Elsevier

World Neurosurgery

Volume 152, August 2021, Pages e589-e596
World Neurosurgery

Original Article
Comparison of Percutaneous Kyphoplasty and Pedicle Screw Fixation for Treatment of Thoracolumbar Severe Osteoporotic Vertebral Compression Fracture with Kyphosis

https://doi.org/10.1016/j.wneu.2021.06.030Get rights and content

Background

Pedicle screw fixation (PSF) has been considered the preferred surgery for the treatment of severe osteoporotic vertebral compression fracture (sOVCF), and sOVCF was traditionally regarded as a relative contraindication to minimally invasive percutaneous kyphoplasty (PKP). Debate has continued regarding the selection of the best surgical method for sOVCF. In the present study, we compared the efficacy and safety between PKP and PSF.

Methods

PKP was performed in 376 patients in group 1 and PSF in 121 patients in group 2. The visual analog scale (VAS), Oswestry disability index (ODI), local kyphotic angle, fractured vertebral body height, and complications were evaluated.

Results

In the immediate postoperative analysis, the mean VAS score for group 1 was 2.4, significantly lower than the VAS score of 4.7 for group 2. The mean ODI score was 44.4% for group 1, lower than the ODI score of 57.1% for group 2. In addition, group 1 had had a significantly better ODI score at 1 year of follow-up. The local kyphotic angle and fractured vertebral body height had recovered better in group 2. In group 1, 113 patients had experienced cement leakage, and 29 patients had undergone PKP for adjacent new vertebral fractures. In group 2, 2 patients had developed wound infections, 4 had developed pneumonia, 2 had developed urinary tract infection, 3 had experienced asymptomatic screw loosening, and 7 had undergone PKP to treat new vertebral fractures and 1 had undergone removal of internal fixation because of back pain.

Conclusions

The results of the clinical and radiological evaluations showed that PKP is comparable to PSF for the treatment of sOVCF with kyphosis, with PKP having the advantages of minimal invasion, quick postoperative pain relief, and functional recovery.

Introduction

Severe osteoporotic vertebral compression fracture (sOVCF) with kyphosis, defined as the collapse of the fractured vertebra to one third or less of the original height,1 has been traditionally regarded as a relative contraindication to minimally invasive percutaneous kyphoplasty (PKP).2 With the advantages of correcting the kyphotic deformity, maintaining the sagittal balance, restoring the normal spinal sequence, and relieving nerve compression when needed, the pedicle screw fixation (PSF) technique was considered the preferred surgery for the treatment of sOVCF.3,4 However, the PSF technique can result in screw loosening, pullout, and breakage.5,6 In recent years, an increasing number of studies have begun to recognize the effectiveness and importance of PKP in the treatment of sOVCF. The PKP technique has the advantages of minimally invasive characteristics, immediate pain relief, and quick functional recovery, with cement leakage and other common PKP technique-related complications reported to be asymptomatic and negligible.7, 8, 9

The increasing age of the population worldwide has resulted, inevitably, in greater risks of morbidity, disability, and mortality from sOVCF, leading to a pressing need to select the most optimal surgery for the treatment of sOVCF.10 A rapid development occurred in the surgical approach and technical details in the past decade.3,11, 12, 13 However, comprehensive evidence-based selection of the surgical methods for sOVCF is still lacking. Hence, the debate has continued regarding the superiority of the PKP versus PSF techniques in treating sOVCF with kyphosis. Thus, the ideal surgical procedure has remained controversial. The present retrospective cohort study was conducted to compare the efficacy and safety between PKP and PSF to determine the optimal option for the treatment of sOVCF.

Section snippets

Methods

We performed a retrospective, single-center cohort study. The patients with sOVCF who had undergone PKP or PSF from January 2013 to January 2018 were recruited from the research section of our institute. The ethics committee of our institution approved the present study, and all participants provided written informed consent. The details of the advantages and disadvantages of the 2 surgical methods were discussed with the patients preoperatively, and the patients chose the surgical treatment

Results

In the immediate postoperative period, the mean VAS score for group 1 was 2.4, significantly lower than the VAS score 4.7 for group 2 (P = 0.000). Also, the mean ODI was 44.4% for group 1, significantly better than the ODI of 57.1% for group 2 (P = 0.000). The patients in group 1 had also had a significantly better ODI at the 1-year postoperative follow-up (P = 0.000). The LKA and FVBH had both recovered better in group 2 than in group 1 at all postoperative follow-up examinations (P = 0.000

Discussion

The key finding of the present study was that the PKP technique was significantly superior to the PSF technique for both immediate pain relief and quick functional improvement postoperatively. However, the PSF technique showed better radiological outcomes and seemed to have an apparent advantage in kyphotic correction. The patients acquired satisfactory therapeutic effects with the PKP procedure, which has the advantages of local anesthesia, a minimally invasive approach, rapid recovery,

Conclusions

Our clinical and radiological evaluations showed that PKP is comparable to PSF for the treatment of sOCVF with kyphosis, and PKP has the advantages of minimal invasion, quick postoperative pain relief, and functional recovery.

CRediT authorship contribution statement

Zhenxing Wen: Conceptualization, Methodology, Resources, Data curation, Investigation, Formal analysis, Software, Visualization, Writing - original draft. Xiaoyi Mo: Methodology, Investigation, Data curation, Software, Formal analysis, Writing - original draft. Shengli Zhao: Methodology, Data curation, Investigation, Software, Formal analysis, Writing - original draft. Wei Lin: Resources, Software, Validation, Formal analysis. Zhipeng Chen: Data curation, Software, Validation. Zifang Huang:

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

    Zhenxing Wen and Xiaoyi Mo contributed equally to the present study.

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