title: A randomized trial comparing 2 techniques of balloon kyphoplasty and curette use for obtaining vertebral body height restoration and angular-deformity correction in vertebral compression fractures due to osteoporosis.
abstract: OBJECTIVE
  Vertebral compression fractures often result in pain and vertebral deformity. We compared 2 different balloon kyphoplasty techniques both using intraoperative curettage.
  
  
  METHODS
  Adults 50 years of age or older with osteoporosis and 1 acute VCF were randomized to undergo bilateral BKP in which the curette was used first (n = 57) followed by inflatable bone tamps or in which IBTs were used first, followed by curettage and a second IBT inflation (n = 55).
  
  
  RESULTS
  Mean procedure duration was 33.5 and 36.8 minutes, and fluoroscopy duration was 3.8 and 3.7 minutes for the CF and IBTF groups, respectively. Two-thirds of VCFs were wedge-shaped, and one-half had dynamic mobility. Anterior height restored postoperatively was 2.28 mm (95% CI, 1.49-3.08 mm; P < .001) and 2.78 mm (95% CI, 1.89-3.66 mm; P < .001) for CF and IBTF groups, representing ∼35% and 39% of lost height restored, but group differences were not significant (P = .4). Intraoperative anterior height gain attributed to dynamic mobility was 2.96 mm (95% CI, 1.92-4.00 mm; P < .001) and 3.05 mm (95% CI, 2.10-4.00 mm; P < .001); additional height attributed to IBT inflation was 1.09 mm (95% CI, 0.77-1.41 mm; P < .001) and 1.25 mm (95% CI, 0.68-1.82 mm; P < .001), representing a 37% and 41% increase. There was no significant height loss on IBT removal and cementation. Both groups had improved pain and ambulation. Asymptomatic leakage occurred in 15% of VCFs. There was 1 nonserious device-related hematoma (IBTF group). One new clinical VCF occurred in each group, but they were not device-related.
  
  
  CONCLUSIONS
  Both techniques resulted in significant vertebral body height and pain improvement. Procedure and adverse event data demonstrated safe curette use in conjunction with balloon kyphoplasty procedures.
authors.affiliation: Klinikum Leverkusen, Leverkusen, Germany. leonard.bastian@klinikum-lev.de
authors.forename: L
authors.initials: L
authors.lastname: Bastian
authors.forename: F
authors.initials: F
authors.lastname: Schils
authors.forename: J B
authors.initials: JB
authors.lastname: Tillman
authors.forename: G
authors.initials: G
authors.lastname: Fueredi
mesh_terms: D000368:Aged; D005260:Female; D050815:Fractures, Compression / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D058498:Kyphoplasty / Q000145:classification / Q000379:methods*; D008297:Male; D058866:Osteoporotic Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011859:Radiography; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D016896:Treatment Outcome