COMPARISON OF EFFECTIVENESS BETWEEN PERCUTANEOUS VERTEBROPLASTY AND PERCUTANEOUS KYPHOPLASTY FOR TREATMENT OF OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURE WITH INTRAVERTEBRAL VACUUM CLEFT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YUWeibo ^1,2 ,  LIANGDe ¹ , JIANGXiaobing ¹ , YELinqiang ¹ , YAOZhensong ²

1. Department of Spinal Surgery, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China;
2. The First School of Clinical Medicine, Guangzhou University of Chinese Medicine;

Corresponding author：

LIANGDe, Email: spinedrjxb@sina.com

Keywords：

Intravertebral vacuum cleft; Osteoporosis; Vertebral compression fracture; Percutaneous vertebroplasty; Percutaneous kyphoplasty

DOI：

10.7507/1002-1892.20160225

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Objective To compare the clinical efficacy and safety between percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC). Methods Between January 2010 and December 2013, 68 patients with single OVCF and IVC were treated, and the clinical data were retrospectively analyzed. Of 68 patients, 48 underwent PVP (PVP group) and 20 underwent PKP (PKP group). There was no significant difference in age, gender, disease duration, fracture level, bone mineral density (BMD), visual analogue scale (VAS), Oswestry disability index (ODI), and preoperative radiological parameters between 2 groups (P > 0.05). The intraoperative incidence of cement leakage, cement volume, and operative time were compared between 2 groups; VAS score was used for evaluation of back pain and ODI for evaluation of dysfunction; the incidence of adjacent vertebral fracture was observed within 2 years. The vertebral height and kyphotic angle were measured on X-ray films; the rate of vertebral compression (CR), reduction rate (RR), progressive height loss (PHL), reduction angle (RA), and progressive angle (PA) were calculated. Results There was no significant difference in cement volume and the incidence of cement leakage between 2 groups (P > 0.05). The operative time in PVP group was shorter than that in PKP group, showing significant difference (t=-8.821, P=0.000). The mean follow-up time was 2.4 years (range, 2.0-3.1 years). The VAS scores and ODI were significantly reduced at 1 day, 1 year, and 2 years after operation when compared with preoperative scores (P < 0.05), but there was no significant difference between different time points after operation in 2 groups (P > 0.05). Adjacent vertebral fracture occurred in 5 cases (10.4%) of PVP group and in 2 cases (10.0%) of PKP group, showing no significant difference (χ²=0.003, P=0.963). BMD was significantly increased at 1 year and 2 years after operation when compared with preoperative BMD (P < 0.05), but no significant difference was found between 2 groups (t=0.463, P=0.642; t=0.465, P=0.646). The X-ray films showed that CR and kyphotic angle were significantly restored at immediate after operation in 2 groups (P < 0.05); but vertebral height and kyphotic angle gradually aggravated with time, showing significant difference between at immediate and at 1 and 2 years after operation (P < 0.05); there was no significant difference in CR and kyphotic angle between 2 groups at each time point (P > 0.05). RR, RA, PHL, and PA showed no significant difference between 2 groups (P > 0.05). Conclusion There is similar clinical and radiological efficacy between PVP and PKP for treatment of OVCF with IVC. Re-collapse could happen after operation, so strict observation and follow-up are needed.

Citation： YUWeibo, LIANGDe, JIANGXiaobing, YELinqiang, YAOZhensong. COMPARISON OF EFFECTIVENESS BETWEEN PERCUTANEOUS VERTEBROPLASTY AND PERCUTANEOUS KYPHOPLASTY FOR TREATMENT OF OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURE WITH INTRAVERTEBRAL VACUUM CLEFT. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(9): 1104-1110. doi: 10.7507/1002-1892.20160225 Copy

1.	Libicher M, Appelt A, Berger I, et al. The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures:results from a radiological and histological study. Eur Radiol, 2007, 17(9):2248-2252.
2.	Matzaroglou C, Georgiou CS, Wilke HJ, et al. Kümmell's disease:is ischemic necrosis or vertebral "microcracking" the first step in the sequence? Med Hypotheses, 2013, 80(4):505.
3.	Wu AM, Lin ZK, Ni WF, et al. The existence of intravertebral cleft impact on outcomes of nonacute osteoporotic vertebral compression fractures patients treated by percutaneous kyphoplasty:a comparative study. J Spinal Disord Tech, 2014, 27(3):E88-93.
4.	Ha KY, Kim YH. Risk factors affecting progressive collapse of acute osteoporotic spinal fractures. Osteoporos Int, 2013, 24(4):1207-1213.
5.	Fang X, Yu F, Fu S, et al. Intravertebral clefts in osteoporotic compression fractures of the spine:incidence, characteristics, and therapeutic efficacy. Int J Clin Exp Med, 2015, 8(9):16960-16968.
6.	Wu AM, Ni WF, Weng W, et al. Outcomes of percutaneous kyphoplasty in patients with intravertebral vacuum cleft. Acta Orthop Belg, 2012, 78(6):790-795.
7.	Huang Y, Peng M, He S, et al. Clinical efficacy of percutaneous kyphoplasty at hyperextension position for treatment of osteoporotic Kümell's disease. Clin Spinal Surg, 2016, 29(4):161-166.
8.	Kong LD, Wang P, Wang LF, et al. Comparison of vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures with intravertebral clefts. European Journal of Orthopaedic Surgery & Traumatology, 2014, 24(Supplement 1):201-208.
9.	Li D, Wu Y, Huang Y, et al. Risk factors of recompression of cemented vertebrae after kyphoplasty for osteoporotic vertebral compression fractures. Int Orthop, 2016, 40(6):1285-1290.
10.	Niu J, Zhou H, Meng Q, et al. Factors affecting recompression of augmented vertebrae after successful percutaneous balloon kyphoplasty:a retrospective analysis. Acta Radiologica, 2015, 56(11):1380-1387.
11.	Kim YC, Kim YH, Ha KY. Pathomechanism of intravertebral clefts in osteoporotic compression fractures of the spine. Spine J, 2014, 14(4):659-666.
12.	Lin CL, Lin RM, Huang KY, et al. MRI fluid sign is reliable in correlation with osteonecrosis after vertebral fractures:a histopathologic study. Eur Spine J, 2013, 22(7):1617-1623.
13.	Maldague BE, Noel HM, Malghem JJ. The intravertebral vacuum cleft:a sign of ischemic vertebral collapse. Radiology, 1978, 129(1):23-29.
14.	Ratcliffe JF. The arterial anatomy of the adult human lumbar vertebral body:a microarteriographic study. J Anat, 1980, 131(Pt 1):57-79.
15.	Benedek TG, Nicholas JJ. Delayed traumatic vertebral body compression fracture; part II:pathologic features. Semin Arthritis Rheum, 1981, 10(4):271-277.
16.	Dupuy DE, Palmer WE, Rosenthal DI. Vertebral fluid collection associated with vertebral collapse. AJR Am J Roentgenol, 2014, 167(6):1535-1538.
17.	Ito Y, Hasegawa Y, Toda K, et al. Pathogenesis and diagnosis of delayed vertebral collapse resulting from osteoporotic spinal fracture. Spine J, 2002, 2(2):101-106.
18.	Zhang GQ, Gao YZ, Chen SL, et al. Comparison of percutaneous vertebroplasty and percutaneous kyphoplasty for the management of Kümmell's disease:A retrospective study. Indian J Orthop, 2015, 49(6):577-5782.
19.	Heo DH, Chin DK, Yoon YS, et al. Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty. Osteoporos Int, 2009, 20(3):473-480.
20.	Wang H, Sribastav SS, Ye F, et al. Comparison of percutaneous vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures:A meta-analysis of the literature. Pain Physician, 2015, 18(3):209-222.
21.	Krauss M, Hirschfelder H, Tomandl B, et al. Kyphosis reduction and the rate of cement leaks after vertebroplasty of intravertebral clefts. Eur Radiol, 2006, 16(5):1015-1021.
22.	Wang G, Yang H, Chen K. Osteoporotic vertebral compression fractures with an intravertebral cleft treated by percutaneous balloon kyphoplasty. J Bone Joint Surg (Br), 2010, 92(11):1553-1557.
23.	Kim YY, Rhyu KW. Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture. Eur Spine J, 2010, 19(11):1907-1912.

1. Libicher M, Appelt A, Berger I, et al. The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures:results from a radiological and histological study. Eur Radiol, 2007, 17(9):2248-2252.
2. Matzaroglou C, Georgiou CS, Wilke HJ, et al. Kümmell's disease:is ischemic necrosis or vertebral "microcracking" the first step in the sequence? Med Hypotheses, 2013, 80(4):505.
3. Wu AM, Lin ZK, Ni WF, et al. The existence of intravertebral cleft impact on outcomes of nonacute osteoporotic vertebral compression fractures patients treated by percutaneous kyphoplasty:a comparative study. J Spinal Disord Tech, 2014, 27(3):E88-93.
4. Ha KY, Kim YH. Risk factors affecting progressive collapse of acute osteoporotic spinal fractures. Osteoporos Int, 2013, 24(4):1207-1213.
5. Fang X, Yu F, Fu S, et al. Intravertebral clefts in osteoporotic compression fractures of the spine:incidence, characteristics, and therapeutic efficacy. Int J Clin Exp Med, 2015, 8(9):16960-16968.
6. Wu AM, Ni WF, Weng W, et al. Outcomes of percutaneous kyphoplasty in patients with intravertebral vacuum cleft. Acta Orthop Belg, 2012, 78(6):790-795.
7. Huang Y, Peng M, He S, et al. Clinical efficacy of percutaneous kyphoplasty at hyperextension position for treatment of osteoporotic Kümell's disease. Clin Spinal Surg, 2016, 29(4):161-166.
8. Kong LD, Wang P, Wang LF, et al. Comparison of vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures with intravertebral clefts. European Journal of Orthopaedic Surgery & Traumatology, 2014, 24(Supplement 1):201-208.
9. Li D, Wu Y, Huang Y, et al. Risk factors of recompression of cemented vertebrae after kyphoplasty for osteoporotic vertebral compression fractures. Int Orthop, 2016, 40(6):1285-1290.
10. Niu J, Zhou H, Meng Q, et al. Factors affecting recompression of augmented vertebrae after successful percutaneous balloon kyphoplasty:a retrospective analysis. Acta Radiologica, 2015, 56(11):1380-1387.
11. Kim YC, Kim YH, Ha KY. Pathomechanism of intravertebral clefts in osteoporotic compression fractures of the spine. Spine J, 2014, 14(4):659-666.
12. Lin CL, Lin RM, Huang KY, et al. MRI fluid sign is reliable in correlation with osteonecrosis after vertebral fractures:a histopathologic study. Eur Spine J, 2013, 22(7):1617-1623.
13. Maldague BE, Noel HM, Malghem JJ. The intravertebral vacuum cleft:a sign of ischemic vertebral collapse. Radiology, 1978, 129(1):23-29.
14. Ratcliffe JF. The arterial anatomy of the adult human lumbar vertebral body:a microarteriographic study. J Anat, 1980, 131(Pt 1):57-79.
15. Benedek TG, Nicholas JJ. Delayed traumatic vertebral body compression fracture; part II:pathologic features. Semin Arthritis Rheum, 1981, 10(4):271-277.
16. Dupuy DE, Palmer WE, Rosenthal DI. Vertebral fluid collection associated with vertebral collapse. AJR Am J Roentgenol, 2014, 167(6):1535-1538.
17. Ito Y, Hasegawa Y, Toda K, et al. Pathogenesis and diagnosis of delayed vertebral collapse resulting from osteoporotic spinal fracture. Spine J, 2002, 2(2):101-106.
18. Zhang GQ, Gao YZ, Chen SL, et al. Comparison of percutaneous vertebroplasty and percutaneous kyphoplasty for the management of Kümmell's disease:A retrospective study. Indian J Orthop, 2015, 49(6):577-5782.
19. Heo DH, Chin DK, Yoon YS, et al. Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty. Osteoporos Int, 2009, 20(3):473-480.
20. Wang H, Sribastav SS, Ye F, et al. Comparison of percutaneous vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures:A meta-analysis of the literature. Pain Physician, 2015, 18(3):209-222.
21. Krauss M, Hirschfelder H, Tomandl B, et al. Kyphosis reduction and the rate of cement leaks after vertebroplasty of intravertebral clefts. Eur Radiol, 2006, 16(5):1015-1021.
22. Wang G, Yang H, Chen K. Osteoporotic vertebral compression fractures with an intravertebral cleft treated by percutaneous balloon kyphoplasty. J Bone Joint Surg (Br), 2010, 92(11):1553-1557.
23. Kim YY, Rhyu KW. Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture. Eur Spine J, 2010, 19(11):1907-1912.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF EFFECTIVENESS BETWEEN PERCUTANEOUS VERTEBROPLASTY AND PERCUTANEOUS KYPHOPLASTY FOR TREATMENT OF OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURE WITH INTRAVERTEBRAL VACUUM CLEFT

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