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A randomized trial of balloon kyphoplasty and nonsurgical management for treating acute vertebral compression fractures: vertebral body kyphosis correction and surgical parameters.

Van Meirhaeghe, Jan; Bastian, Leonard; Boonen, Steven; Ranstam, Jonas; Tillman, John; Wardlaw, Douglas

Authors

Jan Van Meirhaeghe

Leonard Bastian

Steven Boonen

Jonas Ranstam

John Tillman

Douglas Wardlaw

Abstract

The purpose of this multicenter randomized controlled trial was to compare the efficacy and safety of balloon kyphoplasty (BKP) with nonsurgical management (NSM), during 24 months in patients with painful vertebral compression fractures (VCFs). Recently, several large randomized controlled trials have reported how vertebral augmentation compares with NSM for patients with acute VCFs. Few of these trials report on the surgical aspects and radiographical vertebral deformity results. In this study, adults with 1 to 3 VCFs were randomized within 3 months of pain to undergo bilateral BKP (n = 149) or NSM (n = 151). Surgical parameters, subjective quality of life assessments, and objective functional (timed up and go) and radiographical assessments were collected. Compared with NSM, the BKP group had greater improvements in SF-36 physical component summary (PCS) scores at 1 month (5.35 points; 95% CI, 3.41-7.30; P < 0.0001) and when averaged across the 24 months (overall treatment effect 2.71 points; 95% CI, 1.34-4.09; P = 0.0001). The kyphoplasty group also had greater functionality by assessing timed up and go (overall treatment effect -2.49 s; 95% CI, -0.82 to -4.15; P = 0.0036). At 24 months, the change in index fracture kyphotic angulation was statistically significantly improved in the kyphoplasty group (average 3.13° of correction for kyphoplasty compared with 0.82° in the control, P = 0.003). Number of baseline prevalent fractures (P = 0.0003) and treatment assignment (P = 0.004) are the most predictive variables for PCS improvement; however, in patients who underwent BKP, there may also be a link with kyphotic angulation. In BKP, the highest quart for kyphotic angulation correction had higher PCS improvement (13.4 points) than the quart having lowest correction of angulation (7.40 points, P = 0.0146 for difference). The most common adverse events temporally related to surgery (i.e., within 30 days) were back pain (20 BKP, 11 NSM) new VCF (11 BKP, 7 NSM), nausea/vomiting (12 BKP, 4 NSM), and urinary tract infection (10 BKP, 3 NSM). Several other adverse events were possibly related to patient positioning in the operating room. In conclusion, compared with NSM, BKP improves patient quality of life and pain averaged during 24 months and results in better improvement of index vertebral body kyphotic angulation. Perioperative complications may be reduced with more care in patient positioning.

Journal Article Type Article
Publication Date May 20, 2013
Journal Spine
Print ISSN 0362-2436
Electronic ISSN 1528-1159
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 38
Issue 12
Pages 971-983
Institution Citation VAN MEIRHAEGHE, J., BASTIAN, L., BOONEN, S., RANSTAM, J., TILLMAN, J.B. and WARDLAW, D. 2013. A randomized trial of balloon kyphoplasty and nonsurgical management for treating acute vertebral compression fractures: vertebral body kyphosis correction and surgical parameters. Spine [online], 38(12), pages 971-983. Available from: https://doi.org/10.1097/BRS.0b013e31828e8e22
DOI https://doi.org/10.1097/BRS.0b013e31828e8e22
Keywords Balloon kyphoplasty; Vertebral fracture; Osteoporosis; Kyphosis correction

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