Vertebral body stenting fails to improve compression fracture surgery
medwireNews: Vertebral body stenting offers no advantage over balloon kyphoplasty for the treatment of painful vertebral compression fractures, suggests research published in the Journal of Bone and Joint Surgery.
While the study did not assess long-term clinical outcomes of stenting versus kyphoplasty treatment, the researchers emphasize that they "could not confirm that adding a vertebral stent avoided secondary loss of vertebral height, and without achieving this goal a clinical effect is at least questionable."
They found no significant difference in the mean reduction of kyphosis achieved in the 65 patients who were randomly assigned to have 100 levels treated with stenting (n=50) or balloon kyphoplasty (n=50), at 4.7° and 4.5°, respectively.
Moreover, the overall rate of complications was significantly higher in the stenting than kyphoplasty groups, at 48% versus 22%. This was largely due to a significantly higher rate of intraoperative material complications, including cannula issues (10 vs 0%) and a 6% rate of stent issues.
Mean pressure during the procedure was significantly higher with stenting than kyphoplasty (16 vs 24 bar), as were pressures during balloon inflation (12-34 vs 5-28 bar). Two stents failed to open at the recommended pressures and balloon rupture occurred when extra pressure was exerted, the researchers note.
None of the patients required revision surgery or sustained neurologic sequelae but there was no significant difference between the stenting and kyphoplasty groups with regard to the rate of minor (20 vs 12%) or major (10 vs 8%) cement leaks, or in the radiation exposure time (116 vs 96 sec).
"Vertebral body stenting did not achieve the initial goals of avoiding secondary loss of vertebral height and less cement leakage in our study," conclude Clément Werner (University of Zurich, Switzerland) and co-authors.
"One important reason for this was that the stents frequently failed to open properly. This led to insufficient expansion of the balloon tamps with unsatisfactory fracture reduction and was followed by increased pressures during inflation and in some cases by balloon rupture."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Lynda Williams, Senior medwireNews Reporter