Kyphoplasty Treatment and Patient Results

In this presentation, Dr. Lieberman explains the differences between traditional forms of treatment and vertebroplasty and kyphoplasty. It is an interesting analysis!

Kyphoplasty's Development
Surgeons at the Cleveland Clinic have been instrumental in the development and clinical evaluation of the kyphoplasty procedure. Since August 1998, over 300 patients and 750 vertebral bodies have been treated. In the initial phase one Institutional Review Board (IRB) approved study, published in Spine (Lieberman et al, Spine Vol 26 No 14 July 2001), 70 consecutive kyphoplasty procedures were performed in 30 patients over 38 sessions. The indications included painful primary (19 patients) or secondary (5 patients) osteoporotic vertebral compression fractures for a total of 24 patients who did not improve with traditional non-operative treatment modalities.

A further 6 patients presented with painful compression fractures due to multiple myeloma (tumor). The duration of symptoms was 5.9 months (range 0.5 - 24). The symptomatic levels were identified by correlating the clinical data with MRI findings of bone marrow signal changes consistent with compression fractures. The outcome data were obtained by comparing pre-operative and latest post-operative SF-36 data (a functional survey).

Study Outcomes
In this study, all 30 patients tolerated the procedure well, and improvement in pain and mobility was seen early. Virtually all patients subjectively reported immediate relief of their typical fracture pain, and no patient complained of worse pain at the treated levels.

The levels treated ranged from T6 to L5 (sixth thoracic through fifth lumbar vertebrae), with the majority at the thoracolumbar junction (where the thoracic and lumbar regions of the spine meet).

Restoration of vertebral height and spinal alignment was measured using x-rays. Analysis of all 70 levels treated (regardless of fracture age) demonstrated that in 70% of the vertebral bodies, kyphoplasty, on average, restored 47% of the lost height. Cement leakage did occur into the veins around the vertebrae in only 6 vertebral bodies (8%) in the early cases.

Functional survey (SF-36) scores for bodily pain, physical function, role physical, vitality and mental health all showed statistically significant improvement either reaching or approaching the age-matched SF-36 historical controls.

At final follow up there were no major complications related directly to use of this technique or the inflatable bone tamp. In an on-going evaluation of over 300 patients, the results of this initial series have been maintained out to an average follow-up of over 12 months.

Conclusions
These results show that both vertebroplasty and kyphoplasty are well-tolerated procedures associated with pain relief in the treatment of painful progressive osteoporotic or osteolytic vertebral compression fractures. Both are tools in the surgeon's treatment toolbox. Their exact indications are still being evaluated. Kyphoplasty seems to have the advantage of being able to restore spinal alignment and is associated with a much lower rate of cement leaks. Like the treatment of any other broken bone, it appears that early intervention provides the most predictable results for pain relief and vertebral body height restoration.

For information about Dr. Lieberman’s practice: Click Here