributable to the balloon technique. The balloon kyphoplasty was able to stabilize the fractured vertebrae in the long-term and was able to prevent an increase of kyphotic deformity. Balloon kyphoplasty is an outstanding alternative in comparison to the established therapeutic concepts in the treatment of osteolytic vertebral fractures.
Pflugmacher
R
R
Centrum für Muskuloskeletale Chirurgie, Charité--Universitätsmedizin Berlin, Germany. robert.pflugmacher@charite.de
Schulz
A
A
Schroeder
R J
RJ
Schaser
K D
KD
Klostermann
C K
CK
Melcher
I
I
D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D002404:Catheterization; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009101:Multiple Myeloma / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D010014:Osteolysis / Q000175:diagnosis / Q000601:surgery*; D010147:Pain Measurement; D019904:Polymethyl Methacrylate / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000175:diagnosis; D011446:Prospective Studies; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D014057:Tomography, X-Ray Computed
D001843:Bone Cements; D019904:Polymethyl Methacrylate