Comparison of vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures with intravertebral clefts.

BACKGROUND: Few studies have compared the surgical outcomes of vertebroplasty (VP) and kyphoplasty (KP) in the treatment of osteoporotic vertebral compression fractures (VCFs) with intravertebral clefts. METHODS: A retrospective study was conducted to review patients with a single-level osteoporotic VCF treated by VP or KP. Intravertebral clefts were assessed by preoperative computed tomography (CT) and magnetic resonance scans. All enrolled patients were followed up for 12 months. Clinical outcomes, radiological findings and complications were evaluated. RESULTS: A total of 53 patients were available for data analysis. Most of the fractures (75.5 %) occurred in the region of the thoracolumbar junction (T10-L2). Twenty-four patients received VP and 29 patients received KP. Patients in both group had significant pain relief after surgery (P < 0.01). Compared with VP group, there was a significant lower visual analogue scale (VAS) score in KP group at the 6- (P = 0.04) and 12-month follow-up (P = 0.02), but the decreased values of VAS score had no significant correlation with the magnitude of deformity correction. Restoration of vertebral body height and reduction in kyphotic angle were achieved in both groups, and the magnitude of correction was more significant in KP group (P < 0.01). Cement leakage rate in VP group (66.7 %) was higher than that in KP group (20.7 %), and there was a significant difference (P < 0.01). CONCLUSIONS: Intravertebral clefts occur primarily at the thoracolumbar junction and can be detected easily by CT and magnetic resonance imaging scans. Both VP and KP are effective in the treatment of clefts, but patients in KP group tend to have a better pain relief at the medium and long-term follow-up. However, the better pain relief effect of KP cannot be attributed to the higher magnitude of deformity correction.

Effect of shape and severity of vertebral fractures on the outcomes of kyphoplasty.

UNLABELLED: The aim of this retrospective study was to evaluate the effect of shape and severity of osteoporotic vertebral fractures on the clinical and surgical outcomes of kyphoplasty. Ninety-four patients with single level vertebral fractures were enrolled. Fractures were divided into two types according to the shape of the fractured vertebrae: wedge type (n = 54) or biconcave type (n = 40). All fractures were further classified into 3 grades (grade 1-3) according to their severity. The Visual Analog Score for back pain improved significantly in the "wedge" and in the "biconcave" group: there was no significant difference between groups. Wedge type fractures had a significantly greater correction of anterior vertebral height and kyphotic angle than biconcave type fractures (p < 0.01). Biconcave type fractures had a significantly greater correction of the middle vertebral height (p < 0.01), but had a higher risk of intradiscal cement leakage (p = 0.03). Rates of cement leakage in grade 1, grade 2, and grade 3 fractures were 12.8%, 25.8%, and 50.0%, respectively : there was a gradually higher risk of cement leakage as the severity of compression increased (p < 0.01). CONCLUSION: assessing the shape and severity of fractured osteoporotic vertebrae gives an idea of the potential correction of body height and kyphosis, and of the risk of cement leakage.

Evaluation of conservative treatment and timing of surgical intervention for mild forms of cervical spondylotic myelopathy.

The optimal management approach for patients with mild forms of cervical spondylotic myelopathy (MCSM) has not been well established. The aim of the present study was to investigate the outcome of conservative treatment, identify prognostic factors and provide evidence for the timing of surgical intervention. A total of 90 patients with MCSM attending hospital between February 2007 and January 2009 were prospectively enrolled. Initially, all patients received conservative treatment and were followed up periodically. When a deterioration in myelopathy was clearly identified, surgical treatment was conducted. Clinical and radiological factors correlating with the deterioration were examined, and final clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score. At the end of January 2012, follow-ups of >3 years were completed. Seventy-eight patients were available for data analysis. Only 21 patients (26.9%) deteriorated and underwent surgery thereafter (group A), while the remaining 57 patients (73.1%) were treated conservatively throughout (group B). Statistical analysis revealed that segmental instability and cervical spinal stenosis were adverse factors for the prognosis of conservative treatment. Although the JOA scores of the patients in group A declined initially, following surgical intervention, no significant differences were identified in JOA scores between the two groups at the time of the final follow-up (P=0.46). In summary, conservative treatment is effective in MCSM patients. Patients with segmental instability and cervical spinal stenosis have a tendency to deteriorate, but conservative treatment remains the recommendation for the first action. If the myelopathy deteriorates during conservative treatment, timely surgical intervention is effective.