Pain and functional outcome after vertebroplasty and kyphoplasty. A comparative study

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Abstract

Purpose

The aim of this study was to compare the effectiveness of percutaneous vertebroplasty and kyphoplasty to treat pain from non-neoplastic vertebral fractures and improve functional outcomes.

Materials and methods

We compared 30 patients treated by vertebroplasty for non-neoplastic vertebral fractures with 30 patients treated by kyphoplasty for the same condition. Pain was measured with a visual analogue scale (VAS) and functional outcome with the Oswestry disability index (ODI). Baseline data were compared with measurements on the day after the procedure (for pain alone) and at 1 month, 6 months, and 1 year.

Results

The VAS pain score was reduced by 4–5 points on the day after either type of treatment, a statistically significant improvement. The global ODI was significantly improved (by 13–18 points) at 1 month after either procedure. These improvements persisted at 6 months and 1 year. No significant differences in functional outcome were observed between the techniques.

Conclusion

Vertebroplasty and kyphoplasty obtain similar improvements in pain and functional outcomes in these patients. The choice of technique must therefore depend on other factors. An initial improvement with either technique is a good predictor of long-term improvement.

Introduction

Osteoporosis is the most frequent metabolic disease leading to progressive mineral bone loss with architectural bone changes; it has a prevalence of >30% in the over-65-year-old female population [1].

Conservative measures have usually been prescribed for fractures secondary to osteoporosis, including rest, analgesics, anti-inflammatory drugs, or the use of external braces. These treatments may be useful to relieve pain but make little contribution to vertebral stability. Furthermore, chronic medication can produce undesirable side effects, while excessive rest can exacerbate bone demineralization, increasing the risk of bone fractures [2]. Surgery is reserved for fractures associated with vertebral instability or neurological compromise, although the poor bone quality and functional performance of osteoporotic patients reduce the likelihood of a successful outcome [3].

Pain related to vertebral body fractures is now widely treated by vertebroplasty or kyphoplasty. The main reported advantages of kyphoplasty over vertebroplasty (i.e., restoration of vertebral body height and lower rate of cement extravasation) have recently been questioned [4]. Both techniques have proven effective to obtain pain relief, but their comparative impact on functional outcome has not been established [5], [6].

The aim of this study was to compare the short- and long-term effect of these techniques on pain and functional outcomes in the treatment of osteoporotic fractures.

Section snippets

Patients and methods

A prospective cohort study was performed in patients with non-traumatic or low-energy vertebral fractures treated by vertebroplasty and kyphoplasty and diagnosed with primary osteoporosis. Patients with the presence of known causes of osteoporosis (e.g., corticosteroid therapy, inflammatory spondyloartropathy, diabetes mellitus) were excluded.

Inclusion criteria were met by 33 patients out of 67 consecutive vertebroplasty patients and by 35 out of 69 consecutive kyphoplasty patients. Three

Results

With either technique, the VAS pain score was significantly lower (by 4–5 points) on the day after its application and the global ODI score was significantly higher (by 13–18 points) at 1 month, and these improvements persisted at 6 months and 1 year (Table 2).

Before the procedure, the vertebroplasty group had a significantly higher mean age (p = 0.007) and larger number of fractures (p = 0.013) and a non-significantly longer time with pain (p = 0.091) in comparison to the kyphoplasty group (Table 1).

Discussion

Percutaneous treatment of vertebral body fractures by vertebroplasty and kyphoplaty is mainly indicated after the failure of medical therapy or when patients cannot tolerate the pain or the medical treatment. Vertebroplasty has been reported to achieve pain relief in 75–100% of cases, with a complications rate below 1%. Complications are related to leakage into spinal canal or other related structures and are not usually clinically relevant. Severe complications, such as pulmonary embolism,

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