Comparison of inpatient treatment costs after balloon kyphoplasty and non-surgical treatment of vertebral body compression fractures

✓Percutaneous balloon kyphoplasty has become a widely adopted treatment option for patients with pain due to pathological compression fractures. One potential risk of the procedure is the displacement of tumor into the spinal canal and resulting spinal cord or cauda equina injury during inflation of the balloon prior to polymethylmethacrylate (PMMA) placement. In addition, the presence of any remaining tumor between the PMMA and the fractured cortical bone can lead to suboptimal improvement in stabilization and subsequent pain relief. The authors describe a technique to remove tumor from within the vertebral body (VB) through a percutaneous working channel prior to kyphoplasty balloon inflation and augmentation. The technique was successfully used in all three patients who had presented with pain, and the pain improved in all three cases. There was no extravasation of PMMA into the spinal canal in any case. A combined VB tumor debulking and kyphoplasty technique offers the ability to improve the placement of PMMA within the diseased vertebral body, potentially leading to increased safety as well as clinical effectiveness for stabilization of these fractures.

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Results of kyphoplasty in the minimally invasive treatment of vertebral metastasis

Coluna/Columna ◽

10.1590/s1808-18512014130300433 ◽

2014 ◽

Vol 13 (3) ◽

pp. 235-238

Author(s):

Carlos Fernando Pereira da Silva Herrero ◽

Mario Bressan Neto ◽

Carlos Eduardo Sargi Godoy ◽

Vitor Rodrigues Fornazari ◽

Lilian Maria Pacola ◽

...

Keyword(s):

Surgical Treatment ◽

Minimally Invasive ◽

Vertebral Body ◽

Postoperative Period ◽

Spinal Metastases ◽

Balloon Kyphoplasty ◽

Vertebral Metastases ◽

Minimally Invasive Surgical ◽

Minimally Invasive Surgical Treatment ◽

The Mean

OBJECTIVE: To evaluate the clinical and radiological outcome of minimally invasive surgical treatment of vertebral metastases using the technique of kyphoplasty. METHODS: This was a prospective observational study of patients with the diagnosis of spinal metastasis who underwent minimally invasive surgical treatment by filling the vertebral body with balloon kyphoplasty technique. Clinical evaluation included patient age at surgery, diagnosis of the tumor, biopsy results, data of the surgical procedure performed, visual pain scale (VAS) and complications related to surgery. Radiological evaluation involved the study of radiographic procedures in the anteroposterior and lateral incidences, with the analysis of vertebral body kyphosis and the occurrence of extravasation of cement. RESULTS: 22 patients with spinal metastases who were treated by balloon kyphoplasty, 8 (36%) males and 14 (64%) females were studied. The average age was 56.05 years and the mean follow-up was 8.5 months. The mean preoperative VAS was 8.73, 1.73 in the initial postoperative period, and 1.92 in the late postoperative period. CONCLUSION: Kyphoplasty proved to be a safe and effective technique for symptomatic treatment of vertebral metastases.

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5. An International Multicenter Randomized Comparison of Balloon Kyphoplasty and Non-Surgical Management in Patients with Acute Vertebral Body Compression Fractures

The Spine Journal ◽

10.1016/j.spinee.2009.08.009 ◽

2009 ◽

Vol 9 (10) ◽

pp. 3S

Author(s):

Douglas Wardlaw ◽

Steven Cummings ◽

Jan Van Meirhaeghe ◽

Leonard Bastian ◽

John Tillman ◽

...

Keyword(s):

Surgical Management ◽

Vertebral Body ◽

Balloon Kyphoplasty ◽

Compression Fractures ◽

International Multicenter

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173 EVOLVE - Significant Improvements in Pain, Disability, Quality of Life and Overall Health with Use of Balloon Kyphoplasty for Vertebral Compression Fractures in Medicare-Eligible Patients Despite Minimal Improvements in Vertebral Body Height an

Neurosurgery ◽

10.1093/neuros/nyx417.173 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 244-245

Author(s):

John Amburgy ◽

Douglas Beall ◽

Richard Easton ◽

Douglas Linville ◽

Sanjay Talati ◽

...

Keyword(s):

Quality Of Life ◽

Vertebral Body ◽

Body Height ◽

Balloon Kyphoplasty ◽

Vertebral Compression Fractures ◽

Vertebral Body Height ◽

Compression Fractures ◽

Time Points ◽

Pain Disability

Abstract INTRODUCTION Osteoporotic and neoplastic vertebral compression fractures (VCF) are common and painful. In the U.S., there are more than 1.5 million vertebral fractures annually and 40% of those over the age of 80 will experience this pathology, threatening quality of life and increasing morbidity and mortality. Kyphoplasty is a minimally invasive surgery to stabilize the fracture and recent EVOLVE analysis demonstrated minimal improvement in kypohotic angulation or vertebral body height, however, patients demonstrated significant improvements in pain, disability, quality of life and overall health. METHODS Prospective, multicenter 12-month clinical study of outcomes pertaining to activities of daily living, pain, quality of life, and safety parameters in a Medicare-eligible population treated with kyphoplasty for painful acute or subacute VCFs associated with osteoporosis or cancer. RESULTS >NRS back pain improved from 8.7 (scale 0–10) by 5.2, 5.4, 6.0, 6.2 and 6.3 points, at the 7-day, and the 1, 3, 6 and 12-month time points, respectively. ODI improved from 63.4 (scale 0–100) by 30.5, 35.3, 36.3 and 36.2 points, at the 1, 3, 6 and 12-month time points, respectively. The SF-36 PCS was 24.2 at baseline (scale 0–100) and improved 10.7, 12.4, 13.4 and 13.8 points, at 1, 3, 6 and 12 months. The EQ-5D was 0.383 points (scale 0–1) and improved 0.316, 0.351, 0.356 and 0.358 points, at 1, 3, 6 and 12 months. All measures were statistically significant with P < 0.001 at every time point. Despite these significant improvements in pain, disability, qulity of life and overall health, there were only modest, but significant improvements in kyphotic angulation (1.1° improvement) and vertebral body height (4% improvement). CONCLUSION This large, prospective, multicenter study trial demonstrates that utilization of kyphoplasty for vertebral compression fractures provides significant improvements in pain, disability, quality of life, and overall health despite modest improvements in kyphotic angulation and vertebral body height in Medicare-eligible patients.

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