Kyphoplasty feasible even with loss of wall integrity
MedWire News: Kyphoplasty is suitable even for patients whose osteoporotic vertebral fractures have loss of vertebral wall integrity, say Chinese clinicians.
Kyphoplasty has previously been contraindicated for such patients due to the likelihood of bone fragments entering the canal and a greater risk for cement extravasation, explains the team from the First Affiliated Hospital of Soochow University in Suzhou, Jiangsu.
To overcome this issue, the researchers used individualized surgery to perform kyphoplasty in 55 patients with 59 osteoporotic vertebral compression fractures.
The balloon kyphoplasty system was placed into the vertebral body and inflated under fluoroscopic guidance until vertebral body height was restored. Patients with anterior wall damage to the vertebral body had small amounts of middle- or late-stage bone cement of the dough phase placed to block the defect and prevent anterior cement leakage. Once the filling was solid, a second application of late-stage bone cement of paste phase or early-stage bone cement of dough phase was performed.
For patients with posterior wall damage, dynamic X-ray monitoring was used throughout bone filling. The surgeons stopped filling once the bone cement reached the lateral margin or a quarter of the distance left to the posterior wall of the vertebral body.
Huilin Yang and co-authors report that one patient experienced non-symptomatic but none of the patients experienced symptomatic cement extravasation, or developed complications after surgery.
Follow-up after surgery and again 3, 6, and 12 months after the procedure demonstrated that the patients’ vertebral height was significantly restored from 60.5% to an average of 84.3% of vertebral height variation. This was accompanied by a significant improvement in mean kyphotic angle from 16.7° to 8.7°.
Moreover, the patients experienced a significant decrease in pain on a 10-point visual analog scale, where 0 is no pain and 10 is most severe pain. Their scores fell from an average of 7.8 before surgery to 3.5 at final follow-up.
“Kyphoplasty may be considered feasible and safe for the treatment of osteoporotic vertebral fracture with peripheral wall damage, provided that individualized surgical techniques are used to prevent bone cement leakage,” conclude Yang et al.
“Staged bone cement injection can be performed for patients with anterior wall damage, and dynamic… X-ray monitoring can be performed throughout the process for patients with posterior or lateral wall damage in order to prevent bone cement leakage and related complications.”
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By Lynda Williams