Impact of kyphoplasty treatment for vertebral compression fractures on pain and function in 105 patients

Vertebral compression fractures are very common. Symptomatic relief with conservative therapy is often difficult to achieve. Balloon kyphoplasty is a relatively new technique which stabilises the vertebral body and restores spinal alignment in recent fractures, it achieves significant pain relief and improved functional outcome is reported. The aim of this prospective study was to determine the level of pain relief and functional outcome in patients who were initially treated conservatively for 4-6 weeks and if symptoms did not have tendency to resolve, then had kyphoplasty surgery.

105 patients underwent balloon kyphoplasty between April 2006 and August 2010 and had 1 year follow up. Total 170 levels were augmented, 65% (n=68) of patients were female and the average age was 74 years. Pain relief was assessed using visual analogue score (VAS) and functional outcome using Oswestry Disability Index (ODI).

Results showed decrease of the average pre-operative VAS from 8.2 to 4.4 in the immediate postoperative period (p=0.000). This dramatic improvement remained and was 4.1 at 6 weeks, 3.3 at 6 months and 3.6 at 1 year. The average pre-operative ODI was 58. This improved to 47 in the immediate post-operative period (p=0.002). At 6 weeks this had improved further to 40 and further improvements were seen at 6 months (ODI 37) and 1 year (ODI 38). The average screening time was 2 minutes and 20 seconds. The average volume of cement used per level was 5.5 cm3. Radiographic measurements were performed by independent radiologist. The average pre-operative vertebral angle was 11.6° and 10.9° postoperatively. This was maintained throughout the follow up. This represented a negligible 6% improvement in vertebral body angle. We did not experience any clinically significant complications, we have encountered 11 minor complications which did not require any additional measures (cement leaks, penetration of the vertebral body margins by balloons or K wires and rib fractures).

Pain relief and improvement of functional outcome was sustained after one year. Limited number of patients who had 2 year follow up showed trend of minimal deterioration of both parameters (VAS and ODI). This can be explained by incidence of few adjacent segment fractures and progressive overall osteoarthritic changes in this aging population. Radiological evaluation showed maintenance of achieved alignment which did not deteriorate over time. Complication rate was low and did not require any further surgical interventions and did not have any effect on final good clinical outcome.

Balloon kyphoplasty proved to be safe surgical technique and should be considered in patients with ongoing pain following an acute vertebral compression fracture that does not improve with initial conservative treatment. It significantly improves pain and functional status in elderly patients.