Early kyphoplasty in the elderly patient

Prevalence of vertebral compression fractures is over 30 % in the elderly population. The ideal treatment for these fractures remains a subject of debate. The objective in this study is to compare the clinical outcomes of early kyphoplasty and conservative treatment in vertebral compression fractures.

Observational retrospective study of 50 consecutive patients with acute vertebral compression fracture (25 patients treated by kyphoplasty and 25 treated by conservative therapy). Number and location of the fractures, radiographic assessment (Beck Index), symptoms duration, pain intensity (Visual Analog Scale -VAS), patient's functional capacity (Oswestry Disability Index - ODI) and analgesic use and dose were analysed. Both groups were followed for 1 year.

Most of the patients in the sample were women with a mean age of 80,5 years old, both groups being comparable in age and sex (p=1 and p=1 respectively). The mean ASA score for kyphoplasty vs conservative was 2.6 vs 2.5 (p 0,54). VAS at initial diagnosis 8,50 vs 8,80 (p 0,405). VAS two months after initiation of the treatment 4,40 vs 2,40 (p 0,028), and VAS at one year follow-up was 1,80 vs 1,30 (p 0,216). ODI mean scores conservative vs kyphoplasty at initial diagnosis were 69,79 vs 74 (p 0,87) and two months later 31,60 vs15,40 (p 0,03). The mean Beck Index at the diagnosis conservative vs kyphoplasty was 59,20 % vs 61,50 % (p 0,68) and after 1 year 51,80 % vs 57,40 % (p 0,45). In the kyphoplasty group only 1 patient had to be hospitalised during 24 h. Cement leakage was detected in 2 patients without clinical repercussion. In the conservative group 5 patients had home help during their recovery and 3 went to nursing homes.

Kyphoplasty is a minimally invasive surgical procedure with hardly any complications. It offers a faster and greater pain relief to elderly patients than conservative treatment. Early treatment with kyphoplarty allows patients to walk in a short time (early wandering) after the fracture. This treatment avoids long periods of rest and loss of muscle mass. It is a surgical procedure that should be considered as part of the initial therapeutic choices for osteoporotic vertebral fractures.

IV.