Use of single and bilateral vertebroplasty and kyphoplasty for severe osteoporotic vertebral compression fracture

Objective To determine the effects of unilateral and bilateral vertebral transpedicular vertebroplasty and kyphoplasty for the treatment of severe osteoporotic vertebral compression fracture. Methods The clinical data of 63 patients with severe osteoporotic vertebral compression fracture, who underwent vertebroplasty or kyphoplasty in our hospital between January 2013 and August 2016, were retrospectively analyzed. The operative time, intraoperative fluoroscopy time, average vertebral bone cement injection volume, bone cement leakage, preoperative and postoperative visual analogue scale (VAS) scores, pain remission rate, and SF-36 health survey questionnaire were recorded. The changes of the vertebral anterior wall, center, and posterior wall vertical height and vertebral kyphosis angle were compared at the baseline, at 3d after the operation, and at the last follow-up. The patients were followed up for 1 year after the operaiton and the time of new vertebral fracture was recorded. Results For the treatment of severe osteoporotic vertebral compression fracture, unilateral transpedicular vertebroplasty was least costly on the operative time and fluoroscopy time. Its bone cement volume per section was less than that of the kyphoplasty, which was the same as the bilateral transpedicular vertebroplasty. The unilateral and bilateral transpedicular vertebroplasty showed more bone cement leakage and the new vertebral fracture time was shorter. The VAS score, physical health comprehensive score and mental health comprehensive score after the operation in the 3 groups were better than those before the operation. Both of the unilateral and bilateral transpedicular vertebroplasty could effectively relieve pain symptoms. The anterior wall, center and posterior wall vertical height significantly increased after the operation compared with those before the operation. The vertebral kyphosis angle in the 3 groups was significantly improved (all P<0.05). Kyphoplasty significantly favored the recovery of anterior wall, center and posterior wall vertical height and improvement of vertebral kyphosis angle. Conclusion For the treatment of severe osteoporotic vertebral compression fracture, vertebroplasty and kyphoplasty may effectively relieve pain symptoms, restore the vertebral body structure and vertebral height. The effect of unilateral and bilateral vertebroplasty is generally the same, with simple operation, short operative time and less cost, whereas the cement leakage rate and the recovery of vertebral height are less than those of kyphoplasty. Key words: Vertebroplasty; Osteoporosis; Compressive fractures