Immediate and early postoperative pain relief after kyphoplasty without significant restoration of vertebral body height in acute osteoporotic vertebral fractures
Osteoporosis is the most common metabolic disorder of the bones, affecting approximately 28 million people in the US. 16 It is estimated that 35% of all women older than 65 years of age suffer from this disorder, 5 which predominantly affects postmenopausal women. Because age is the most important risk factor for osteoporosis, the number of affected individuals is anticipated to increase substantially in the coming years, as a result of the increase in life expectancy in the population of the
... population of the industrialized countries. 7,34 In the US alone, approximately 1.5 million fractures occur annually as a result of primary or secondary osteoporosis, and almost half of those (700,000) involve the spine. 7, 16, 25, 35 Osteoporotic VCFs are a significant cause of morbidity and mortality in postmenopausal women and elderly men. Object. Painful osteoporotic vertebral compression fractures (VCFs) are a significant cause of disability in the elderly population. Kyphoplasty, a recently developed minimally invasive procedure, has been advocated for the successful management of these fractures in terms of immediate pain relief, and also for restoration of the premorbid level of daily activities. In this retrospective study the authors report on their experience with the early management of VCFs with kyphoplasty. Methods. A retrospective analysis was conducted in 13 patients (seven women and six men) whose ages ranged from 48 to 87 years (mean age 71.5 Ϯ 11 years [mean Ϯ standard deviation]). The interval between onset of symptoms and surgical intervention ranged from 4 to 9 weeks. Twenty levels (12 thoracic, eight lumbar) were treated in this cohort. Immediate and early postoperative (1-month follow-up visit) visual analog scale (VAS) pain scores, activity levels, and restoration of vertebral body (VB) height were assessed. The mean preoperative VAS score was 8 Ϯ 1, whereas the immediate and early postoperative scores were 1 Ϯ 1. These findings reflected a resolution of 90 to 100% of preoperative pain. All patients resumed routine activities within hours of the procedure, although improvement in VB height was not accomplished in this cohort. No major complications were encountered in this clinical series. Conclusions. Kyphoplasty is a safe and effective method for the treatment of osteoporotic VCFs. Failure to restore VB height does not seem to interfere with the excellent pain management and good functional outcome provided by this procedure. KEY WORDS • osteoporosis • vertebral compression fracture • pain • kyphoplasty • polymethyl methacrylate Neurosurg. Focus / Volume 18 / March, 2005 1 Abbreviations used in this paper: PMMA = polymethyl methacrylate; VAS = visual analog scale; VB = vertebral body; VCF = vertebral compression fracture.