Balloon kyphoplasty safe, effective for OVF with middle column compromise
Elderly patients with osteoporotic vertebral fractures (OVF) should refrain from undergoing highly invasive surgery, but those with no posterior wall mobility or paralysis may benefit from balloon kyphoplasty (BKP) for OVF with posterior vertebral wall damage, according to a study presented at the 5th Scientific Meeting Asian Federation of Osteoporosis Societies (AFOS) 2017 in Kuala Lumpur, Malaysia.
There was no mobility of middle column in either preoperative standing or dorsal lateral view in any of the patients included in the study. An improvement was observed in the lumbar pain visual analogue scale (VAS), from a preoperative mean score of 8.5 (range, 7 to 10) to a postoperative mean of 2 (0 to 7). [AFOS 2017, abstract BPA 03]
In five patients, neurological symptoms were improved. Furthermore, all patients who had had difficulty in maintaining the sitting posture became ambulatory following surgery. Activities of daily living (ADL) scores did not vary, with a mean preoperative score of 8.7 (0 to 9) and a mean postoperative score of 8.6 (7 to 12), which suggested no correlation with the spinal cord occupation rate of the middle column.
Complications were reported in four patients. Two participants had bone cement leakage in the lateral vertebral wall, with no symptom aggravation, and the other two had adjacent vertebral fracture that required a brace.
In an earlier study, Gan and colleagues concluded that BKP is a safe and effective method for OVF with middle column compromise but without neurological deficit. In addition, spontaneous remodelling of the spinal canal also occurs after BKP. [Injury 2014;45:1539-1544]
In the current study, “as for the vertebral canal occupation rate, results did not have a difference either,” researchers said.
A total of nine patients (mean age at time of surgery 81 years; 8 women) were included. The mean duration of postoperative follow-up was 8.6 (1 to 24) months, and the mean duration between onset and surgery was 3.6 (1 to 7) months.
Preoperative neurological symptoms presented in five patients (epiconus in two patients, cauda equine in one and nerve root in two). There were six patients who had difficulty in maintaining the sitting posture. The fractured vertebral body was T6 in one patient, T12 in two, L1 in five and L4 in one.
In all participants, the posterior vertebral wall protruded into the vertebral canal. The posterior vertebral wall had a mean spinal cord occupation rate of 38.2 percent (21 to 54 percent). The occupation rate was ≥20 percent but <40 percent in four patients and ≥40 percent but <60 percent in five patients.
Researchers evaluated pre- and postoperative imaging findings, scores on the lumbar pain VAS and ADL score (ADL part of the Japan Orthopedic Association scoring system) in these patients.
“The limitation of our study was that the number of our cases was small,” researchers said.
BKP is indicated for the treatment of OVF, in which the middle column is often damaged during conservative therapy, they explained.