Percutaneous kyphoplasty in hyperextension position for treatment of osteoporotic vertebral compression fracture with vacuum phenomenon

Objective: To evaluate the efficacy of percutaneous kyphoplasty (PKP) in hyperextension position for the treatment of osteoporotic vertebral compression fracture (OVCF) with vacuum phenomenon.

Methods: Between April 2004 and August 2009, 35 patients who suffered from OVCF with vacuum phenomenon were treated with PKP in hyperextension position, 8 patients were excluded because of lost follow-up. In 27 follow-up cases, there were 9 males and 18 females with an average age of 75 years (range, 58-90 years) and with an average disease duration of 9.8 months (range, 2-17 months). One vertebral body was involved in 26 cases and 2 vertebral bodies were involved in 1 case. According to the imaging examination and Krauss et al. criterion, all patients were diagnosed as having vertebral vacuum phenomenon. Refer to the lateral X-ray views, the height and the kyphotic angle of the involved vertebral body were measured pre- and postoperatively. The surgical outcomes were evaluated by using visual analogue scale (VAS) and Oswestry disability index (ODI) system.

Results: All operations were performed successfully with no severe complication. The mean follow-up of 27 patients was 32 months (range, 24-58 months). The mean clinical healing time of OVCF was 4 months (range, 3-6 months). The VAS score, ODI system, anterior and medial height of involved vertebral body, kyphotic angle of involved vertebral body were improved significantly at 1 week after operation and at last follow-up (P < 0.05); there was no significant difference between at 1 week after operation and at last follow-up (P > 0.05). There was no significant difference in the posterior height of involved vertebral body among different postoperative time-points (P > 0.05). Asymptomatic cement leakage occurred in 3 patients. Adjacent vertebral fracture occurred in 1 patient at 7 months. Intravertebral vacuums showed a compact and solid cement filling pattern.

Conclusions: PKP in hyperextension position can significantly relieve back pain, restore vertebral height, and correct local kyphosis in the treatment of OVCF with vacuum phenomenon.