2018, Cilt 10, Sayı 1, Sayfa(lar) 001-010
Non-Balloon Kyphoplasty with High Viscosity Cement: Short-Term Clinical Outcomes
Aykut Akpınar1, Uzay Erdoğan2, Ali Osman Akdemir1
1Sağlık Bilimleri Üniversitesi Haseki Eğitim ve Araştırma Hastanesi, Nöroşirürji Kliniği, İstanbul, Türkiye
2Sağlık Bilimleri Üniversitesi Bakırköy Ruh ve Sinir Hastalıkları Hastanesi, Nöroşirürji Kliniği, İstanbul, Türkiye
Keywords: Kyphoplasty, Cement, Spinal trauma, Visual Analogue Scale, Oswestry Disability Index

Aim: Vertebral compression fractures (VCF) can lead to severe acute and chronic pain, impaired mobility, reduced quality of life, and an increased risk of mortality due to limited mobility. Percutaneous vertebroplasty (VP) and kyphoplasty (KP) are two vertebral augmentation procedures (VAPs) which are minimally invasive surgical options in the treatment of painful VCFs. Vertebral fractures may result in acute pain around the fracture site, loss of vertebral height due to vertebral collapse, spinal instability, and kyphotic deformity. The main goal of the VP and KP procedures is to provide immediate pain relief for patients and restore the vertebral height lost due to the fracture. This study aims to evaluate KP in terms of pain, disability, and quality of life. Costeffective radiological variables (i.e., vertebral height restoration) and KP for cement extravasation and complications profile were analyzed. Unipedicular or bipedicular approaches were compared.

Methods: Following an injury, the patients had conservative treatment of VCFs including bed-rest bracing and analgesics for four weeks. In 55 patients, a total of 83 vertebral fractures were present. The main causes were falling from a height, traffic accident, and malignancies. We used spinal anesthesia for all patients. Vertebral augmentation was done under fluoroscopy.

Results: The mean age was 59.18 years (SD16.13). The rate of female population (56.4%) and osteoporotic patients (54.5%) was higher. Thoracolumbar junction (T10-L2) fractures were the most common fractures of spinal column. L1 was the most often affected vertebra (24.09%). After VAP, pain scores of the patients statistically significantly decreased. Unipedicular or bipedicular approaches provided the same pain reduction. The pain scores of osteoporotic patients and preoperative and postoperative pain scores were higher than non-osteoporotic groups. Preoperative and postoperative pain scores of the female patients were higher than male patients. Seven patients (12.7%) had cement leakages.

Conclusion: Our study result suggest that the use of the optimal material to provide the optimal result for patient is at the discretion of the surgeon. Clinicians can take the advantage of increased working time. Creating cavity by using drill and curve curette or a balloon and high-viscosity cement under low pressure can minimize leakage complications.