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Vertebroplasty, kyphoplasty comparable in treating osteoporotic vertebral compression fractures

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GENEVA — While orthopedic surgeons worldwide are embracing vertebroplasty and kyphoplasty as treatments for painful osteoporotic vertebral compression fractures, researchers conducting one of the first comparative studies on the procedures said neither shows a clear-cut, statistically significant advantage.

Marco Teli, MD, who presented the study at Spine Week 2008, here, said some surgeons have reported success using kyphoplasty to reduce and fix collapsed vertebral compression fractures (VCFs) greater than 30°. "It is also considered somewhat safer but significantly more expensive than vertebroplasty," he said.

In the prospective, comparative trial, investigators from the Galeazzi Orthopaedic Insititute in Milan, Italy, enrolled 52 patients with a mean age of 61 years and a mean follow-up of 35 months. Outcome measures included the SF-36, Oswestry Disability Index (ODI) and Visual Analog Scale (VAS).

All patients who were observed with either one or two symptomatic VCFs in the thoracic or lumbar spine underwent 1 month of conservative treatment (ie, analgesia, brace and progressive mobilization) before being offered to enter the study due to persistent pain. Patients with VCF wedging less than 30° were offered treatment with vertebroplasty, while those with a more severe collapse (greater than 30°) were offered kyphoplasty. The surgeons used the same instruments for both procedures.

"We also collected bone biopsies on all of the patients during surgery to exclude the presence of primary or metastatic malignancy," he said.

Teli said there was no statistically significant difference between the groups in terms of SF-36, ODI or VAS scores, but all scores improved significantly within the groups. There was only one symptomatic complication: a case of intercostal neuralgia due to extravertebral cement leakage in Group 1.

"If we consider the clinical parameters of the two procedures, we observed that in our hands after 3 years, kyphoplasty and vertebroplasty do not provide different outcomes," he said. "The particular advantage of fracture reduction using kyphoplasty, which has long been discussed in various papers, still needs confirmation. And if you're considering the cost/benefit ratio of the two procedures, you might have to justify using the more-expensive kyphoplasty."

For more information:

• Teli M, Lovi A, Brayda-Bruno M, Grava G. Do kyphoplasty and vertebroplasty provide different outcomes in the treatment of painful osteoporotic vertebral compression fractures? Paper AB31. Presented at Spine Week 2008. Geneva, Switzerland.