Balloon Kyphoplasty for Managing Intractable Pain in Pediatric Pathologic Vertebral Fractures.
BACKGROUND
Vertebral compression fractures are a common result of osteoporosis and osteopenia secondary to steroid use and chemotherapy treatment. Balloon kyphoplasty is a treatment option with good to excellent results well described in adults. Although a few recent studies have been published regarding the use of kyphoplasty in children, no formal indication exists for the pediatric population. The purpose of this study is to describe the outcomes of 3 chronically ill children with intractable pain from vertebral compression fractures, managed with kyphoplasty.


METHODS
We retrospectively reviewed 3 pediatric patients who underwent balloon kyphoplasty for vertebral compression fractures secondary to chronic illness. Patient variables included age, sex, primary diagnosis and treatments, levels of vertebral fracture, and time elapsed from initial therapy to fracture. A numeric rating scale of 0 to 10 was used for patient-reported pain, before and after kyphoplasty. Preoperative and postoperative analgesic use and physical function were also described. Surgical variables included levels of kyphoplasty, operative time, and procedure-related complications.


RESULTS
The primary diagnoses were relapsed rhabdomyosarcoma, abdominal desmoplastic small round cell tumor, and IPEX-like (immune dysregulation, polyendrocrinopathy, enteropathy, X-linked) syndrome. All 3 patients were males, aged 12, 12, and 13, respectively, at the time of kyphoplasty. Pain scores were 8 to 9 preoperatively in 2 patients, severely affecting their physical function including independent walking. Excruciating back pain was a contributing factor to the respiratory distress of the third patient, who required elective intubation. All of the patients reported significant pain relief (range, 0 to 2) and improved physical function with kyphoplasty. The third patient was successfully extubated 1 week postoperatively and eventually returned to baseline activity. There were no complications related to kyphoplasty.


CONCLUSIONS
Balloon kyphoplasty seems to be safe in terminally ill children and may be a useful tool for managing intractable pain due to vertebral compression fractures.


METHODS
Level IV-retrospective case series.
Departments of *Pediatric Orthopaedic Surgery ‡Pediatric Hematology and Oncology, Cleveland Clinic, Cleveland, OH †Children's Hospital Los Angeles, Children's Center for Cancer and Blood Diseases, University of Southern California Keck School of Medicine, Los Angeles, CA.
Jane S
JS
Hoashi
Stefanie M
SM
Thomas
Ryan C
RC
Goodwin
David P
DP
Gurd
Rabi
R
Hanna
Thomas E
TE
Kuivila
D000293:Adolescent; D001851:Bone Diseases, Metabolic / Q000209:etiology; D002648:Child; D002908:Chronic Disease; D050815:Fractures, Compression / Q000150:complications / Q000601:surgery*; D005598:Fractures, Spontaneous / Q000150:complications / Q000601:surgery*; D006801:Humans; D058498:Kyphoplasty / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D010024:Osteoporosis / Q000150:complications; D059408:Pain Management; D010148:Intractable Pain / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome