Efficacy Of Vertebral Augmentation On Osteoporotic Vertebral Compression Fractures Combined With Intravertebral Vacuum Cleft

Object To investigate and compare the clinical efficacy of two types of vertebral augmentation(PVP and PKP)for Osteoporotic Vertebral Compression Fractures(OVCFs)without neurologic symptoms combined with Intravertebral Vacuum Cleft(IVC).Method In this study,62 patients(65 vertebrae),who had no neurologic symptoms and were treated with vertebral augmentation,with osteoporotic vertebral compression fractures combined with intravertebral vacuum cleft were enrolled,from January 2011 to December 2019 in the Affiliated Hospital of Qingdao University.Including 9 males and 53 females,patients who aged from 55 to 88 years are at average age of(74.24±8.20)years old.The completed clinical data of all patients had been reviewed.The period of follow-up ranged from 1-108 months,mean(37.55±25.12)months(The last follow-up is by the time of the the last review or postoperative complications that need treatment).The enrolled cases were divided into PVP group and PKP group according to surgical methods.The data were reviewed retrospectively and the patients were followed up effectively T.he VAS score,rate of anterior height of injured vertebrae and local kyphosis Cobb‘s angle were measured before and after surgery.Select appropriate statistical methods of SPSS 22.0 to evaluate,analyzis and compare the clinical efficacy of PVP and PKP groups.Result In this study,a total of 65 vertebrae with fractures combined with IVC were mainly concentrated on T12 and L1 vertebrae(64.62%,including 21 cases of L1 vertebrae and 21 cases of T12 vertebrae).All of fractures demonstrated IVCs on three-dimensional CT image.42(64.62%)cases showed osteosclerosis of edge of clefts.In MRI scan,there were 30 cases of gas signals(46.15%)and 35 cases of liquid signals(53.85%)inside the clefts.8(12.31%)cases without neurologic symptoms but demonstrated compression of nerve in MRI.38 patients / 39 vertebrae get X-ray exam of extension and flexion positions,in which 34 cases(87.18%)showed “open sign”.There were 25 patients / 27 vertebrae treated with PVP,who’s VAS score(preoperatively,1 day postoperatively and at the last follow-up)is [(7.92±2.12),(1.72±0.74)and(1.56±0.65)],anterior height [(68.86±15.20),(71.17±15.04)and(68.97±14.74)]% and local kyphosis Cobb’s angle [(19.88±10.76),(17.60±10.01)and(17.65±10.06)]°.Besides,37 patients / 38 vertebrae were treated with PKP,who’s VAS score is [(7.89±1.68),(1.97±0.83)and(1.76±0.80)],anterior height [(62.11±18.47),(80.22±13.90)and(79.21±14.65)]% and local kyphosis Cobb‘s angle [(18.78±11.78),(15.19±10.08)and(16.34±10.41)]°.Comparation of the VAS score,anterior height and local kyphosis Cobb’s angle between which preoperatively and 1 day postoperatively showed significant difference in all groups(P<0.05).When the last review,the VAS score in all groups have decreased from that 1 day postoperatively(P<0.05).In addition,the anterior height of PVP group have decreased and the local kyphosis Cobb’s angle of PKP group have increased compared with which 1 day postoperatively(P<0.05).There were no significant differences of the preoperative data between two groups(P>0.05).The anterior height when both 1 day postoperatively and the last follow-up of PKP group is greater than it of PVP group,with significant difference(P<0.05).Furthermore,there were no significant differences of the VAS score and local kyphosis Cobb’s angle between two groups.There were 1 case of bone cement leakage occurred in spinal canal,8 cases in intervertebral disc and 3 cases in paravertebral tissue,but all of whom have no clinical symptoms.7 patients suffered adjacent vertebral compression fractures postoperatively 16.6 months averaged later(occurrence rate 10.77%).The incidence of bone cement leakage and adjacent vertebral compression fractures of PVP group is lower than PKP group,but without significant differences(P>0.05).One patient who underwent PKP suffered displacement of bone cement 1 month later.A tiny cleft can be detected in CT image of 1 case of PVP and 1 case of PKP after surgery but without clinical symptoms.Conclusion Both PVP and PKP are effective therapy for OVCFs without neurologic symptoms combined with IVC.PKP can restore the anterior height of vertebrae better.In terms of the image efficacy in postoperative long-term follow-up,the anterior height of vertebrae may reduce in PVP group,and the local kyphosis Cobb’s angle may increase in PKP group.High attention in surgery operation required because of the risk of bone cement leakage.