| Background:Osteoporotic vertebral compression fracture is the most frequent type of all osteoporotic fractures.It constitutes a major health care problem of osteoporosis worldwide.In spite of this,there is considerable uncertainty regarding its frequency,the severity and duration of the pain,and the magnitude of impairment in terms of disability and disturbed activities of daily life during the post-fracture period.When vertebral compression fractures become symptomatic and cause disability,several treatment options are available to alleviate pain and correct the sagittal imbalance of the spine.Pain reduction and stabilization are of primary importance with osteoporotic vertebral compression fractures.Although many patients heal with conservative treatment consisting of rest or activity modification,analgesics,and bracing,the management of severe pain compels some patients to seek surgical intervention via 2 procedures:vertebroplasty and kyphoplasty.Although there is abundant support in the literature for both procedures,there remains debate over whether vertebroplasty or kyphoplasty is superior for the treatment of osteoporotic vertebral compression fracture.This study shows the comparison between these two techniques.Objectives:Osteoporotic vertebral compression fractures cause significant burden and some patients are debilitated by the pain due to the fracture.Conventional surgery carries a high risk and has a poor outcome.The goal of this study is to to assess the efficacy and safety of PVP compared to PKP in the treatment of single or multiple level osteoporotic vertebral compression fractures(OVCF),regarding vertebral body height,local wedge angle and pain relief assessment using visual analog score(VAS),ODI score and their complications.Study design:RetrospectiveMaterials and method:This retropective study included 40 patients diagnosed with painful OVCF in our hospital.Those who didn't respond to conservative therapy were included and allocated either to vertebroplasty or kyphoplasty group.Nine patients were treated with vertebroplasty and 31 with kyphoplasty using polymethylmethacrylate(PMMA)cement as bone filler and the results of the two interventions were compared statistically.Last follow-up(6 months)was done in all 40 patients for the pain assessment.From a total number of 66 fractured vertebra,31(46.96%)were thoracic and 35(53.03%)lumbar.The number of thoracic spines in vertebroplasty group was 10(62.5%)versus 21(42%)in kyphoplasty group.Regarding the number of lumbar spines,6(37.5%)in vertebroplasty versus 29(58%)in kyphoplasty group.The mean age of patients was 68.77years in vertebroplasty group whereas 69.90years in kyphoplasty group.Surgical procedures were performed under local anaesthesia,and a unilateral as well as bilateral transpedicular approach was used.No statistical analysis has been done between two approaches.An imaging evaluation measuring vertebral height(anterior,middle and posterior)and local wedge angle was performed prior to the procedures and postoperatively.Evaluation of pain was carried out using a visual analogue scale(VAS),Oswestry disability index(ODI)prior to operation and postoperatively at 1 week,3 and 6 months.Plain radiograph was taken only after surgery.Results:The duration of follow-up period for pain evaluation was 6 months.All forty patients were involved till the final follow-up(6months).The average age in vertebroplasty group was 68.77± 8.72 years and 69.90±10.14years in kyphoplasty group.Womens' percentage in vertebroplasty was 88.88%and 64.51%in kyphoplasty groups.Overall,the results showed that there were statistical significances in the 2 groups when compared with their preoperative values with regard to improvement in VAS and ODI scores(P<0.05)at all postoperative intervals,despite the fact that VAS and ODI pain scores slightly increased at final follow-up(6 months)in vertebroplasty group.Both treatment groups achieved marked vertebral height restoration and local wedge angle reduction,but the radiographic parameters were significantly better in the kyphoplasty group(P<0.05).The anterior,middle,posterior heights got increased by 5.59±4.0mm,4.53±4.47mm,4.00±4.30mm and 9.56± 6.03mm,10.99±4.87mm,9.92±6.79mm after the Vertebroplasty and kyphoplasty procedures respectively(p<0.05).It showed that Kyphoplasty increased the height more than that of vertebroplasty when compared with their preoperative values which is statistically significant.And when kyphoplasty compared with vertebroplasty in term of their height restoration,there was statistical significance(P<0.05).Likewise,the local wedge angles got decreased by 2.62±2.47°,5.84±2.66° after vertebroplasty,kyphoplasty respectively(P<0.05)when compared with their properatives values.When kyphoplasty compared with vertebroplasty in terms of wedge angle reduction,there was statistical significane(P<0.05).Comparatively kyphoplasty decreased wedge angle more.The incidence of cement leakage per treated vertebrae in the vertebroplasty group was 25%versus 20%in the kyphoplasty group,which isnot statistically significant(P=0.181).No symptomatic cement leakages occurred in both groups.There were no postoperative complications,such as nerve injury or pedicle fracture,in either of the two groups.Conclusion:PVP and PKP are both safe and effective techniques for treating OVCF.PKP has advantages over PVP in terms of vertebral height restoration,wedge angle reduction and cement leakage prevention but has a similar long-term pain relief,functional outcome.Kyphoplasty achieved better height restoration and improvement of the wedge angle than vertebroplasty.Vertebroplasty resulted the higher incidence of cement leakage into the disk space than kyphoplasty without any clinical manifestations. |
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