Functional and Radiological Outcome of Percutaneous Balloon Kyphoplasty for the Treatment of Osteoporotic Vertebral Compression Fractures – A Prospective Study

Abstract

Introduction: Vertebral compression fractures (VCFs) constitute a major health-care problem, not only because of their high incidence but also because of their direct and indirect negative impacts on both patients’ health-related quality of life and costs to the health-care system regardless of their etiology, the mainstay of management for symptomatic VCFs is medical therapy, which may include analgesics, bed rest, brace or corset, and/or rehabilitation, The aim of this study is to evaluate balloon kyphoplasty as a surgical option for osteoporotic thoracolumbar compression fracture. Subjects and Methods: This prospective study was conducted in the Department of Orthopedics, Sree Mookambika Institute of Medical Sciences, Kanyakumari, among 20 patients with symptomatic osteoporotic VCFs between March 2022 and February 2023. We include both male and female patients with fresh VCF (AO type A1), magnetic resonance imaging/X-ray/computed tomography-scan proven fracture not older than 3 months. We include patients who underwent conservative treatment for 2–6 weeks including pain medication and physiotherapy but with no improvement in pain. Patients with a Visual Analog Scale (VAS) above 4 of 10 were included. We excluded patients with burst fractures (in some A3.1-fractures possible) – Flexion-distraction and rotational injuries (AO type B and C) – Medical contraindications (bleeding disorders and sepsis), and patients with neurological deficits. All the patients included in the study were explained in detail about the procedure and informed written consent was obtained. All the routine investigations were done including the radiological and blood investigations. Statistical Analysis Used: The data collected were subjected to data entry in MS Excel. The data were analyzed using SPSS (SPSS Inc. IBM Chicago City, Illinois State, USA) version 20.0 using the Chi-square test. Results: In the mean age of the study population was 63 ± 9, prospective study the pain in terms of mean VAS significant improvement from 7.55 ± 0.6 preoperatively to 1.95 ± 1.5 postoperatively at the end of the 1-year follow-up, which is statistically significant with P < 0.05. The functional outcome using the mean Oswestry Disability Index (ODI) score which shows significant improvement from 76.6 ± 6 preoperatively to 21.5 ± 16 postoperatively at the end of the 1-year follow-up, which is statistically significant with P < 0.004. Moreover, the radiological outcome using the mean anterior vertebral height was improved from 52.65 ± 1.2 preoperatively to 71 ± 1.1 postoperatively at the end of 1-year follow-up and the mean kyphotic angle was improved from 14.3° ± 1.5° preoperatively to 7.5° ± 0.6° at 1-year postoperative follow-up. Complications such as cement extravasation have been noted in two patients (10%). Conclusion: Balloon kyphoplasty achieves excellent immediate and long-term results in the treatment of osteoporotic VCFs. VAS and ODI scores were very useful tools in assessing the pain and functional outcome of osteoporotic VCFs using balloon kyphoplasty. Based on our results, we conclude that balloon kyphoplasty rapidly reduces pain and disability and improves function and quality of life. Radiologically, we could achieve a reasonable vertebral body height and we could also correct the kyphotic angle. Therefore, the treatment of VCFs with balloon kyphoplasty may be considered a safe, effective, and minimally invasive approach, with excellent functional and radiological outcomes.

Keywords

• anterior vertebral height
• kyphotic angle
• osteoporotic vertebral compression fractures
• oswestry disability index
• visual analog scale