Effectiveness, security and height restoration on fresh compression fractures--a comparative prospective study of vertebroplasty and kyphoplasty.

INTRODUCTION: Painful fractures of the spine pose a serious clinical problem which gains in importance with the increasing ageing of our population. When conservative treatment of these fractures fails, with vertebroplasty and kyphoplasty we have two percutaneous minimally invasive stabilising procedures at our disposal. PATIENTS AND METHODS: We performed a prospective study of 90 patients with fresh osteoporotic vertebral fractures who had been treated with vertebroplasty or kyphoplasty in our clinic between January 1, 2005, and December 31, 2007. Clinical analysis included Oswestry score and VAS index; the vertebral body height restoration (mean vertebral body height, kyphosis angle, anterior/posterior edge) was evaluated radiologically; furthermore, all occurring complications were recorded. The follow-up time was 1 year, 80 patients could be examined at follow-up; 8 patients had died of a tumour disease, lost to follow-up were 2.2%. RESULTS: Both procedures succeeded in significantly (p<0.001) increasing quality of life (Oswestry score) and reducing pain (VAS). Following vertebroplasty there were two cases of cement leakage into the spinal canal with consecutive paraparesis which disappeared completely after the cement had been surgically removed. Altogether, 11 adjacent level fractures were observed, 4 in the vertebroplasty and 7 in the kyphoplasty group. CONCLUSION: This study compares vertebroplasty and kyphoplasty with regard to their effectiveness, safety, and restoration of vertebral body height, and complications. There were no differences between the groups with regard to quality of life and pain improvement, but the rate of serious complications was higher after vertebroplasty. Mean vertebral body height restoration at 1 year follow-up was significantly higher (p<0.05) in the kyphoplasty group. It remains to be seen in future long-term studies whether or not restoration of vertebral body height has an effect on the clinical result.