Comparison of kyphoplasty with use of a calcium phosphate cement and non-operative therapy in patients with traumatic non-osteoporotic vertebral fractures

Abstract

One of the current standard treatment options for younger patients with stable traumatic vertebral fractures is conservative treatment using braces. Kyphoplasty as a minimally invasive procedure has been shown to be effective in stabilizing vertebral body fractures, resulting in immediate pain relief and improved physical function. The purpose of this prospective study was to clarify whether patients with acute traumatic vertebral fractures benefit more from kyphoplasty or from conservative treatment with a brace. A prospective study was undertaken in two centers. Forty patients with acute painful traumatic vertebral body fractures type A1-A3 (AO-classification) after adequate trauma, without osteoporosis, suitable for kyphoplasty or therapy by brace were included into the study. Follow-up was 12 months. Patients of the kyphoplasty group showed an immediate beneficial and significant effect postoperatively, and better outcomes 1 and 3 months after operation compared to the conservatively treated group in pain feeling, mobility and vertebral body height. After 12 months the difference between both groups was not significant excepting the vertebral body height. Kyphoplasty provides early and lasting reduction of pain and improvement of daily activity. However, there are clinically asymptomatic cement leakages in up to 45% of which we do not know the consequences in long term. Every patient with traumatic vertebral body fracture treated by kyphoplasty has to be informed about that. Long-time results are outstanding and our findings require confirmation by randomized controlled trials.

Balloon-Kyphoplasty for Vertebral Compression Fractures

“…Unlike BKP, in vertebroplasty bone cement is injected into the vertebra at high pressure and free: so cement-leakage rate is higher, especially if there are many fracture cracks, such as for traumatic VCFs [Schmelzer et al, 2009]. In his meta-analysis on 69 clinical studies, Hulme [Hulme et al, 2006] reported leakage rates in 41% of cases during vertebroplasty and in 9% of cases during BKP.…”

“…The most commonly described complication is an extravertebral leakage of bone cement [Groen et al, 2004], more likely in traumatic VCFs compared to pathologic VCFs due to more fracture cracks in traumatic fracture [Schmelzer-Schmied et al, 2009]. The systematic review of the literature by Hulme found rates of cement leakage in vertebroplasty of 41% (n = 2283 levels) and in kyphoplasty of 9% (n = 1486 levels) of treated vertebrae.…”

Effectiveness of a bone substitute (CERAMENT™) as an alternative to PMMA in percutaneous vertebroplasty: 1-year follow-up on clinical outcome

“…The success of this material is based on immediate relief of pain and mechanical stabilization improving physical functions [3,8] as well as low cost [9]. However, clinical trial results have exposed a high complication rate in percutaneous vertebroplasty with PMMA range from 1 to 10 % [10,11], highlighting potential weaknesses such as thermal injury to surrounding tissues, potentially causing neurological damage, increasing fracture risk at adjacent levels due to the high inherent stiffness, and potential toxicity caused by the reactive material [2,4,9,12].…”

“…Both procedures are today proven and accepted as standard of care for pain caused by compression fractures of the spine, such as traumatic non-osteoporotic vertebral fractures and traumatic compressive vertebral collapses, especially in younger patients [3,6,7].…”

“…Percutaneous vertebral body augmentation, using a minimally invasive procedure, has been used, for decades, for vertebral fracture pain management in patients where conservative treatments, such as analgesics, bed rest, and bracing had failed [1][2][3].…”