| BackgroundVertebral compression fractures are a growing health concern with important socioeconomic effects.These fractures are considered to be an indicator of osteoporosis and constitute a major health problem due to their effects,both direct and indirect,on the patient’s quality of life while continuing to be a burden to the health system.As the global elderly population continues to grow,so will the prevalence of osteoporotic vertebral fractures and their associated complications.Localised back pain,which can be debilitating,is the primary and major symptom of vertebral fractures;with pain being associated with an estimated 84% of such fractures.Difficulties with activities of daily living,loss of independence,depression or low self-esteem,impaired mobility and poor balance contribute to the higher morbidity and mortality rates in such patients.Treatment of these fractures remains a challenge,and although various approaches are available,each has its limitations.Nowadays,with increased availability,minimally invasive procedures like percutaneous vertebroplasty and kyphoplasty are taking over conservative treatment in the management of such fractures.These cement augmentation procedures help to stabilise painful vertebral fractures refractory to medical therapy with goals of improving pain and functional outcome.Vertebroplasty which involves the injection of bone cement into the body of the fractured vertebra aims to alleviate pain while preventing further collapse of the vertebra.Kyphoplasty,on the other hand,uses an inflatable balloon to create a cavity before cement injection and has added potential benefits of restoring vertebral height,reducing kyphosis and decreasing the risks of cement leakage with low-pressure injection.Our present study aims to compare the effectiveness and outcome of percutaneous vertebroplasty and kyphoplasty performed under local and general anaesthesia regarding pain relief,kyphosis correction and anterior vertebral height restoration in patients with symptomatic osteoporotic vertebral compression fractures.MethodsA retrospective study was carried out involving 47 patients undergoing vertebral augmentation procedures in the Department of Spine Surgery in the Second Affiliated Hospital of Dalian Medical University.The sample consisted of 11 males and 36 females.13 patients underwent vertebroplasty while 34 had kyphoplasty.The surgeries were performed either under local anaesthesia(34 cases)or general anaesthesia(13 cases).A total of 63 vertebral fractures were treated,ranging from T8 to L5 level;17 fractures being in the vertebroplasty group and 46 for kyphoplasty.All procedures were performed in the operation theatre setting by spine surgeons under Carm guidance.Lateral radiographs before and after surgery were used to measure the anterior vertebral height and the local kyphotic angle.Data obtained was analysed with SPSS 22.0.ResultsThe sample of 47 patients(mean age 74.57 ± 8.38 years)was divided into two groups:vertebroplasty group(n = 13,mean age 75.38 ± 5.36 years)and kyphoplasty group(n= 34,mean age 74.26 ± 9.33 years)with no significant age difference between the two groups(t = 0.046,p = 0.687).There were 11 males(mean age 78.91 ± 6.95 years),and they were significantly older than the 36 females(mean age 73.25 ± 8.41 years)(t= 2.025,p = 0.049).Thirty-four patients had vertebral augmentation under local anaesthesia(mean age75.71 ± 9.02 years)while the other 13(mean age 71.62 ± 5.67 years)underwent the procedure under general anaesthesia with no significant age disparity between the two groups(t = 1.518,p = 0.136).The vertebroplasty group had one male and 12 female patients while the kyphoplasty group had ten males and 24 females and there was no significant gender difference between the two groups(χ2 = 2.475,p = 0.116).The 47 patients had between one and four fractures treated each for a total of 63 fractures with 17 fractures treated in the vertebroplasty group against 46 fractures for the kyphoplasty group.The fracture levels ranged from T8 level to L5 level.The mean anterior vertebral height(AVH)of the patients in the kyphoplasty group(21.65 ± 3.66 mm)was slightly higher than that of patients in the vertebroplasty group(21.35 ± 4.12 mm)but was not statistically significant(t =-0.278,p = 0.782).Postoperatively,the AVH in the kyphoplasty group(23.39 ± 3.54 mm)was still higher than that of the vertebroplasty group(22.53 ± 3.92 mm),but no statistically significant difference could be seen(t =-0.833,p = 0.408).In both procedures,there was a statistically significant increase in AVH with vertebral augmentation;with height in vertebroplasty rising from a mean of 21.35 ± 4.12 mm to22.53 ± 3.92 mm(t =-3.305,p = 0.004)while that in the kyphoplasty group increased from a mean of 21.65 ± 3.66 mm to 23.39 ± 3.54 mm(t =-9.676,p = 0.000).When the two procedures were compared to each other regarding percentage AVH change,the change in kyphoplasty(8.53 ± 6.42%)was slightly higher than that of vertebroplasty(6.09 ± 7.61%)but of no statistical significance(t =-1.269,p = 0.209).The mean percentage change in AVH was seen to be higher in those procedures performed under general anaesthesia(9.08 ± 6.00%)than those under local anaesthesia(7.22 ± 7.16%)but not of statistical significance(t =-1.037,p = 0.304).There was a higher change in AVH in vertebroplasty being performed under local anaesthesia(6.41 ± 7.37%)than under general anaesthesia(3.75 ± 12.37%)but of no statistical significance(t = 0.452,p = 0.658).The percentage AVH change in kyphoplasty was higher in procedures performed under general anaesthesia(9.61 ±5.34%)than under local anaesthesia(7.69 ± 7.14%)but not statistically significant(t=-1.006,p = 0.320).For procedures performed under local anaesthesia,although not statistically significant(t =-0.548,p = 0.587),the mean percentage AVH change in vertebroplasty group(6.41 ± 7.37%)was slightly lower than that of the kyphoplasty group(7.69 ±7.14%).A similar trend was seen for procedures performed under general anaesthesia with mean AVH change higher in kyphoplasty(9.61 ± 5.34%)than in vertebroplasty(3.75 ± 12.37%)but not statistically significant(t =-1.342,p = 0.195).Preoperatively,the mean local kyphotic angle(LKA)in patients undergoing kyphoplasty(21.65 ± 3.66°)was more than those undergoing vertebroplasty(14.65 ±9.38°)but not of statistical significance(t = 0.056,p = 0.956).Postoperatively,the mean LKA was more in patients undergoing vertebroplasty(14.06 ± 9.33°)than kyphoplasty(13.30 ± 6.87°)but again of no statistical significance(t = 0.350,p =0.728).The LKA changed from 14.65 ± 9.38° to 14.06 ± 9.33° after surgery in the vertebroplasty group and was not statistically significant(t = 1.571,p = 0.136).In the kyphoplasty group,there was a change from 14.52 ± 7.28° to 13.30 ± 6.87° after surgery which was statistically significant(t = 4.085,p = 0.000).Regarding the change of LKA,a higher mean percentage change was seen in the kyphoplasty group(-9.12 ± 19.77%)than in the vertebroplasty group(-4.55 ± 12.43%)but was not of statistical significance(t = 0.887,p = 0.379).A mean percentage change in LKA of-8.90 ± 21.61% was seen in patients of local anaesthesia group compared to-5.99 ± 8.48% for the general anaesthesia group.No statistical difference was seen between the two groups(t =-0.604,p = 0.548).In vertebroplasty,a greater change in LKA was observed in patients undergoing the procedure under general anaesthesia(-13.33 ± 4.71%)than under local anaesthesia(-3.38 ± 12.75%),but the two groups were not statistically different(t = 1.068,p =0.302).In the kyphoplasty group,patients with local anaesthesia(-12.08 ± 25.05%)had a higher change in LKA than patients with general anaesthesia(-5.26 ± 8.49%);but not of statistical significance(t =-1.165,p = 0.250).The percentage change in LKA under local anaesthesia was higher in the kyphoplasty group(-12.08 ± 25.05%)than in vertebroplasty group(-3.38 ± 12.75%).No superiority of kyphoplasty was seen statistically(t = 1.251,p = 0.219).In patients undergoing vertebral augmentation under general anaesthesia,again no statistical difference was found(t =-1.304,p = 0.207)although the change in LKA was more marked in vertebroplasty(-13.33 ± 4.71%)than in kyphoplasty(-5.26 ± 8.49%).Conclusion To sum up,our study revealed that vertebral augmentation procedures-both vertebroplasty and kyphoplasty-relieved back pain and increased the anterior vertebral height in the management of vertebral compression fractures but none was superior to the other.Although kyphoplasty was better in decreasing the local kyphotic angle at the fracture site,it showed no statistical superiority to vertebroplasty.Furthermore,both procedures yielded almost similar results when performed under either local or general anaesthesia. |
PDF Full Text Request