Balloon Kyphoplasty Versus Conservative Treatment for Acute Osteoporotic Vertebral Fractures With Poor Prognostic Factors: Propensity Score Matched Analysis Using Data From Two Prospective Multicenter Studies. Issue 2 (15th January 2019)

• Record Type: Journal Article
• Authors: Hoshino, Masatoshi; Takahashi, Shinji; Yasuda, Hiroyuki; Terai, Hidetomi; Watanabe, Kyoei; Hayashi, Kazunori; Tsujio, Tadao; Kono, Hiroshi; Suzuki, Akinobu; Tamai, Koji; Ohyama, Shoichiro; Toyoda, Hiromitsu; Dohzono, Sho; Kanematsu, Fumiaki; Hori, Yusuke; Nakamura, Hiroaki
• Is Part Of: Spine. Volume 44:Issue 2(2019)
• Publication Date: 2019-01-15
• Subjects: an aging population -- balloon kyphoplasty -- conservative treatment -- delayed union -- magnetic resonance imaging -- multicenter study -- osteoporosis -- poor prognostic factors -- propensity score matched analysis -- vertebral fracture; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000002769
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: A multicenter, prospective, single-arm, intervention study. Objective: The aim of this study was to investigate efficacy of balloon kyphoplasty (BKP) for acute osteoporotic vertebral fractures (OVFs) in patients with poor prognostic factors. Summary of Background Data: The indications for BKP remain unclear. Characteristic magnetic resonance imaging (MRI) findings (high-intensity or diffuse low-intensity area in fractured vertebrae on T2-weighted images) were reportedly predictive of delayed union. Methods: This study enrolled 106 patients with poor prognostic MRI findings who underwent BKP within 2 months after injury, and 116 controls with acute OVFs and the same poor prognostic factors who underwent conservative treatment. Patients were propensity score matched in a logistic regression model adjusted for age, sex, number of baseline old fractures, and fracture level. The primary outcome was reduction in activities of daily living (ADLs) at 6 months after fracture, and the secondary outcomes were improvement in short-form (SF)-36 subscales, back pain visual analog scale (VAS) score, and vertebral body deformity. Results: A decrease in ADLs occurred in 5.6% of patients in the BKP group and 25.6% of patients in the conservative treatment group ( P < 0.001). The SF-36 vitality subscale score improved by 26.9 ± 25.9 points in the BKP group and 14.5 ± 29.4 points in the control group ( P = 0.03). The VAS pain score improved by 43.4 ± 34.4 in the BKP group and 52.2 ± 29.8 in the control group ( P = 0.44). The vertebral body wedge angle improved by 5.5 ± 6.2° in the BKP group and −6.3 ± 5.0° in the control group ( P < 0.0001). The percent vertebral body height improved by 15.2 ± 19.2% in the BKP group and −20.6 ± 14.2% in the control group ( P < 0.0001). Conclusion: ADLs, quality of life, and vertebral deformity showed greater improvement with BKP intervention for acute OVF with poor prognostic factors than with conservative treatment at 6 months after injury. Our treatment strategy uses BKP intervention according to the presence or absence of poor prognostic MRI findings. Level of Evidence: 4 Abstract : Balloon kyphoplasty intervention for acute osteoporotic vertebral fracture with poor prognostic factors (high-intensity or diffuse low-intensity area in the fractured vertebrae on T2-weighted magnetic resonance images) was more effective than conservative treatment in terms of activities of daily living, quality of life, and vertebral deformity 6 months after injury.