Clinical Outcomes of Patients with Osteoporotic Thoracolumbar Fracture Treated with Percutaneous Vertebroplasty and Balloon Kyphoplasty

Yıl 2023, Cilt: 8 Sayı: 4, 518 - 524, 18.12.2023

Güray Bulut , Aziz Çataltepe

https://doi.org/10.26453/otjhs.1356559

Öz

Objective: We aimed to evaluate the clinical outcomes of vertebroplasty (VP) or kyphoplasty (KP) in patients with vertebral body fractures due to osteoporosis.
Materials and Methods: We retrospectively analysed 26 patients who underwent VP and KP for thoracolumbar osteoporotic fracture. Two groups were formed according to the procedure. While VP was applied to 14 cases, KP was applied to 12 cases. The cases were evaluated radiologically with Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and X-ray radiography. Before and after treatment, the Oswestry Disability Index (ODI) was used to compare daily activities, while the visual analogue scale (VAS) measured resting pain.
Results: VP and KP were applied to 22 female and 4 male cases. Preoperative VAS scores were similar in both groups and were not statistically significant (p=0.995). Preoperative ODI scores were similar in both groups and were not statistically significant (p=0.842). Cement leakage without the neurological deficit was observed in 5 patients.
Conclusion: The effects of VP and KP procedures on VAS and ODI scores are similar. However, economically, the cost of KP is relatively high compared to VP. The study suggests using VP due to its low cost and clinically similar results on VAS and ODI scores compared to KP.

Anahtar Kelimeler

Kyphoplasty, osteoporosis, pain, vertebral compression fracture, vertebroplasty

Perkütan Vertebroplasti ve Balon Kifoplasti ile Tedavi Edilen Osteoporotik Torakolomber Kırığı Olan Hastaların Klinik Sonuçları

Öz

Amaç: Bu çalışma ile osteoporoza bağlı olarak vertebra korpus fraktürü gelişmiş hastalara uygulanan vertebroplasti (VP) veya kifoplastinin (KP) klinik sonuçlarını değerlendirmeyi amaçladık.
Materyal ve Metot: Kliniğimizde torakolomber osteoporotik kırık nedeniyle VP ve KP uygulanan 26 hasta retrospektif incelendi. Yapılan yönteme göre iki grup oluşturularak VP 14 olguya ve KP 12 olguya uygulandı. Olgular radyolojik olarak Magnetik Rezonans Görüntüleme (MRG), Bilgisayarlı Tomografi (BT) ve X-ray radyografi ile değerlendirildi. Hastaların istirahat ağrıları visual analog skala (VAS) kullanılarak; günlük yaşam aktiviteleri ise Oswestry Disabilite İndeksi (ODİ) kullanılarak tedavi öncesi ve tedavi sonrası karşılaştırıldı.
Bulgular: Torakolomber vertebra korpus kırığı olan 22 kadın ve 4 erkek vakaya VP ve KP uygulandı. Ameliyat öncesi VAS skorları her iki grupta da benzerdi ve istatistiksel olarak anlamlı değildi (p=0,995). Ameliyat öncesi ODI skorları her iki grupta da benzerdi ve istatistiksel olarak anlamlı değildi (p=0,842). 5 hastada nörolojik defisit yapmayan sement kaçağı görüldü.
Sonuç: VP ve KP prosedürlerinin VAS ve ODİ skorları üzerindeki etkileri benzerdir. Ancak ekonomik olarak KP'nin maliyeti VP'ye göre nispeten oldukça yüksektir. Mevcut çalışma, VP'nin KP ile karşılaştırıldığında düşük maliyeti ve VAS ve ODI skorlarında klinik olarak benzer sonuçlara sahip olması nedeniyle VP'nin uygulanmasını önermektedir.

Anahtar Kelimeler

Ağrı, kifoplasti, osteoporoz, vertebral kompresyon kırığı, vertebroplasti

Kaynakça

• McGirt MJ, Parker SL, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL. Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine J. 2009;9(6):501-508. doi:10.1016/j.spinee.2009.01.003
• Wang H, Sribastav SS, Ye F, et al. Comparison of Percutaneous Vertebroplasty and Balloon Kyphoplasty for the Treatment of Single Level Vertebral Compression Fractures: A Meta-analysis of the Literature. Pain Physician. 2015;18(3):209-222.
• Han S, Wan S, Ning L, Tong Y, Zhang J, Fan S. Percutaneous vertebroplasty versus balloon kyphoplasty for treatment of osteoporotic vertebral compression fracture: a meta-analysis of randomised and non-randomised controlled trials. Int Orthop. 2011;35(9):1349-1358. doi:10.1007/s00264-011-1283-x
• Savage JW, Schroeder GD, Anderson PA. Vertebroplasty and kyphoplasty for the treatment of osteoporotic vertebral compression fractures. J Am Acad Orthop Surg. 2014;22(10):653-664. doi:10.5435/JAAOS-22-10-653
• Wong CC, McGirt MJ. Vertebral compression fractures: a review of current management and multimodal therapy. J Multidiscip Healthc. 2013;6:205-214. doi:10.2147/JMDH.S31659
• Abduljabbar FH, Al-Jurayyan A, Alqahtani S, et al. Does Balloon Kyphoplasty Deliver More Cement Safely into Osteoporotic Vertebrae with Compression Fractures Compared with Vertebroplasty? A Study in Vertebral Analogues. Global Spine J. 2015;5(4):300-307. doi:10.1055/s-0035-1546818
• Lu Q, Liu C, Wang D, Liu H, Yang H, Yang L. Biomechanical evaluation of calcium phosphate-based nanocomposite versus polymethylmethacrylate cement for percutaneous kyphoplasty. Spine J. 2019;19(11):1871-1884. doi:10.1016/j.spinee.2019.06.007
• Movrin I, Vengust R, Komadina R. Adjacent vertebral fractures after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture: a comparison of balloon kyphoplasty and vertebroplasty. Arch Orthop Trauma Surg. 2010;130(9):1157-1166. doi:10.1007/s00402-010-1106-3
• Anselmetti GC, Muto M, Guglielmi G, Masala S. Percutaneous vertebroplasty or kyphoplasty. Radiol Clin North Am. 2010;48(3):641-649. doi:10.1016/j.rcl.2010.02.020
• Buchbinder R, Johnston RV, Rischin KJ, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev. 2018;4(4):CD006349. doi:10.1002/14651858.CD006349.pub3
• Langner S, Henker C. Vertebroplastie und Kyphoplastie: Eine kritische Stellungnahme [Vertebroplasty and kyphoplasty: A critical statement]. Radiologe. 2020;60(2):138-143. doi:10.1007/s00117-020-00651-z
• Galibert P, Deramond H, Rosat P, Le Gars D. Note préliminaire sur le traitement des angiomes vertébraux par vertébroplastie acrylique percutanée [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty]. Neurochirurgie. 1987;33(2):166-168.
• Boss S, Srivastava V, Anitescu M. Vertebroplasty and Kyphoplasty. Phys Med Rehabil Clin N Am. 2022;33(2):425-453. doi:10.1016/j.pmr.2022.01.008
• Key BM, Symanski J, Scheidt MJ, Tutton SM. Vertebroplasty, Kyphoplasty, and Implant-Based Mechanical Vertebral Augmentation. Semin Musculoskelet Radiol. 2021;25(6):785-794. doi:10.1055/s-0041-1739531
• Walter J, Haciyakupoglu E, Waschke A, Kalff R, Ewald C. Cement leakage as a possible complication of balloon kyphoplasty--is there a difference between osteoporotic compression fractures (AO type A1) and incomplete burst fractures (AO type A3.1)?. Acta Neurochir (Wien). 2012;154(2):313-319. doi:10.1007/s00701-011-1239-3
• Wu J, Guan, Y, Fan S. Analysis of risk factors of secondary adjacent vertebral fracture after percutaneous kyphoplasty. Biomedical Research 2017;28(5)1956–1961.
• Lee CP, Fu TS, Liu CY, Hung CI. Psychometric evaluation of the Oswestry Disability Index in patients with chronic low back pain: factor and Mokken analyses. Health Qual Life Outcomes. 2017;15(1):192. doi: 10.1186/s12955-017-0768-8
• Okazaki T, Nakagawa H, Yagi K, Hayase H, Nagahiro S, Saito K. Bone scintigraphy for the diagnosis of the responsible level of osteoporotic vertebral compression fractures in percutaneous balloon kyphoplasty. Clin Neurol Neurosurg. 2017;152:23-27. doi:10.1016/j.clineuro.2016.11.007
• Yang H, Zou J. Filling materials used in kyphoplasty and vertebroplasty for vertebral compression fracture: a literature review. Artif Cells Blood Substit Immobil Biotechnol. 2011;39(2):87-91. doi:10.3109/10731199.2010.503319
• Filippiadis DK, Marcia S, Masala S, Deschamps F, Kelekis A. Percutaneous Vertebroplasty and Kyphoplasty: Current Status, New Developments and Old Controversies. Cardiovasc Intervent Radiol. 2017;40(12):1815-1823. doi:10.1007/s00270-017-1779-x
• Seah SJ, Yeo MH, Tan JH, Hey HWD. Early cement augmentation may be a good treatment option for pain relief for osteoporotic compression fractures: a systematic review and meta-analysis. Eur Spine J. 2023;32(5):1751-1762. doi:10.1007/s00586-023-07658-9
• Jindal V, Binyala S, Kohli SS. Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral body compression fractures: clinical and radiological outcomes. Spine J. 2023;23(4):579-584. doi:10.1016/j.spinee.2022.11.015
• Abdelgawaad AS, Ezzati A, Govindasamy R, Krajnovic B, Elnady B, Said GZ. Kyphoplasty for osteoporotic vertebral fractures with posterior wall injury. Spine J. 2018;18(7):1143-1148. doi:10.1016/j.spinee.2017.11.001
• Yaltirik K, Ashour AM, Reis CR, Özdoğan S, Atalay B. Vertebral augmentation by kyphoplasty and vertebroplasty: 8 years experience outcomes and complications. J Craniovertebr Junction Spine. 2016;7(3):153-160. doi:10.4103/0974-8237.188413
• Zhao G, Liu X, Li F. Balloon kyphoplasty versus percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures (OVCFs). Osteoporos Int. 2016;27(9):2823-2834. doi:10.1007/s00198-016-3610-y
• Al-Nakshabandi NA. Percutaneous vertebroplasty complications. Ann Saudi Med. 2011;31(3):294-297. doi:10.4103/0256-4947.81542
• Noguchi T, Yamashita K, Kamei R, Maehara J. Current status and challenges of percutaneous vertebroplasty (PVP). Jpn J Radiol. 2023;41(1):1-13. doi:10.1007/s11604-022-01322-w
• Song D, Meng B, Chen G, et al. Secondary balloon kyphoplasty for new vertebral compression fracture after initial single-level balloon kyphoplasty for osteoporotic vertebral compression fracture. Eur Spine J. 2017;26(7):1842-1851. doi:10.1007/s00586-016-4784-x
• Alpantaki K, Koutserimpas C, Arkoudis NA, Hadjiapavlou A. Retrograde Flow Cement Leakage during Kyphoplasty. Maedica (Bucur). 2022;17(1):74-79. doi:10.26574/maedica.2022.17.1.74
• Ren H, Feng T, Cao J, et al. A Retrospective Study to Evaluate the Effect of Dynamic Fracture Mobility on Cement Leakage in Percutaneous Vertebroplasty and Percutaneous Kyphoplasty in 286 Patients with Osteoporotic Vertebral Compression Fractures. Med Sci Monit. 2022;28:e935080. doi:10.12659/MSM.935080