BACKGROUND

As life expectancy in the population rises, osteoporotic fractures are seen most frequently in the vertebral column. Percutaneous kyphoplasty is increasingly used for pain reduction and stabilization in these patients, but the efficacy, cost-effectiveness, and safety of the procedure remain uncertain.

BACKGROUND

Osteoporosis with subsequent osteoporotic vertebral compression fractures is an increasingly important disease due not only to its significant economic impact but also to the increasing age of our population. Pain reduction and stabilization are of primary importance with osteoporotic vertebral compression fractures.

Objective: Effectiveness and safety of Balloon Kyphoplasty as a method of treatment for osteoporotic vertebral fractures of the thoracolumbar spine.

Materials and Methods: From January 2003 to December 2008, 102 patients (27 males and 75 females), from 56 to 82 years old (mean age 72) were treated with balloon kyphoplasty procedures for 156 osteoporotic vertebral fractures of the thoracic or lumbar spine, in a mean follow up of 24 months (6 to 45 months). The patients had progressive and painful compression fractures more than 2 months. All fractures were analyzed for improvement in sagittal alignment (Cobb angle, kyphotic angle, sagittal index, vertebral height). The patients were evaluated using the visual analog scale (VAS) and the Oswestry Disability Score. Radiographs were performed postoperatively, and at 1, 3, 6, and 12 months.

Results: The score according to pain, the patient’s ability to ambulate independently and without difficulty, and the need for medications improved significantly (P < 0.001) after kyphoplasty. Vertebral height significantly increased at all postoperative intervals, with ≥10% height increases in 88% of fractures. Morphometric height ratios for treated fractures also significantly increased. There were no severe kyphoplasty-related complications, such as neurological defects, cement leakage or narrowing of the spinal canal whereas additional fractures occurred at the adjacent vertebrae at a rate of 10%.

Conclusions: Kyphoplasty provided a safe and effective treatment for pain and disability in patients with vertebral compression fractures due to osteoporosis.

We report a prospective study of 26 cases of fracture of the distal third of the femur treated with the Derby intramedullary nail. This new design controls rotation and allows compression of the fracture, permitting early weight-bearing. All the fractures united in good position within four months, 12 of them with minimal external callus. There were no implant failures and the only serious complication was one case of deep infection.