Comparison of Percutaneous Kyphoplasty and Pedicle Screw Fixation for Treatment of Thoracolumbar Severe Osteoporotic Vertebral Compression Fracture with Kyphosis

Jun 15, 2021World neurosurgery

Comparing Balloon Spine Repair and Screw Fixation for Severe Spine Fractures with Curved Spine in Osteoporosis

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Abstract

The mean visual analog scale (VAS) score was 2.4 for patients undergoing percutaneous kyphoplasty (PKP) compared to 4.7 for those receiving pedicle screw fixation (PSF).

PKP resulted in a lower mean Oswestry disability index (ODI) score of 44.4% compared to 57.1% for PSF.
At one year of follow-up, the ODI score continued to favor PKP over PSF.
Local kyphotic angle and fractured vertebral body height improved more significantly in the PSF group.
Cement leakage was reported in 113 patients who underwent PKP, along with 29 cases of adjacent new vertebral fractures.
PSF complications included 2 wound infections, 4 pneumonia cases, and 3 instances of asymptomatic screw loosening.

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BACKGROUND: Pedicle screw fixation (PSF) has been considered the preferred surgery for the treatment of severe osteoporotic vertebral compression fracture (sOVCF), and sOVCF was traditionally regarded as a relative contraindication to minimally invasive percutaneous kyphoplasty (PKP). Debate has continued regarding the selection of the best surgical method for sOVCF. In the present study, we compared the efficacy and safety between PKP and PSF.

METHODS: PKP was performed in 376 patients in group 1 and PSF in 121 patients in group 2. The visual analog scale (VAS), Oswestry disability index (ODI), local kyphotic angle, fractured vertebral body height, and complications were evaluated.

RESULTS: In the immediate postoperative analysis, the mean VAS score for group 1 was 2.4, significantly lower than the VAS score of 4.7 for group 2. The mean ODI score was 44.4% for group 1, lower than the ODI score of 57.1% for group 2. In addition, group 1 had had a significantly better ODI score at 1 year of follow-up. The local kyphotic angle and fractured vertebral body height had recovered better in group 2. In group 1, 113 patients had experienced cement leakage, and 29 patients had undergone PKP for adjacent new vertebral fractures. In group 2, 2 patients had developed wound infections, 4 had developed pneumonia, 2 had developed urinary tract infection, 3 had experienced asymptomatic screw loosening, and 7 had undergone PKP to treat new vertebral fractures and 1 had undergone removal of internal fixation because of back pain.

CONCLUSIONS: The results of the clinical and radiological evaluations showed that PKP is comparable to PSF for the treatment of sOVCF with kyphosis, with PKP having the advantages of minimal invasion, quick postoperative pain relief, and functional recovery.

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Comparison of Percutaneous Kyphoplasty and Pedicle Screw Fixation for Treatment of Thoracolumbar Severe Osteoporotic Vertebral Compression Fracture with Kyphosis

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