Poster Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Balloon Kyphoplasty Prevents Vertebral Deformity Progression in Acute Thoracolumbar Osteoporotic Vertebral Fractures (#230)

Junichi Yamada 1 , Tatsuhiko Fujiwara 2
  1. Matsusaka Municipal Hospital, Matsusaka, MIE, Japan
  2. Orthopaedic surgery, Mie university graduate school od medicine, Tsu, Japan

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Introduction: Number of patients with osteoporotic vertebral fractures (OVFs) has been increasing as the progression of super aging society in Japan. OVFs are generally treated conservatively as the first line of management, however, failure of conservative treatment for OVFs is more commonly seen when certain risk factors are present such as posterior wall fracture, higher age, lower BMI, specific MRI findings and thoracolumbar level.  Severe deformity of OVFs was reported to be more significantly associated with back pain, lower ADL and shorter life expectancy than mild deformity. Recently, our institution follows an early surgical intervention approach for osteoporotic OVFs, using balloon kyphoplasty (BKP) as the primary treatment. The purpose of this study was to compare the progression of OVF deformities of between those who conservatively treated and those who underwent BKP treatment.

Methods: 57 patients (17 men and 40 women, 81.7 ± 7.7 y/o) who conservatively treated from June 2018 to July 2021 (the group C) and 91 patients (22 men and 69 wemen, 81.1 ± 7.7 y/o) who underwent BKP from August 2021 to July 2024 (the group B) were the subjects of this study. The patients of both groups were treated with administration. The lateral spine radiographs at supine and sitting position were taken when hospitalized (BL) and three months after the treatment (3M). Of vertebral deformities evaluated using Genant’s semiquantitative method [1], grade 0-2 were classified into the mild deformity and grade 3 was classified into the severe deformity. Cobb angles of upper endplate and lower endplate of fractured vertebrae were designated as vertebral kyphotic angle.

Results: There were no significant differences in age, gender distribution, BMI and bone mineral density between the groups. The percentages of severe deformities of supine BL, sitting BL and sitting 3M were 10.5%, 41.7% and 80.5% in the C group, and 8.3%, 48.9% and 24.4% in the B group. Chi-square test showed that the percentage of severe deformities of sitting 3M was significantly lower in the B group than in the C group (P<0.01) while there were significant differences in those of supine BL and of sitting BL. Unpaired T-test showed significantly lower kyphotic angle of sitting 3M in the B group (14.9 ± 7.7 degree) than that in the C group (23.4 ± 7.7 degree) and no significant differences in that of supine BL and sitting BL between the groups. Cement leakage was seen in 10% of patients, however they had no symptoms.

Discussion: This study showed that an early BKP intervention significantly prevented vertebral deformity progression at 3M after treatment compared to conventional treatment. Early BKP would contribute to preventing severe back pain and maintaining patient’s ADL and life expectancy. Further investigations into safety [2], long-term outcome [3] and cost-effectiveness [4] are still needed for early BKP as fist-line treatment for acute thoracolumbar OVFs. 

  1. [1]H. K. Genant et al. Journal of Bone and Mineral Research 1993;8:1137-1148. [2]D. Wardlaw et al. The Lancet 2009;373:1016-1024. [3]J. T. Liu et al. J Neurosurg Spine 2015;23:94-8. [4]S. Takahashi et al. Spine 2019;44.