The Treatment of Osteoporotic Thoraco-lumbar Burst Fractures by Unilateral Percutaneous Kyphoplasty: A Prospective Observation Study

Objective: Osteoporotic thoraco-lumbar burst fractures with serious pain are very common, and the optimal treatment of burst fractures without any neurological deficits has not yet been properly codified. The objective of this study was to evaluate prospectively the clinical effects and pain relief of unilateral percutaneous kyphoplasty (PKP) on osteoporotic thoraco-lumbar burst fractures.

Methods: Forty-six patients with osteoporotic thoraco-lumbar burst fractures were treated by PKP in our hospital from January 2016 to January 2017. The height of posterior wall (HPW), the height of anterior wall (HAW) and kyphotic angle (KA) were measured via x-ray radiographs before surgery, one day after surgery and at final follow-up. Visual analogue scale (VAS) score and the oswestry disability index (ODI) score were evaluated preoperatively, postoperatively and at final follow-up. All the patients with osteoporotic thoraco-lumbar burst fractures were treated by unilateral PKP. Radiological evaluation (anteroposterior and lateral x-ray radiographs and CT) was performed.

Results: All patients were followed-up, and the mean follow-up was 28.8 ± 7.0 months. The preoperative HAW was 20.1 ± 2.3 mm, and the HAW was significantly improved to 22.9 ± 2.4 mm after operation (p < .05), and at the final follow-up, the HAW was 19.9 ± 2.1 mm, which was lower than the postoperative HAW. The HPW was also significantly corrected after surgery (p < .05). There were no significant differences between postoperative HPW and HPW at the final follow-up (p > .05). The KA was significantly corrected after operation (p < .05), but relapse occurred at the final follow-up, and at the final follow-up, the average of KA was 19.4 ± 1.6 degree. The VAS and ODI were significantly improved at the final follow-up compared to the preoperative period (p < .05). Cement leakage was found in eight patients, and adjacent vertebral fracture (VF) was found in two patients.

Conclusions: Our results showed that unilateral PKP acquired satisfactory treatment effect and pain relief in the management of osteoporotic thoraco-lumbar burst fractures. Meticulous evaluation of preoperative images and careful repetitious injection of cement are important to prevent cement leakage.

Significance: Our present results showed that unilateral PKP was an effective method to obtain satisfactory pain relief in the management of osteoporotic thoraco-lumbar burst fractures. It may a good indication for the patients with osteoporotic thoraco-lumbar burst fractures, and the patients could not tolerate the serious acute pain by conservative treatment.