Kyphoplasty versus Conservative Treatment: A Case–Control Study in 110 Postmenopausal Women Population. Is Kyphoplasty Better than Conservative Treatment?

Abstract

Introduction Osteoporosis is a highly prevalent and one of the most debilitating and costly chronic diseases worldwide and it is also responsible for approximately 1.5 million vertebral fragility fractures (VCFs) a year.1,2,3 Most of the patients experiencing an osteoporotic VCFs remain asymptomatic or minimally symptomatic; however, a large part of these patients do experience significant pain, resulting in decreased quality of life and disability and mortality too.4 The consequences of these fractures include pain and, in many cases, progressive vertebral collapse with resultant spinal kyphosis. Minimally invasive procedures, namely, kyphoplasty and vertebroplasty, represent a recent advance to the treatment of osteoporotic VCFs.5,6,7 The aim of this study is to compare effects in terms of recovery and quality of life and to compare deformity prevention efficacy of kyphoplasty and conservative treatment in postmenopausal women with an osteoporotic VCF. The aim of this study is to provide an efficacy assessment of kyphoplasty as compared with standard conservative treatment in postmenopausal women (bracing immobilization).8,9,10 Patients and Methods We designed a retrospective case–control study on 110 postmenopausal women. Included in this study were patients who were diagnosed with postmenopausal osteoporosis according to National Osteoporosis Foundation (NOF) guidelines, with a recent (< 2 weeks) symptomatic osteoporotic vertebral compression fracture (VCF), no more than two (if any) old VCFs with no resultant kyphotic deformity, and whose treatment starts no later than 15 days from the VCF time. Study population was split in a surgery cohort and a conservative cohort according to the provided treatment. All patients were asked to fill in VAS, SF-12, and Eq. 5D questionnaires at different time points up to 12 months after treatment. Segmental kyphosis at fracture level was also measured for our analysis. Results Kyphoplasty-treated patients had lower back pain VAS scores at 1 month as compared with conservatively treated patients ( p < 0.05). Eq. 5D questionnaire also showed a better quality of life at 1 month for surgically treated patients ( p < 0.05). As for the SF-12 no significant difference was observed. At 12 months, scores from all scales were not statistically different between the two cohorts, although surgically treated patients showed better trends than conservatively treated patients in pain and quality of life. Kyphoplasty was able to restore more than 55% of the original segmental kyphosis, whereas patients in conservative cohort lost 6.67% of the original segmental kyphosis on average. Conclusion Kyphoplasty seems to be a safe and effective procedure in reducing back pain due to painful VCF. The kyphosis restoring effect is also extremely interesting and can be achieved only in the first days after fracture time. In conclusion, kyphoplasty is a procedure that offers a fast recovery and a better quality of life at 1 month after treatment, helping restoring segmental kyphosis after VCFs.11,12,13 Acknowledgments There was no external funding source and no funding source played a role in the investigation. References Who are candidates for prevention and treatment for osteoporosis? Osteoporos Int 1997;7(1):1–6 Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006;17(12):1726–1733 Iqbal MM, Sobhan T. Osteoporosis: a review. Mo Med 2002;99(1):19–24 Gold DT. The clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone 1996;18(3, Suppl):185S–189S Jarvik JG, Kallmes DF. Point of view. Efficacy of vertebroplasty and kyphoplasty. Spine 2009;34(6):613–614 Kallmes DF, Comstock BA, Heagerty PJ, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009;361(6):569–579 Weinstein JN. Balancing science and informed choice in decisions about vertebroplasty. N Engl J Med 2009;361(6):619–621 Lyritis GP, Mayasis B, Tsakalakos N, et al. The natural history of the osteoporotic vertebral fracture. Clin Rheumatol 1989;8(2, Suppl 2):66–69 Prather H, Watson JO, Gilula LA. Nonoperative management of osteoporotic vertebral compression fractures. Injury 2007;38(3, Suppl 3):S40–S48 Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 2001;26(14):1511–1515 Ledlie JT, Renfro M. Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg 2003;98(1, Suppl):36–42 Voggenreiter G. Balloon kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fractures. Spine 2005;30(24):2806–2812 Pradhan BB, Bae HW, Kropf MA, Patel VV, Delamarter RB. Kyphoplasty reduction of osteoporotic vertebral compression fractures: correction of local kyphosis versus overall sagittal alignment. Spine 2006;31(4):435–441

Comparative study on the biomechanics between improved PVP and traditional PKP in the treatment of vertebral peripheral wall damage-type OVCF

“…According to literature, the diagnostic standard of osteoporosis in BMD is 2.5 times lower than the mean peak of BMD of normal bones ( 13 ), and the mechanical characteristics that constitute the bones are generally considered as a combination of collagen fibers and calcium phosphate, among which calcium phosphate determines the bone stiffness ( 14 ), and the content of calcium is closely related to vertebral BMD and bone strength ( 15 ), therefore, decalcification can cause vertebral osteoporosis. Research has shown that the reason behind vertebral fracture is that the stress exceeds the strength of the trabecular bone, and the main structure of vertebral body is able to bear, and the trabecular bone structure is damaged and the local fracture is further developed, which leads to the vertebral fracture ( 16 ). In conclusion, if decalcification can be realized rapidly and vertebral compression fracture with peripheral wall damage can be achieved by external force, then the peripheral wall damage-type OVCF animal model will be established successfully.…”

Spinal Orthoses in the Treatment of Osteoporotic Thoracolumbar Vertebral Fractures in the Elderly: A Systematic Review With Quantitative Quality Assessment

“…6,12 Included articles in previous reviews, in the present review and excluded articles are summarized for each review in Table 4. The following articles were included in previous reviews and excluded here as follows: included in six [6][7][8][9][10]12 and excluded here due to no outcome definition, 37 included in two 9,10 and excluded due to language availability, included in three 7,9,10 and excluded due to missing fracture status (with/without/healed) (n = 5), 38À42 included in one 6 excluded because the intervention was taping, 43 included in one 11 and were excluded because primary intervention was medication, 44 included in one 12 and excluded here due to a crossover design to surgery, 45,46 comparison to kyphoplasty, 47 primary comparison regarding bed rest and inclusion of traumatic fractures, 48 orthosis not primary intervention and solely report of reduction over time, 49 orthosis not primary intervention. 50 Despite five 5,7-10 reviews detected the low evidence for the use of orthoses in the treatment of OVF, their use was recommended.…”

Der Zeitpunkt der Kyphoplastie beeinflusst das Ergebnis: eine prospektive Analyse

“…Es gibt zur Behandlung dieser Frakturen unterschiedliche Therapiealternativen [4]. Es kann eine konservative Behandlung mittels oraler Schmerztherapie und Miederversorgung durchgeführt werden.…”