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PubMed2004

Balloon kyphoplasty for the treatment of pathological vertebral compressive fractures.

BACKGROUND: Previous clinical studies have shown the safety and effectiveness of balloon kyphoplasty in the treatment of pathological vertebral compression fractures (VCFs). However, they have not dealt with the impact of relatively common comorbid conditions in this age group, such as spinal stenosis, and they have not explicitly addressed the use of imaging as a prognostic indicator for the restoration of vertebral body height. Neither have these studies dealt with management and technical problems related to surgery, nor the effectiveness of bone biopsy during the same surgical procedure. This is a prospective study comparing preoperative and postoperative vertebral body heights, kyphotic deformities, pain intensity (using visual analogue scale) and quality of life (Oswestry disability questionnaire) in patients with osteoporotic vertebral compression fractures (OVCFs) and osteolytic vertebral tumors treated with balloon kyphoplasty. METHODS: Thirty-two consecutive patients, 27 OVCFs (49 vertebral bodies [VBs]) and 5 patients suffering from VB tumor (12 VBs) were treated by balloon kyphoplasty. The mean age was 68.2 years. All patients were assessed within the first week of surgery, and then followed up after one, three and six months; all patients (27 OVCFs and 5 tumor patients) were followed up for 12 months, 17 patients (14 OVCFs and 3 tumors) were followed up for 18 months and 9 patients (8 OVCFs and 1 tumor) were followed up for 24 months (mean follow up 18 months). The correction of kyphosis and vertebral heights were measured by comparing preoperative and postoperative radiographic measurements. RESULTS: Thirty-one patients (96.9%) exhibited significant and immediate pain improvement: 90% responded within 24 h and 6.3% responded within 5 days. Daily activities improved by 53% on the Oswestry scale. In the OVCF group, kyphosis correction was achieved in 24/27 patients (89.6%) with a mean correction of 7.6 degrees . Anterior wall height was restored in 43/49 VBs (88%) (mean increment of 4.3 mm), and mid vertebral body height was restored in 45/49 VBs (92%) (mean increment of 4.8 mm). Edema (high intensity signal) on short tau inversion recovery (STIR) was evidenced in all OVCF patients who experienced symptoms for less than nine months and was associated with correction of deformity. Cement leakage was the only technical problem encountered; it occurred in 5/49 VBs (10.2%) of the osteoporotic group and 1/12 VBs (8.3%) of the tumor group but had no clinical consequences. The incidence of leakage to the anterior epidural space was 2%. Spinal stenosis was present in three patients (11.1%) who responded successfully to subsequent laminectomy. Retrieval of tissue samples for biopsy was successful in 10/15 cases (67%). New fractures occurred in the adjacent level in 2/27 OVCF patients (7.4%). CONCLUSIONS: Associated spinal stenosis with OVCF should not be overlooked; STIR MRI is a good predictor of deformity correction with balloon kyphoplasty. The prevalence of a new OVCF in the adjacent level is low.

Aged↗

PubMed1993

Contrast-enhanced MRI of healed pathologic vertebral compression fracture mimicking active disease in a patient treated for lymphoma.

Despite the valuable contribution of MRI, the distinction between benign and malignant compression fractures of the spine is sometimes difficult, and cannot with certainty be based on T1- and T2-weighted signal criteria alone, or on the configuration of the compression fracture. This case report demonstrates that in certain instances neither can gadolinium enhancement specifically make this determination in cases of treated malignancy of the spinal column. Because treated neoplasia having benign histologic characteristics may continue to enhance with IV gadolinium, biopsy evaluation must be undertaken in this setting in order to prove the diagnosis.

Bone Marrow↗

PubMed2004

Percutaneous vertebroplasty for malignant compression fractures with epidural involvement.

PURPOSE: To evaluate safety and effectiveness of performance of percutaneous vertebroplasty (PVP) in patients with malignant compression fractures and involvement of the epidural space. MATERIALS AND METHODS: PVP was performed in 50 patients with metastatic disease or multiple myeloma between June 1998 and April 2002. Twenty-five women (mean age, 62.3 years; range, 38-85 years) and 25 men (mean age, 63.1 years; range, 37-92 years) were included. Cases were retrospectively reviewed. Patients who had undergone cross-sectional imaging were classified into three groups. First group had no epidural involvement; second group, mild epidural involvement without contact with spinal cord or nerve roots; third group, moderate involvement and contact with spinal cord or nerve roots. Procedural safety was evaluated with review of all post-PVP complications and their treatment. Effectiveness was evaluated with follow-up phone calls for assessment of change in pain level and activity after PVP. Follow-up calls were performed at 1 day; 2 weeks; 1, 3, and 6 months; and 1 and 2 years. Differences between groups were assessed with singly ordered Kruskal-Wallis test. RESULTS: Fourteen patients were classified in the first group, 18 in the second, and 18 in the third. There were no significant differences in pain or mobility outcomes among groups. At the last follow-up call, 41 (82%) of 50 patients reported improvement in pre-PVP pain. Six (12%) reported no change, and three (6%) reported increased pain. After PVP in 26 (52%) patients, there was a period of increased mobility; in 19 (38%), no improvement in mobility occurred; and in five (10%), decreased mobility was reported. Complications included acute increased pain or new areas of pain in seven (14%) patients. None of these required surgery; four were treated with nerve root block; two, with central epidural injection; and one, with overnight intravenous steroids. CONCLUSION: PVP can be performed safely and effectively with conscious sedation in patients with malignant compression fractures and epidural involvement.

Adult↗

PubMed1991

Vertebral compression fractures at the onset of acute lymphoblastic leukemia in a child.

A child with acute lymphoblastic leukemia, spinal osteoporosis with vertebral compression fractures, and hypercalcemia appearing early in the course of the hematologic disease was followed for two and a half years. Bone mineral density (BMD), measured by single photon absorptiometry at the radial shaft, was within normal limits for age and sex. However, x-rays of vertebrae and vertebral BMD, measured by dual photon absorptiometry, showed marked demineralization. Despite leukemic remission, the spinal osteoporosis became worse and the patient required aggressive treatment for eight months. Treatment included 50 units of calcitonin subcutaneously every other day, 1,000 mg/day of oral calcium, and 3,000 IU/day of vitamin D. The back pain disappeared quickly, and laboratory controls showed a significant diminution of bone turnover. No new compression fractures occurred. Eighteen months later, the patient continued in remission and menarche had occurred. Dual photon absorptiometry revealed a significant "catch up" of the lumbar spine BMD. X-ray examination showed a marked remodeling of the vertebral bodies. BMD measurements in this child indicate that bone loss affected the trabecular bone compartment or occurred only at active bone marrow sites. The rapid clinical amelioration and objective biochemical, densitometric, and radiologic evidence of bone improvement warrant further clinical trials on similarly affected patients.

Back Pain↗

PubMedDate not supplied

Intrathecal infusion of bupivacaine with or without buprenorphine relieved intractable pain in three patients with vertebral compression fractures caused by osteoporosis.

BACKGROUND AND OBJECTIVES: At present, there is no reliable method of relieving "refractory" pain in patients with compression fractures of the vertebral bodies caused by osteoporosis. We explored the possibility of relieving this type of pain by intrathecal (i.t.) infusion of bupivacaine with or without buprenorphine. METHODS: An 18-g nylon i.t. catheter was inserted via a lumbar interspace with its tip positioned at the level of the fractured vertebra from which the maximal pain originated. Bupivacaine (2.375-5.0 mg/mL) with (n = 1) or without (n = 2) buprenorphine (0.015 mg/mL) was infused through the i.t. catheter from an external electronic pump. The infusion began in the operating room at a basic rate of 0.1-0.2 mL/h, with optional bolus doses (0.1 mL, 1-4 times/h) via patient controlled analgesia. The daily dose of i.t. bupivacaine was adjusted to provide satisfactory pain relief [visual analogue scores (VAS) = 0-2 on a scale of 0-10]. RESULTS: Satisfactory pain relief was obtained with daily doses of i.t. bupivacaine ranging from 10 to 70 (mean approximately 25) mg and buprenorphine from 0.02 to 0.2 (mean = 0.15) mg. The duration of i.t. treatment was 37, 387, and 407 days, respectively. Two patients terminated the i.t. treatment when it was no longer needed. Treatment was discontinued in the third patient because of death caused by irreversible heart failure. The 2 surviving patients were still free of pain 1,074 and 1,476 days after termination of the i.t. treatment. No severe complications occurred. CONCLUSIONS: Continuous intrathecal infusion of bupivacaine, with or without buprenorphine, appeared to be an effective method for the long-term treatment (months to > 1 year) of "refractory" pain from vertebral compression fractures, in this small group of patients.

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PubMed2005

[Percutaneous vertebroplasty for osteoporotic vertebral compression fractures: experiences and prospective clinical outcome in 26 consecutive patients with 50 vertebral fractures].

PURPOSE: Prospective evaluation of vertebroplasty for osteoporotic compression fractures concerning pain reduction, demand of analgesics and quality of life. MATERIAL AND METHODS: In 26 consecutive patients, 50 vertebral fractures were treated by percutaneous vertebroplasty under fluoroscopic (n = 44) or combined fluoroscopic/CT guidance (n = 6). Prospective follow-up was performed after 6 (for 50 vertebral fractures) and 12 months (for 27 vertebral fractures). Visual analogue scale (VAS) and numeric rating scale (NRS) was applied for the assessment of pain. Subjective quality of life and analgesics demand was documented semi-quantitatively. RESULTS: Mean interval from the beginning of pain symptoms to therapy was 8.5 weeks. Vertebroplasty was technically successful in all evaluated patients. Pain severity decreased from 10 (defined at baseline as initial pain score) to 2.8 after 6 months and 2.7 after 12 months. Subjective quality of life was reported as very well, well or improved in 92 % (n = 26 after 6 months) or 100 % (n = 13 after 12 months). No need for additional analgesic therapy was observed in 69.3 % (n = 26) after 6 months and 61.5 % (n = 13) after 12 months. Eight newly developed vertebral fractures were observed during follow-up, with 5 fractures directly adjacent to previously treated vertebrae. Leakage of polymethyl methacrylate (PMMA) into the intervertebral space or spinal canal was observed in 22 % and 20 % respectively (n = 50 vertebrae) . No neurologic deterioration or complications requiring surgery were observed. CONCLUSION: Vertebroplasty is a successful therapeutic approach for the treatment of osteoporotic vertebral fractures. Persistent improvement of clinical symptoms was shown at follow-up after 6 and 12 months.

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PubMed2005

Kyphoplasty for salvage of a failed vertebroplasty in osteoporotic vertebral compression fractures: case report and surgical technique.

Osteoporotic vertebral compression fractures are a significant source of morbidity. Recently described techniques of vertebroplasty and kyphoplasty have provided consistent successful outcomes in the short term. However, techniques to address the failure of vertebroplasty have not been addressed. We present two cases of failed vertebroplasty that were revised with a kyphoplasty technique. Both patients had near complete resolution of preoperative symptoms and had a significant vertebral height restoration more than 10 months after revision with kyphoplasty. In conclusion, kyphoplasty technique can be utilized to salvage failed vertebroplasty.

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PubMed2003

Reporting height restoration in vertebral compression fractures.

STUDY DESIGN: Prospective radiographic analysis of vertebral compression fractures (VCFs) that underwent vertebroplasty. OBJECTIVE: Illustrate the variability in apparent magnitude of vertebral height restoration when this outcome is reported by four different methods commonly used in the vertebroplasty literature. Propose a consensus method for reporting vertebral height restoration. SUMMARY OF BACKGROUND DATA: Measuring and reporting height restoration of fractured vertebrae presupposes a consensus of method that does not exist. Lack of consensus makes the interpretation of reports and comparison of outcomes of interventions that claim vertebral height restoration difficult. MATERIALS AND METHODS: Preoperative and postoperative standing lateral radiographs of 65 VCFs in 41 patients were compared to assess operative vertebral height restoration. Restorations of vertebral height occurred in 23 instances and were reported by each of the following commonly used methods: (1) absolute restoration in millimeters; (2) percent restoration relative to initial fracture height; (3) percent restoration relative to lost vertebral height; and (4) percent restoration relative to referent vertebral height. RESULTS: Apparent magnitude of height restoration varied nearly four-fold depending on initial fracture severity and reporting method. CONCLUSIONS: Substantial apparent variability in the reported magnitude of identical height restorations demonstrates the need for a consensus method for measuring, reporting, and interpreting this outcome. Rationale is presented to support the recommendation that reports of vertebral height restoration should: include all index vertebral height dimensions (posterior (Hp), middle (Hm) and anterior (Ha) vertebral height); include absolute measurements of all referent vertebral heights; be reported relative to a referent normative height; include a correction for inter-radiographic measurement error; take into consideration the dynamic mobility of some osteoporotic VCFs; and include the calculated precision error for all measurements.

Humans↗

PubMed2002

Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures.

OBJECT: The use of polymethylmethacrylate (PMMA) cement by percutaneous injection in cases requiring vertebroplasty provides pain relief in the treatment of osteoporotic vertebral compression fractures. A retrospective study was performed to assess what caused PMMA cement to leak into the epidural space and to determine if this leakage caused any changes in its therapeutic benefits. METHODS: Polymethylmethacrylate was injected into 347 vertebral compression fractures in 159 patients. The cement leaked into the epidural space in 92 (26.5%) of 347 treated vertebrae in 64 (40.3%) of the 159 patients, as demonstrated on postoperative computerized tomography scanning. Epidural leakage of PMMA cement occurred more often when injected above the level of T-7 (p = 0.001) than below. The larger the volume of PMMA injected the higher the incidence of epidural leakage (p = 0.03). Using an injector also increased epidural leakage (p = 0.045). The position of the needle tip within the vertebral body and the pattern of venous drainage did not affect epidural leakage of the cement. Leakage of PMMA into the epidural space reduced the pain relief expected after vertebroplasty. The immediate postoperative visual analog scale scores were higher (and therefore reflective of less pain relief) in patients in whom epidural PMMA leakage occurred (p = 0.009). Three months postoperatively, the authors found the highest number of patients presenting with pain relief, including those in the group with epidural leakage, and at this follow-up stage there were no significant differences between the two groups. CONCLUSIONS: The authors found that epidural leakage of PMMA after percutaneous vertebroplasty was dose dependent. The larger amount of injected PMMA, the higher the incidence of leakage. Injecting vertebral levels above T-7 also increased the incidence of epidural leakage. Epidural leakage of PMMA may attenuate only the immediate therapeutic effects of vertebroplasty.

Dose-Response Relationship, Drug↗

PubMed2006

Intravenous pamidronate for pain relief in recent osteoporotic vertebral compression fracture: a randomized double-blind controlled study.

INTRODUCTION: We performed a randomized, double-blind, controlled clinical trial comparing intravenous pamidronate and placebo for pain relief in recent osteoporotic vertebral compression fractures (VCF). METHODS: Patients suffered from recent (<21 days), painful, osteoporosis-related VCF. They were randomized to receive daily intravenous infusions of either placebo or 30 mg pamidronate for three consecutive days (total pamidronate: 90 mg). The main criterion for efficacy was improvement in standing pain on a 100-mm visual analogical scale (VAS) at day 7. Secondary criteria were standing pain at days 3 and 30; supine pain at days 3, 7, and 30; patients' overall assessment of improvement; mobility index; and number of "20% responders" and "50% responders" (respectively, 20% and 50% improvement in standing pain at days 7 and 30). Statistical analysis with non-parametric tests was carried out on an intention to treat basis. RESULTS: Thirty-two patients were enrolled in the study; 16 were given placebo and 16 pamidronate. Thirty-one patients were evaluated at day 7 and 26 patients at day 30. VAS pain decreased significantly in both groups at day 7 (placebo -23 mm, pamidronate -42 mm, p<0.01). The difference in pain scores between groups was -23.25 mm (confidence interval (CI) [-42.3; -4.2], p=0.018) at day 7 and -26 mm at day 30 (p=0.03), in favor of pamidronate. At day 7, there were 4 versus 12 "50% responders," respectively, in the placebo and in the pamidronate groups (likelihood ratio: 8.372; p=0.004) and 9 versus 14 "20% responders" (likelihood ratio: 4.038; p=0.044). At day 30, there were 5 versus 10 "50% responders," respectively, in the placebo and in the pamidronate groups, and 7 versus 11 "20% responders." Patients' overall assessment of improvement at day 7 was 37+/-26 mm in the placebo group and 59+/-30 mm in the pamidronate group (p=0.019), and 42+/-26 mm and 72+/-21 mm at day 30 (p=0.07). The two groups did not differ significantly at days 7 and 30 for supine pain, Schober index, or finger-ground distance. No significant adverse reaction related to treatment occurred. CONCLUSION: Pamidronate provides rapid and sustained pain relief in patients with acute painful osteoporotic VCF and is well tolerated. Further investigations are needed to better define the place of pamidronate in the management of painful recent osteoporotic collapse.

Acute Disease↗

PubMed2006

Vertebral height restoration in osteoporotic compression fractures: kyphoplasty balloon tamp is superior to postural correction alone.

INTRODUCTION: Kyphoplasty has been shown to restore vertebral height and sagittal alignment. Proponents of vertebroplasty have recently demonstrated that many vertebral compression fractures (VCFs) are mobile and positional correction can lead to clinically significant height restoration. The current investigation tested the hypothesis that positional maneuvers do not achieve the same degree of vertebral height correction as kyphoplasty balloon tamps for the reduction of low-energy VCFs. METHODS: Twenty-five consecutive patients with a total of 43 osteoporotic VCFs were entered into a prospective analysis. Each patient was sequentially evaluated for postural and balloon vertebral fracture reduction. Preoperative standing and lateral radiographs of the fractured vertebrae were compared with prone cross-table lateral radiographs with the patient in a hyper-extension position and on pelvic and sternal rolls. Following positional manipulation, patients underwent a unilateral balloon kyphoplasty. Postoperative standing radiographs were evaluated for the percentage of height restoration related to positioning and balloon kyphoplasty. RESULTS: In the middle portion of the vertebrae, the percentage available for restoration restored with extension positioning was 10.4% (median 11.1%) and after balloon kyphoplasty was 57.0% (median 62.2%). This difference was statistically significant (p<0.001). Thus, kyphoplasty provided an additional 46.6% of the height available for restoration from the positioning alone. With operative positioning, 51.2% of VCFs had >10% restoration of the central portion of the vertebral body, whereas 90.7% of fractures improved at least 10% following balloon kyphoplasty (p<0.002). CONCLUSION: Although this study supports the concept that many VCFs can be moved with positioning, balloon kyphoplasty enhanced the height reduction >4.5-fold over the positioning maneuver alone and accounted for over 80% of the ultimate reduction. If height restoration is the goal, kyphoplasty is clearly superior in most cases to the positioning maneuver alone.

Aged↗

PubMed2002

Characterization of benign and metastatic vertebral compression fractures with quantitative diffusion MR imaging.

BACKGROUND AND PURPOSE: Conventional imaging techniques cannot be used to unambiguously and reliably differentiate malignant from benign vertebral compression fractures. Our hypothesis is that these malignant and benign vertebral lesions can be better distinguished on the basis of tissue apparent diffusion coefficients (ADCs). The purpose of this study was to test this hypothesis by using a quantitative diffusion imaging technique. METHODS: Twenty-seven patients with known cancer and suspected metastatic vertebral lesions underwent 1.5-T conventional T1-weighted, T2-weighted, and contrast-enhanced T1-weighted imaging to identify the lesions. Diffusion-weighted images of the areas of interest were acquired by using a fast spin-echo diffusion pulse sequence with b values of 0-250 s/mm(2). The abnormal regions on the diffusion-weighted images were outlined by using the conventional images as guides, and the ADC values were calculated. On the basis of pathologic results and clinical findings, the cases were divided into two categories: benign compression fractures and metastatic lesions. The ADC values for each category were combined and plotted as histograms; this procedure was followed by statistical analysis. RESULTS: The patient group had 12 benign fractures and 15 metastases. The mean ADC values, as obtained from the histograms, were (1.9 +/- 0.3) x 10(-4) mm(2)/s and (3.2 +/- 0.5) x 10(-4) mm(2)/s for metastases and benign fractures, respectively. CONCLUSION: Our results indicate that quantitative ADC mapping, instead of qualitative diffusion-weighted imaging, can provide valuable information in differentiating benign vertebral fractures from metastatic lesions.

Adult↗

PubMed1986

Lateral compression fractures of the pelvis: the importance of plain radiographs in the diagnosis and surgical management.

The management of pelvic fractures varies according to the nature of the disruptive force and hence the type of injury. Stabilization with compression devices or slings, which may be warranted in some injuries are contraindicated in lateral compression fractures due to the exacerbation of pelvic collapse they will induce. The diagnosis of this type of fracture is therefore of the utmost importance, and yet is frequently missed due largely to ignorance of this type of injury and its significance. Despite mention of this entity in surgical publications, there is a paucity of information in the radiologic literature, and no definitive radiologic appearances have been described. Forty-three patients with lateral compression fractures admitted to the Shock Trauma Unit of the University of Maryland were studied, and the radiologic features, together with diagnostic signs specific to this injury are presented.

Fracture Fixation↗

PubMed1997

Vertebral compression fractures in pediatric patients with Crohn's disease.

Osteoporosis is known to be a significant complication of Crohn's disease in adult patients. The association of osteoporosis and the development of vertebral compression fractures is well delineated. This case report describes 5 pediatric patients with Crohn's disease in whom vertebral compression fractures associated with a marked reduction in bone density developed. As in adults, the association of osteoporosis and Crohn's disease in pediatric patients is multifactorial, including corticosteroid use, calcium and vitamin D homeostasis, malnutrition, alteration in sex hormones, and site of disease. At the time of diagnosis of the vertebral fractures, the patients' ages ranged from 10.6 to 16.8 years, they had persistent and severe back pain, and 3 of 5 patients had a decrease in height. They were taking 13.7-41.6 mg/day of corticosteroid, and all 5 patients had terminal ileal involvement. Bone mineral density measured by dual-energy x-ray absorptiometry was well below 2SD from the mean in all patients (z-score, -2.31 to -5.11). Because of the high morbidity and mortality associated with fractures that result from low bone mineral density, medical care of all pediatric patients with Crohn's disease should include an evaluation of bone mineral density.

Adolescent↗

PubMed2005

Static and fatigue mechanical behavior of bone cement with elevated barium sulfate content for treatment of vertebral compression fractures.

The use of bone cement to treat vertebral compression fractures in a percutaneous manner requires placement of the cement under fluoroscopic image guidance. To enhance visualization of the flow during injection and to monitor and prevent leakage beyond the confines of the vertebral body, the orthopedic community has described increasing the amount of radiopacifier in the bone cement. In this study, static tensile and compressive testing, as well as fully reversed fatigue testing, was performed on three PMMA-based bone cements. Cements tested were SimplexP with 10% barium sulfate (Stryker Orthopedics, Mahwah, NJ) which served as a control; SimplexP with 36% barium sulfate prepared according to the clinical recommendation of Theodorou et al.; and KyphX HV-R with 30% barium sulfate (Kyphon Inc., Sunnyvale, CA). Static tensile and compressive testing was performed in accordance with ASTM F451-99a. Fatigue testing was conducted in accordance with ASTM F2118-01a under fully reversed, +/-10-, +/-15-, and +/-20-MPa stress ranges. Survival analysis was performed using three-parameter Weibull modeling techniques. KyphX HV-R was found to have comparable static mechanical properties and significantly greater fatigue life than either of the two control materials evaluated in the present study. The static tensile and compressive strengths for all three PMMA-based bone cements were found to be an order of magnitude greater than the expected stress levels within a treated vertebral body. The static and fatigue testing data collected in this study indicate that bone cement can be designed with barium sulfate levels sufficiently high to permit fluoroscopic visualization while retaining the overall mechanical profile of a conventional bone cement under typical in vivo loading conditions.

Barium Sulfate↗

PubMed1981

Delayed traumatic vertebral body compression fracture; part I: clinical features.

We have described three patient who sustained trauma to their spines followed by persisting pain. Initial radiographs were negative, but on subsequent examinations compression fractures were demonstrated. This sequence of events resembles the clinical picture described by Kümmell in 1895 with significant differences. A plethora of early written description with minimal radiographic documentation suggests that this is a relatively rare condition. It is appropriate, therefore, to present these cases with the suggestion that traumatic injuries with persisting thoracic or upper lumbar back pain should be followed up radiographically in order to demonstrate the occurrence of subsequent compression fractures. These fractures may be treated with simple braces.

Aged↗

PubMed1977

Compression fractures of the thoracic and lumbar spine from compensable injuries.

Compression fractures of the thoracic and lumbar spine have a worse prognosis than is commonly realized. A study of 142 patients with this type of injury reveals several important features which affect the long term prognosis in these injuries. Severe compression, comminution, disc space narrowing adjacent to the fracture site, a low anatomical level of the fracture site, a low anatomical level of the fracture, and body cast immobilization in those with mild or moderate type fractures, are some of the factors associated with persistent long term back problems.

Adolescent↗

PubMed2006

Balloon kyphoplasty for symptomatic vertebral body compression fractures results in rapid, significant, and sustained improvements in back pain, function, and quality of life for elderly patients.

STUDY DESIGN: Prospective, single-arm interventional cohort. OBJECTIVE: To evaluate the safety and effectiveness of balloon kyphoplasty to treat symptomatic vertebral body compression fractures (VCFs). SUMMARY OF BACKGROUND DATA: VCFs treated nonoperatively can diminish function and quality of life, and lead to chronic health effects. The short-term safety and effectiveness of balloon kyphoplasty for symptomatic VCFs are well-documented, but long-term follow-up is needed. METHODS: A total of 155 elderly patients with symptomatic VCFs were enrolled in a prospective, multicenter treatment study of balloon kyphoplasty at 19 geographically diverse US centers. Outcomes included back pain severity, bedrest, and limited activities because of back pain, back disability score, and SF-36 Medical Outcomes Survey, at 7 days (visual analog scale only), and 1, 3, 12, and 24 months after treatment. RESULTS: Patients reported severe back pain (15/20 on visual analog scale) interfering with daily activities 90% of days per month before kyphoplasty. Physical functioning and quality of life were also markedly impaired. Statistically significant (P < 0.001) improvements occurred in all pain, functional, and mental health outcomes at the first follow-up after treatment and were maintained for 24 months. CONCLUSIONS: Elderly patients with symptomatic VCFs had rapid, significant, and sustained improvements in back pain, back function, and quality of life following balloon kyphoplasty.

Aged↗