Prophylactic Percutaneous Kyphoplasty Treatment for Nonfractured Vertebral Bodies in Thoracolumbar for Osteoporotic Patients

Abstract

Purpose. The occurrence of new vertebral compression fractures (VCFs) is a common complication after percutaneous kyphoplasty (PKP). Secondary VCFs after PKP occur predominantly in the thoracolumbar segment (T11 to L2). Prophylactic injections of cement into vertebral bodies in order to reduce new VCFs have rarely been reported. The main purpose of this study was to investigate whether prophylactically injecting cement into a nonfractured vertebral body at the thoracolumbar level (T11-L2) could reduce the occurrence of new VCFs. Methods. From July 2011 to July 2018, PKP was performed in 86 consecutive patients with osteoporotic vertebral compression fractures (OVCFs) in the thoracolumbar region (T11-L2). All patients selected underwent PKP because of existing OVCFs (nonprophylactic group). Additionally, 78 consecutive patients with fractured vertebrae in the thoracolumbar region (T11-L2) with OVCFs underwent PKP and received prophylactic injections of cement into their nonfractured vertebrae in the thoracolumbar region (T11-L2) (prophylactic group). The visual analog scale (VAS) scores and incidence of new VCFs after PKP were compared between the two groups. Results. The mean VAS scores improved from 8.00±0.79 preoperatively to 1.62±0.56 at the last follow-up in the nonprophylactic group and improved from 8.17±0.84 to 1.76±0.34 in the prophylactic group (P>0.05). In the nonprophylactic group, 21 of 86 patients (24.4%) developed new VCFs within one year after PKP, of whom 15 patients (71.4%) developed VCFs within 3 months. In the prophylactic group, 8 of 78 patients (10.3%) developed new VCFs within one year, and 6 of these 8 patients (75%) developed new VCFs within 3 months. The incidence of new VCFs was significantly higher in the nonprophylactic group than that in the prophylactic group at one year (P=0.018), but there were no statistically significant differences at three months (P=0.847). Conclusions. Prophylactic injections of cement into nonfractured (T11-L2) vertebral bodies reduced the incidence of secondary VCFs after PKP in patients with OVCFs, but there was no significant difference in local back pain (VAS) scores between the two groups.