Advertisement

International Orthopaedics

, Volume 43, Issue 2, pp 359–365 | Cite as

The therapeutic effects of percutaneous kyphoplasty on osteoporotic vertebral compression fractures with or without intravertebral cleft

  • Zhe Li
  • Tie Liu
  • Peng Yin
  • Yu Wang
  • Shengen Liao
  • Shuo Zhang
  • Qingjun SuEmail author
  • Yong Hai
Original Paper
  • 178 Downloads

Abstract

Purpose

The purpose of this study was to investigate the clinical effects of percutaneous kyphoplasty (PKP) on osteoporotic vertebral compression fractures (OVCFs) with or without intravertebral cleft (IVC).

Methods

From 2010 to 2016, 309 OVCFs patients (43 males, 266 females) treated with PKP were included in our study. All patients were divided into no intravertebral cleft (NIVC) group and intravertebral cleft (IVC) group according to pre-operative magnetic resonance imaging. Anterior wall height (AWH), posterior wall height (PWH), and kyphotic angle (KA) of the injured vertebral body were evaluated pre-operatively, post-operatively, and at final follow-up.

Results

All patients were followed up for 12~34 months, with an average of 16.2 months. The incidence of IVC was associated with older age and lower bone mineral density (BMD). The anterior wall, posterior wall, and kyphotic angle of vertebral bodies of patients from both groups were significantly improved immediately after surgery. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) also improved significantly without significant difference between the two groups. At the final follow-up, compared to that immediately after surgery, the anterior wall height decreased and kyphotic angle increased significantly in both groups. Compared to the NIVC group, the kyphotic angle in the IVC group increased more significantly within 1 year after surgery. The volume of bone cement injected in the IVC group was larger and consequent. The IVC group had higher incidence of bone cement leakage than the NIVC group, but there was no statistic difference between two groups.

Conclusion

Our results suggested that unilateral PKP was a safe and reliable treatment for OVCFs with IVC. However, the IVC group had higher incidence of bone cement leakage during surgery and more severe KA rebound during the follow-up period. Therefore, to reduce the incidence of bone cement leakage, it is very important to evaluate the pre-operative imaging and inject the cement carefully and repetitiously. When cement leakages are found, injection should be stopped immediately. Longer rehabilitation interventions such as wearing suitable brace, doing exercise to strengthen low-back muscle, and replacing bending with squatting in ordinary living are essential to prevent KA rebound in patients with OVCFs with IVC. However, extended follow-up may be necessary for patients with OVCFs with IVC.

Keywords

Osteoporosis Intervertebral vacuum cleft Kyphoplasty Vertebral compression fracture 

Notes

Funding

This study was supported by the funding from Beijing Municipal Science and Technology Commission No. SCW2016-29 and Beijing Municipal Bureau of Health No. 2016-4-2033.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by our Institutional Review Board in compliance with the Helsinki Declaration.

Informed consent

Written consent was obtained from all the subjects prior to participation in this study.

References

  1. 1.
    Hide IG, Gangi A (2004) Percutaneous vertebroplasty: history, technique and current perspectives. Clin Radiol 59:461–467.  https://doi.org/10.1016/j.crad.2004.01.001 CrossRefGoogle Scholar
  2. 2.
    Phillips FM, Pfeifer BA, Lieberman IH, Kerr EJ 3rd, Choi IS, Pazianos AG (2003) Minimally invasive treatments of osteoporotic vertebral compression fractures: vertebroplasty and kyphoplasty. Instr Course Lect 52:559–567Google Scholar
  3. 3.
    Fang X, Yu F, Fu S, Song H (2015) Intravertebral clefts in osteoporotic compression fractures of the spine: incidence, characteristics, and therapeutic efficacy. Int J Clinical Experimental Medicine 8:16960–16968Google Scholar
  4. 4.
    Wu AM, Lin ZK, Ni WF, Chi YL, Xu HZ, Wang XY, Huang QS (2014) The existence of intravertebral cleft impact on outcomes of nonacute osteoporotic vertebral compression fractures patients treated by percutaneous kyphoplasty: a comparative study. J Spinal Disord Tech 27:E88–E93.  https://doi.org/10.1097/BSD.0b013e31829142bf CrossRefGoogle Scholar
  5. 5.
    Kim YC, Kim YH, Ha KY (2014) Pathomechanism of intravertebral clefts in osteoporotic compression fractures of the spine. Spine J: official J North Am Spine Soc 14:659–666.  https://doi.org/10.1016/j.spinee.2013.06.106 CrossRefGoogle Scholar
  6. 6.
    Libicher M, Appelt A, Berger I, Baier M, Meeder PJ, Grafe I, Dafonseca K, Noldge G, Kasperk C (2007) The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study. Eur Radiol 17:2248–2252.  https://doi.org/10.1007/s00330-007-0684-0 CrossRefGoogle Scholar
  7. 7.
    Malghem J, Maldague B, Labaisse MA, Dooms G, Duprez T, Devogelaer JP, Vande Berg B (1993) Intravertebral vacuum cleft: changes in content after supine positioning. Radiology 187:483–487.  https://doi.org/10.1148/radiology.187.2.8475295 CrossRefGoogle Scholar
  8. 8.
    Kim KT, Suk KS, Kim JM, Lee SH (2003) Delayed vertebral collapse with neurological deficits secondary to osteoporosis. Int Orthop 27:65–69.  https://doi.org/10.1007/s00264-002-0418-5 Google Scholar
  9. 9.
    Saita K, Hoshino Y, Kikkawa I, Nakamura H (2000) Posterior spinal shortening for paraplegia after vertebral collapse caused by osteoporosis. Spine 25:2832–2835CrossRefGoogle Scholar
  10. 10.
    Wiggins MC, Sehizadeh M, Pilgram TK, Gilula LA (2007) Importance of intravertebral fracture clefts in vertebroplasty outcome. AJR Am J Roentgenol 188:634–640.  https://doi.org/10.2214/ajr.06.0542 CrossRefGoogle Scholar
  11. 11.
    Zou D, Zhang K, Ren Y (2015) Therapeutic effects of PKP on chronic painful osteoporotic vertebral compression fractures with or without intravertebral cleft. Int J Clin Exp Med 8:15780–15786Google Scholar
  12. 12.
    Nakamae T, Fujimoto Y, Yamada K, Takata H, Shimbo T, Tsuchida Y (2013) Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research. Society 22:1624–1632.  https://doi.org/10.1007/s00586-013-2686-8 Google Scholar
  13. 13.
    Vogl TJ, Pflugmacher R, Hierholzer J, Stender G, Gounis M, Wakhloo A, Fiebig C, Hammerstingl R (2013) Cement directed kyphoplasty reduces cement leakage as compared with vertebroplasty: results of a controlled, randomized trial. Spine 38:1730–1736.  https://doi.org/10.1097/BRS.0b013e3182a14d15 CrossRefGoogle Scholar
  14. 14.
    Ha KY, Kim YH (2013) Risk factors affecting progressive collapse of acute osteoporotic spinal fractures. Osteoporosis Int: a J Established as Result Cooperation Between European Foundation Osteoporosis National Osteoporosis Foundation USA 24:1207–1213.  https://doi.org/10.1007/s00198-012-2065-z CrossRefGoogle Scholar
  15. 15.
    McKiernan F, Faciszewski T (2003) Intravertebral clefts in osteoporotic vertebral compression fractures. Arthritis Rheum 48:1414–1419.  https://doi.org/10.1002/art.10984 CrossRefGoogle Scholar
  16. 16.
    Chen B, Fan S, Zhao F (2014) Percutaneous balloon kyphoplasty of osteoporotic vertebral compression fractures with intravertebral cleft. Indian J Orthopaedics 48:53–59.  https://doi.org/10.4103/0019-5413.125498 CrossRefGoogle Scholar
  17. 17.
    Tanigawa N, Kariya S, Komemushi A, Tokuda T, Nakatani M, Yagi R, Sawada S (2009) Cement leakage in percutaneous vertebroplasty for osteoporotic compression fractures with or without intravertebral clefts. AJR Am J Roentgenol 193:W442–W445.  https://doi.org/10.2214/ajr.09.2774 CrossRefGoogle Scholar
  18. 18.
    Wang G, Yang H, Chen K (2010) Osteoporotic vertebral compression fractures with an intravertebral cleft treated by percutaneous balloon kyphoplasty. J bone Joint Surgery British Volume 92:1553–1557.  https://doi.org/10.1302/0301-620x.92b11.24671 CrossRefGoogle Scholar
  19. 19.
    Wu AM, Chi YL, Ni WF (2013) Vertebral compression fracture with intravertebral vacuum cleft sign: pathogenesis, image, and surgical intervention. Asian Spine J 7:148–155.  https://doi.org/10.4184/asj.2013.7.2.148 CrossRefGoogle Scholar
  20. 20.
    Krauss M, Hirschfelder H, Tomandl B, Lichti G, Bar I (2006) Kyphosis reduction and the rate of cement leaks after vertebroplasty of intravertebral clefts. Eur Radiol 16:1015–1021.  https://doi.org/10.1007/s00330-005-0056-6 CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopedics, Beijing Chaoyang HospitalCapital Medical UniversityBeijingPeople’s Republic of China

Personalised recommendations