Outcomes of different minimally invasive surgical treatments for vertebral compression fractures: An observational study

Abstract

BACKGROUND Osteoporosis with vertebral compression fractures is increasingly common in the elderly population. Cement augmentation is one of the effective surgical treatments for these patients. Currently, there are several different types of cement augmentation treatments. No studies have compared the safety and efficacy of different cement augmentation types for the treatment of such fractures; thus, we retrospectively compared vertebroplasty, balloon kyphoplasty, and kyphoplasty with SpineJack or an intravertebral expandable pillar. AIM To compare the postoperative safety and efficacy of each surgical intervention in treating vertebral compression fractures. METHODS We retrospectively analyzed 354 patients with acute vertebral compression fractures, defined as signal changes in the T1 weighted magnetic resonance imaging, and randomly divided the patients into five groups. Their visual analog scale scores for pain, kyphotic angle, average body height, rate of cement leakage, and occurrence of adjacent vertebral compression fractures were followed for 1 year. One-way analysis of variance, the post hoc Bonferroni test, and Fisher exact probability test were used for statistical analyses. RESULTS All pain scores significantly improved 12 mo postoperatively; however, there was no significant difference between the groups (P= 0.325). Kyphoplasty with SpineJack significantly reduced the kyphotic angle (P= 0.028) and restored the height of the vertebral body (P= 0.02). The rate of adjacent compression fractures was the highest in the vertebroplasty group, with a statistically significant difference according to the Fisher exact probability test (P= 0.02). The treatment with the lowest cement leakage rate cannot be identified because of the small sample size; however, kyphoplasty with SpineJack, an IVEP, and vesselplasty resulted in lower rates of cement leakage than balloon kyphoplasty and vertebroplasty. CONCLUSION Kyphoplasty with SpineJack has good outcomes in kyphotic angle reduction and body height restoration. Vertebroplasty has the highest cement leakage rate and adjacent compression fracture occurrence.