Treatment of osteoporotic vertebral fracture by percutaneous vertebroplasty or kyphoplasty

Background: Vertebral compression fracture is the most common complication of osteoporosis. It can induce intractable pain and may result in progressive kyphosis. Vertebroplasty is used to treat pain and stabilize the spine, but it does not restore vertebral body height or eliminate spinal deformity. Kyphoplasty involves vertebroplasty and realignment of the fractured vertebra with bone cement, thereby decreasing kyphosis. Instead of the traditional balloon kyphoplasty, we have performed kyphoplasty more simply by postural reduction, and patients selected appropriately. Methods: Between March 2001 and December 2003, 169 patients with thoracic or lumbar vertebral fractures due to osteoporosis underwent percutaneous transpedicular vertebroplasty at Tri-Service General Hospital, Taiwan. On retrospective examination, we found that the vertebral body height was restored without balloon kyphoplasty in 43 patients. Here, we describe the criteria used for patient selection, the therapeutic technique, the possible complications and pitfalls, the technical achievements, and the immediate clinical results and long-term clinical outcome. We calculated the vertebral body height and kyphotic angle, and assessed pain levels (on a visual analog scale), daily life activity, and medication requirements, before and after treatment. Results: After cement injection, 99.4% of the patients experienced an immediate relief of back pain. In addition, we observed restoration of the vertebral body height and correction of the kyphotic curve in 25.4% of these patients. With gradually improving techniques and proper selection of patients, the occurrence of vertebral body height restoration increased from 23% to 61% from 2001 to 2003. Conclusions: As the same procedure of vertebroplasty, our retrospective analysis showed that adequate patient selection, postural reduction, and improved surgical techniques may enhance restoration of the vertebral body height and reduction of the kyphotic angle.