Comparison of percutaneous vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures / 中华放射学杂志

ABSTRACT

ObjectiveTo investigate and compare the efficacy, safety, and cost effectiveness in the treatment of painful osteoporotic vertebral compression fractures ( OVCFs ) with percutaneous vertebroplasty (PVP) and kyphoplasty(PKP). MethodsSeventy-two patients (96 vertebrae) with painful OVCFs were treated by PVP (n ＝34) or PKP (n ＝38) under radiological monitoring. After bone biopsy needle into the compressed vertebra, bone cement (polymethylmethacrylate) was injected in PVP group, and that was inserted followed by the inflation of vertebra to create cavities in PKP group. The fluoroscopy time, total amount of bone cement injected, and cost were recollected respectively. The score of visual analogue scale point( VAS, 10-point scale)was determined at before the procedures, and 24 hours, one week, and one month after the procedures.Pain relief and complications were observed.The Cobb angle and vertebral heights of the anterior, middle, and posterior border were measured pre-and post-operative. ResultsThe two procedures were technically successful in all patients. The follow-up ranged from 1. 0 to 34. 0 months [mean time, (8. 9 ±3.2) months]. The Mean fluoroscopy time of treating per vertebra in PVP group was ( 11. 1 ± 10. 6 ) min, which was significant shorter than that ( 23.5 ± 13. 0) min in PKP group( P ＜0. 05 ).The mean total cost per patient was (5127. 2 ± 502.3 ) yuan in PVP group, which were strikingly lower than that(32 301.4 ±3204. 6) yuan in PKP group (P ＜0. 05).(3)There was no significant difference( P ＞0. 05 ) in average cement volumes in PVP group [ (4. 9 ± 1.1 ) ml]and PKP group [ (5.4 ± 1.7 ) ml]. Pain relief of was observed in 94. 1％ (32/34) of PVP group and in 92. 1％ (35/38) of PKP group. The score of VAS at pre-operation was (8. 3 ±0. 4 vs 7.9 ±0. 8) ,and at post-operative 24 h (2. 9 ±0. 9 vs 2. 8 ± 1. 2),1 week (2.6 ± 0. 9 vs 2.6 ± 1. 1 ), and 1 month (2.6 ± 0. 9 vs 2. 5 ± 1.3 ) were no difference at PKP and PVP group(P ＜0.05). There was significant difference between pre- and post-operative time point in each group. The Cobb angle, anterior and middle height of vertebra was corrected in both PVP and PKP group. In PVP group, the preoperative Cobb angle, anterior and middle height of vertebra was (24. 2 ± 3.8 )°,( 19. 1 ± 1.4) mm, (25. 2 ± 1.0) mm, which was significant different ( P ＜ 0. 05 ) from that of ( 19.4 ±3.9)°, (21.0 ± 1.5) mm, (27.0 ± 1.2) mm at pre-operation.In PKP group,there was significant difference (P ＜ 0. 05 ) in the preoperative Cobb angle, anterior and middle height of vertebra [(25. 1 ±5.0)°vs(10.7 ±2.8)°, (19.5 ± 1.5) mm vs (24.3 ± 1.9) mm, (25.4 ± 1.1) mm vs (29.7 ±1.3) mm, respectively]. As to the above index, the overall correcting effect in PKP was much better than that in PVP( P ＜0. 05 ). Cement leakage occurred in 9 cases in PVP group and 3 cases in PKP group ( P ＜0. 05 ) but no symptoms. There were no major complications during operation in the two groups. Conclusion PVP and PKP are effective and safe in the treatment of painful OVCFs but PVP is more cost effective than PKP.