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Percutaneous Balloon Kyphoplasty in Treatment of Painful Osteoporotic Occult Vertebral Fracture: A Retrospective Study of 89 Cases

View Article: PubMed Central - PubMed

ABSTRACT

Background: The definition of a vertebral fracture is usually based on the presence of a deformation of the vertebral body and this can be misleading in the presence of a fracture without radiologic collapse with the definition of occult osteoporotic vertebral fractures (OOVFs). STIR sequence of MRI images showing hyperintensity signal was the most confirmative screening examination used to determine the presence of painful OOVFs. To date, clinical management of OOVFs has been rarely discussed.

Material/methods: Between 2011 and 2013, 89 patients suffering from painful OOVFs underwent 142 percutaneous balloon kyphoplasty (PKP) procedures. Outcome data (mean variation of anterior and middle vertebral body height, visual analog scale [VAS] scores, Oswestry Disability Index [ODI] scores, and SF-36 scores) were recorded preoperatively, postoperatively, and at 1 month, 6 months, and 2 year after treatment, to evaluate the results.

Results: We successfully treated 89 patients (142 vertebral bodies) with PKP. Cement leakages were observed in 12 (8.45%) treated vertebral bodies and there were 5 new adjacent vertebral fractures during the follow-up period. The mean variation of anterior and middle vertebral body height changed from 96.5±3.4% preoperatively to 97.2±2.5% postoperatively (p>0.05) and from 96.3±2.8% preoperatively to 97.9±3.1% postoperatively (p>0.05), respectively. The mean VAS scores were reduced significantly from pre-surgery to post-surgery (8.3±1.2 to 2.9±0.7; p<0.05), as was the ODI score (76.4±12.5 to 26.7±5.6; p<0.05). The SF-36 scores, including Bodily Pain (BF), Vitality (VT), Physical Function (PF), and Social Functioning (SF), all showed notable improvement (P<0.05). These variations were maintained during the 2-year follow-up period.

Conclusions: PKP is a safe and effective method in the treatment of painful OOVFs.

No MeSH data available.


Distribution of vertebral bodies treated by PKP (n=142).
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f1-medscimonit-23-1682: Distribution of vertebral bodies treated by PKP (n=142).

Mentions: From January 2011 to December 2013, 923 kyphoplasties were performed in 688 patients at our institution. Among them, 89 patients (55 females and 34 males), aged 56–79 years, had 1 or 2 OOVFs, and underwent 142 PKP procedures. The mean time since onset of pain to the intervention was 1.25 months in all patients. The levels treated by PKP were distributed as shown in Figure 1. Bone mineral density was preoperatively measured as an indicator of osteoporosis with dual-energy X-ray absorptiometry in all cases. We only included the osteoporotic patients (according to the World Health Organization; these patients have a T-score −2.5 or lower, meaning a bone density that is 2.5 standard deviations below the mean of a 30-year-old man/woman [7]). The mean T-score was −3.1.


Percutaneous Balloon Kyphoplasty in Treatment of Painful Osteoporotic Occult Vertebral Fracture: A Retrospective Study of 89 Cases
Distribution of vertebral bodies treated by PKP (n=142).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5391800&req=5

f1-medscimonit-23-1682: Distribution of vertebral bodies treated by PKP (n=142).
Mentions: From January 2011 to December 2013, 923 kyphoplasties were performed in 688 patients at our institution. Among them, 89 patients (55 females and 34 males), aged 56–79 years, had 1 or 2 OOVFs, and underwent 142 PKP procedures. The mean time since onset of pain to the intervention was 1.25 months in all patients. The levels treated by PKP were distributed as shown in Figure 1. Bone mineral density was preoperatively measured as an indicator of osteoporosis with dual-energy X-ray absorptiometry in all cases. We only included the osteoporotic patients (according to the World Health Organization; these patients have a T-score −2.5 or lower, meaning a bone density that is 2.5 standard deviations below the mean of a 30-year-old man/woman [7]). The mean T-score was −3.1.

View Article: PubMed Central - PubMed

ABSTRACT

Background: The definition of a vertebral fracture is usually based on the presence of a deformation of the vertebral body and this can be misleading in the presence of a fracture without radiologic collapse with the definition of occult osteoporotic vertebral fractures (OOVFs). STIR sequence of MRI images showing hyperintensity signal was the most confirmative screening examination used to determine the presence of painful OOVFs. To date, clinical management of OOVFs has been rarely discussed.

Material/methods: Between 2011 and 2013, 89 patients suffering from painful OOVFs underwent 142 percutaneous balloon kyphoplasty (PKP) procedures. Outcome data (mean variation of anterior and middle vertebral body height, visual analog scale [VAS] scores, Oswestry Disability Index [ODI] scores, and SF-36 scores) were recorded preoperatively, postoperatively, and at 1 month, 6 months, and 2 year after treatment, to evaluate the results.

Results: We successfully treated 89 patients (142 vertebral bodies) with PKP. Cement leakages were observed in 12 (8.45%) treated vertebral bodies and there were 5 new adjacent vertebral fractures during the follow-up period. The mean variation of anterior and middle vertebral body height changed from 96.5±3.4% preoperatively to 97.2±2.5% postoperatively (p>0.05) and from 96.3±2.8% preoperatively to 97.9±3.1% postoperatively (p>0.05), respectively. The mean VAS scores were reduced significantly from pre-surgery to post-surgery (8.3±1.2 to 2.9±0.7; p<0.05), as was the ODI score (76.4±12.5 to 26.7±5.6; p<0.05). The SF-36 scores, including Bodily Pain (BF), Vitality (VT), Physical Function (PF), and Social Functioning (SF), all showed notable improvement (P<0.05). These variations were maintained during the 2-year follow-up period.

Conclusions: PKP is a safe and effective method in the treatment of painful OOVFs.

No MeSH data available.