title: Long-term follow-up study of osteoporotic vertebral compression fracture treated using balloon kyphoplasty and vertebroplasty.
abstract: OBJECTIVE
  Long-term follow-up study is required for verifying whether the clinical outcomes of kyphoplasty and vertebroplasty are altered. The authors' findings showed only subtle differences between these operations within a 5-year period. However, they still suggest the use of vertebroplasty over kyphoplasty in view of the treatment costs. In their previous study, the authors performed a short-term prospective comparison between vertebroplasty and kyphoplasty. Vertebroplasty was recommended instead of kyphoplasty for the treatment of vertebral compression fractures (VCFs) because of the subtle differences between this procedure and kyphoplasty and the treatment costs. To determine whether these clinical outcomes persist in the long term, they continued to observe the patients from their short-term study over a longer-term period. METHODS :One hundred cases of VCF were assigned randomly to either the kyphoplasty or the vertebroplasty group. In cement augmentation, the authors used polymethylmethacrylate as bone filler. Pain was assessed by using a visual analog scale (VAS). For each patient, vertebral body height and wedge angle were measured from reconstructed CT images.
  
  
  RESULTS
  The duration of the follow-up period was 5 years. Vertebral body height, kyphotic wedge angle, and VAS score were not evidently altered. Eight patients in the kyphoplasty group had an adjacent fracture after the procedure, whereas 7 patients in the vertebroplasty group had an adjacent fracture after the procedure. These adjacent fractures occurred within 1 year of surgery in both treatment groups except in 1 kyphoplasty-treated patient in whom the adjacent fracture was noted 16 months after treatment. Three patients in the vertebroplasty group had a nonadjacent fracture, and 4 patients in the kyphoplasty group had a nonadjacent fracture. The link between angular correction and the occurrence of adjacent fracture was statistically significant in the vertebroplasty group.
  
  
  CONCLUSIONS
  Excessive angular correction is a critical concern in the risk of adjacent fracture after vertebroplasty. Given the subtle differences between vertebroplasty and kyphoplasty observed over the course of 5 years, vertebroplasty remains the preferred option in view of the costs.
authors.affiliation: School of Medicine, Chung-Shan Medical University, and Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Jung-Tung
authors.initials: JT
authors.lastname: Liu
authors.affiliation: School of Medicine, Chung-Shan Medical University, and Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Cho-shun
authors.initials: CS
authors.lastname: Li
authors.affiliation: School of Medicine, Chung-Shan Medical University, and Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Cheng-Siu
authors.initials: CS
authors.lastname: Chang
authors.affiliation: School of Medicine, Chung-Shan Medical University, and Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Wen-Jui
authors.initials: WJ
authors.lastname: Liao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D058498:Kyphoplasty / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D010147:Pain Measurement; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate
keywords: PMMA = polymethylmethacrylate; RCT = randomized controlled trial; VAS = visual analog scale; VCF = vertebral compression fracture; angular correction; cement augmentation; deformity; kyphoplasty; osteoporosis; vertebral compression fractures; vertebroplasty