Balloon Kyphoplasty Versus Conservative Treatment for Acute Osteoporotic Vertebral Fractures With Poor Prognostic Factors Propensity Score Matched Analysis Using Data From Two Prospective Multicenter Studies
- 14 January 2019
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Spine
- Vol. 44 (2), 110-117
- https://doi.org/10.1097/BRS.0000000000002769
Abstract
Study Design. A multicenter, prospective, single-arm, intervention study. Objective. The aim of this study was to investigate efficacy of balloon kyphoplasty (BKP) for acute osteoporotic vertebral fractures (OVFs) in patients with poor prognostic factors. Summary of Background Data. The indications for BKP remain unclear. Characteristic magnetic resonance imaging (MRI) findings (high-intensity or diffuse low-intensity area in fractured vertebrae on T2-weighted images) were reportedly predictive of delayed union. Methods. This study enrolled 106 patients with poor prognostic MRI findings who underwent BKP within 2 months after injury, and 116 controls with acute OVFs and the same poor prognostic factors who underwent conservative treatment. Patients were propensity score matched in a logistic regression model adjusted for age, sex, number of baseline old fractures, and fracture level. The primary outcome was reduction in activities of daily living (ADLs) at 6 months after fracture, and the secondary outcomes were improvement in short-form (SF)-36 subscales, back pain visual analog scale (VAS) score, and vertebral body deformity. Results. A decrease in ADLs occurred in 5.6% of patients in the BKP group and 25.6% of patients in the conservative treatment group (P<0.001). The SF-36 vitality subscale score improved by 26.9 +/- 25.9 points in the BKP group and 14.5 +/- 29.4 points in the control group (P = 0.03). The VAS pain score improved by 43.4 +/- 34.4 in the BKP group and 52.2 +/- 29.8 in the control group (P = 0.44). The vertebral body wedge angle improved by 5.5 +/- 6.28 in the BKP group and +/- 6.3 +/- 5.08 in the control group (P<0.0001). The percent vertebral body height improved by 15.2 +/- 19.2% in the BKP group and +/- 20.6 +/- 14.2% in the control group (P<0.0001). Conclusion. ADLs, quality of life, and vertebral deformity showed greater improvement with BKP intervention for acute OVF with poor prognostic factors than with conservative treatment at 6 months after injury. Our treatment strategy uses BKP intervention according to the presence or absence of poor prognostic MRI findings.Keywords
This publication has 27 references indexed in Scilit:
- Impact of Initial Conservative Treatment Interventions on the Outcomes of Patients With Osteoporotic Vertebral FracturesSpine, 2013
- Cement leakage as a possible complication of balloon kyphoplasty—is there a difference between osteoporotic compression fractures (AO type A1) and incomplete burst fractures (AO type A3.1)?Acta Neurochirurgica, 2011
- Characteristic Radiographic or Magnetic Resonance Images of Fresh Osteoporotic Vertebral Fractures Predicting Potential Risk for NonunionSpine, 2011
- Balloon kyphoplasty for the treatment of acute vertebral compression fractures: 2-year results from a randomized trialJournal of Bone and Mineral Research, 2011
- Twelve-Months Follow-up in Forty-Nine Patients With Acute/Semiacute Osteoporotic Vertebral Fractures Treated Conservatively or With Percutaneous VertebroplastySpine, 2010
- Nationwide survey of current medical practices for hospitalized elderly with spine fractures in JapanJournal of Orthopaedic Science, 2010
- Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fractureEuropean Spine Journal, 2009
- Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trialThe Lancet, 2009
- Balloon Kyphoplasty and Vertebroplasty for Vertebral Compression FracturesSpine, 2006
- An estimate of the worldwide prevalence and disability associated with osteoporotic fracturesOsteoporosis International, 2006