Percutaneous Balloon Kyphoplasty Determined Safe, Effective Method for Treatment of Vertebral Compression Fractures with Posterior Wall Disruption

Alp Ozpinar, MD

Vertebral compression fractures (VCFs) are one of the most common comorbidities encountered in the elderly population. The incidence is increasing as the percentage of the aging population rises with an annual incidence of VCFs reaching 750,000 in the United States. The associated mortality rate in these patients is 2.5 times higher than in patients without VCFs. Nonoperative treatment, kyphoplasty, and vertebroplasty are available options for the management of symptomatic compressive vertebral fractures. Bed rest and analgesics for the management of VCFs are known to further accelerate bone loss and muscle wasting. Immobility can also result in systemic complications (pulmonary, cardiovascular, musculoskeletal, or immune) and are often responsible for decreasing survival rates in VCF patients.

Percutaneous balloon kyphoplasty (BK) is widely accepted as both a safe and effective method for the treatment of symptomatic benign vertebral compression fractures of the thoracic and lumbar spines. In addition to pain control, BK also allows for a correction of kyphotic deformity in certain cases. A disruption in the posterior wall of the affected vertebrae as seen on pre-procedure CT imaging is considered by many clinicians to be either a relative or an absolute contraindication to BK.

At UPMC, we have studied 114 consecutive patients (treated between 2010 and 2015) who were retrospectively identified with posterior wall disruption as determined on pre-procedure imaging. All cases were performed using a bipedicular technique by a single neurosurgeon. Each case was examined for cement leakage, anterior vertebral body height, improvement in pain determined by the visual analogue scale (VAS) score from baseline and one-month post procedure, and clinical sequelae from cement leakage. One hundred seven levels of BK were performed. No patient had radiographic evidence of cement leakage into the spinal canal; 14 (12%) cases had asymptomatic cement leakage outside of the vertebral body. The mean anterior vertebral body height was 14.35 +/- 5.4 mm pre-procedure and 19.32 +/- 5.3 mm post-procedure (p=0.001). Mean VAS was 8.7 pre- and 2.5 post-procedure (p=0.001). There were no cases of new neurological symptoms in any patient after BK. 

Balloon kyphoplasty in the setting of posterior wall disruption as seen on pre-procedure imaging was found to be a safe and highly effective treatment for patients with benign compression fractures. Posterior wall disruption should not be considered a contraindication to BK. Patients can still achieve a high level of clinical success and safety in this setting.