Early Clinical Outcomes with Kyphoplasty, the Minimally Invasive Reduction and Fixation of Painful Osteoporotic Vertebral Body Compression Fracture VCF

Hansen A. Yuan, MD
Steven R. Garfin, MD (San Diego, CA)
Isador H. Lieberman, MD (Cleveland, Ohio)
Mark A. Reilly MD (Berkeley. CA)
Kenneth Yonemura, MD (Syracuse, NY)

Purpose:

Retrospective review of kyphoplasty treatment for patients immobilized by painful osteoporotic vertebral body compression fractures (VCF).

Methods:

A multi–center retrospective review of our first 30 kyphoplasties was performed. T5–L5 fractures 2–16 weeks old, with pain on examination and marrow edema on MRI, were reduced using Kyphon inflatable bone tamps under fluoroscopic guidance and local or general anesthesia. Hand–mixed PMMA (40 g SimplexP( powder, 10 ml SimplexP( monomer, 200 mg tobramycin, 3 g barium) was injected retrograde under image and volume control. Pain, disability, vertebral height, and T5–L1 kyphosis were measured pre–procedure, post–procedure, and last follow–up.

Results:

52 fractures were treated in 30 procedures for 26 patients (73% female, ave. age, 74). 25 patients were available for follow–up (one died from leukemia). 23/25 (92%) patients reported significant pain relief within hours, and remain independently mobile (follow–up, 3–10 months). Two patients without pain relief did not have pain at the treated levels during follow–up. The average restoration of vertebral body height was: anterior, 45% (n=10), midline, 71% (n=13) and posterior, 54% (n=8). The average reduction in T5–L1 kyphosis was 1 7 degrees (n=6). There were no procedure–related complications, and no cement failures.

Conclusions:

Deformity caused by VCF is associated with functional impairment, reduced lung function and excess pulmonary–related deaths. In this initial series, VCF'S were safely treated by kyphoplasty, resulting in early reduction of pain, disability and deformity. Patients are being followed for longer–term outcomes. These results support further use of kyphoplasty.