Interdisciplinary Neurosurgery (Mar 2021)
The effectiveness of cement augmentation in kyphosis correction of dynamically loaded osteoporotic vertebral fractures: A retrospective case series
Abstract
Background: Osteoporotic fracture of vertebrae is the presentation of osteoporosis, in most elderly patients and treatment of these fractures aims in pain relief, correction of kyphosis and management of osteoporosis. The purpose of the study is to evaluate the clinical usefulness of cement augmentation and the ability of cement augmented vertebrae to withstand physiological axial load. Materials and methods: We did a retrospective analysis of all patients (62 patients and 67 vertebrae) from 2015 to 2019 in whom a stand-alone percutaneous cement augmentation was done for primary osteoporotic vertebral fractures. The kyphotic angle (KA), wedge angle (WA) and anterior vertebral height (AVH) were measured in radiographs taken pre-operatively and post-operatively in slump sitting and supine position. The mobility of the vertebra was determined radiologically by the difference in KA, WA and AVH in two positions (slump sitting and supine) and were compared. Functional outcome was analyzed using VAS scores for back pain. Results: The mean age group was 67.66 + 11.49 years, with thoracolumbar region being the most commonly involved. There was a significant improvement in back pain scores post cement augmentation from a pre-operative VAS of 6.91 ± 1.7 to a post-operative VAS score of 1.74 ± 1.1. The kyphotic deformity parameters like KA, WA and AVH also improved post cement augmentation. The difference of KA, WA and AVH between sitting and supine position preoperatively were 4.85 ± 6.87degrees, 2.61 ± 6.35 degrees and 0.26 ± 0.47 cm. The difference of post-operative KA, WA and AVH in two different positions was 1.02 ± 0.76 degrees, 0.05 ± 0.21 degrees and 0.03 ± 0.04 and were statistically significant than pre-operative measurements. Conclusion: The cement augmentation technique in addition to pain relief, it also improves the kyphotic deformity of the fractured vertebrae. The kyphotic deformity correction achieved by the procedure remain sustained even in physiological axial loading of the cement augmented vertebra.
