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ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 3  |  Page : 289-292

Clinical effect of balloon kyphoplasty in elderly patients with multiple osteoporotic vertebral fracture


1 Department of Orthopaedic, Zhangye People's Hospital, Hexi University, Zhangye, Gansu, China
2 Department of Orthopaedic, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai, Hebei, China

Date of Acceptance23-Jul-2018
Date of Web Publication6-Mar-2019

Correspondence Address:
Dr. J J Kong
Department of Orthopaedic, Jizhong Energy Xingtai Mining Group General Hospital, Xingtai, Hebei
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_8_18

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   Abstract 


Objective: This study aims to discuss the clinical effect of balloon kyphoplasty on elderly patients with multiple osteoporotic vertebral fractures. Methods: The observation group was treated with balloon kyphoplasty, and the control group was managed with conservative treatment. Image indices, pain degree, daily life disturbance, and occurrences of complications were compared between the two groups. Results: In total, 116 elderly patients with multiple osteoporotic vertebral fracture admitted in our hospital from January 2016 to June 2017 were chosen and divided randomly into observation (n = 58) and control groups (n = 58). The observation group showed a significantly higher trailing edge, leading edge, and midcourt line and larger upper thoracic kyphosis compared with the control group (P < 0.05). Before the treatment, no statistically significant differences were observed between the two groups in terms of visual analog scale (VAS) score and daily life disturbance score (P > 0.05). However, the VAS score and the daily life disturbance score of the two groups decreased sharply after the treatment (P < 0.05). Moreover, the VAS score and the daily life disturbance score of the observation group were significantly lower than those of the control group (P < 0.05). The observation group showed lower occurrence rate of complications compared with the control group (P < 0.05). Conclusions: Balloon kyphoplasty can significantly improve the image indices of patients with multiple osteoporotic vertebral fractures and relieve their pain degree and daily life disturbance. Balloon kyphoplasty exhibited a low occurrence rate of complications and high safety and is, thus, worthy of clinical applications.

Keywords: Balloon kyphoplasty, clinical effect, multiple osteoporotic vertebral fractures


How to cite this article:
Liu Q, Cao J, Kong J J. Clinical effect of balloon kyphoplasty in elderly patients with multiple osteoporotic vertebral fracture. Niger J Clin Pract 2019;22:289-92

How to cite this URL:
Liu Q, Cao J, Kong J J. Clinical effect of balloon kyphoplasty in elderly patients with multiple osteoporotic vertebral fracture. Niger J Clin Pract [serial online] 2019 [cited 2019 May 22];22:289-92. Available from: http://www.njcponline.com/text.asp?2019/22/3/289/253464




   Introduction Top


Multiple osteoporotic vertebral fractures refer to the reduction of bone mass, fine structural damages to bones, and increase in bone fragility.[1] Vertebral fracture is characterized by multiple and frequent occurrences among elderly; this condition considerably affects the physical health and life quality of the patients.[2] Compared with conservative treatment, balloon kyphoplasty presents the advantages of minimal trauma, simple operation, and low pain degree.[3] This study discussed the clinical effect of balloon kyphoplasty on multiple osteoporotic vertebral fracture to provide references for clinical treatment.


   Methods Top


In total, 116 elderly patients with multiple osteoporotic vertebral fractures admitted in our hospital from January 2016 to June 2017 were chosen as respondents. They all underwent X-ray and computed tomography examination and satisfied the diagnostic standards of multiple osteoporotic vertebral fracture. This study was approved by the Medical Ethics Committee of our hospital. All respondents signed an informed consent prior to their participation. The patients were randomly divided into the observation (n = 58) and control groups (n = 58). The observation group included 28 males and 39 females, with an average age of 61–89 years (65.34 ± 2.57). About 37 cases presented with fractures of the lumbar vertebra, and 21 cases were detected with fractures of the thoracic vertebra. The control group included 29 males and 29 females, with an average of 60–87 years (65.78 ± 2.81). Thirty cases had fractures of the lumbar vertebra, and 20 cases manifested fractures of the thoracic vertebra. The two groups showed no statistically significant difference in terms of general information, such as gender, age, and fracture position (P > 0.05).

Treatment methods

Patients in the control group were provided with conservative treatment, including analgesia using drugs, physical treatment, and fixation treatment, and maintained in bed for 3 months. In contrast, patients in the observation group were subjected to balloon kyphoplasty. Each patient was given local anesthesia in prone posture, and the surgical site was routinely disinfected. Under C-arm fluoroscopy, paracentesis was performed on the external upper end of the pedicle of the vertebral arch. The operator produced a bone tunnel inside the centrum via fluoroscopy. The balloon was sent from the lateral pedicle of the vertebral arch to ensure that the lateral balloon was located in the lower frontal area of the patient's vertebral body. The balloon was tilted from the back to the front. After confirming that they matched in shape, the injection device was connected. Both balloons were injected with Omnipaque. Then, pressurization and dilatation were performed to ensure satisfactory restoration of the vertebral body (otherwise the balloon reaches the surrounding skin of the vertebral body). Afterward, the injection was stopped. The controlling force was lower than 300 psi. Pressurization was stopped when the fracture recovered well, and the balloon was collected. The mud was stirred evenly and injected into the balloon from both sides of bone cement simultaneously. With the assistance of X-ray fluoroscopy, injection was stopped when the bone cement was about to spill over. When the bone cement injector impacted the bone cement and rendered the curing complete, the relevant device was pulled out; the wound was routinely cleaned and sutured, and the related injured vertebral operation was accomplished. During the operation, the surgeon needs to closely monitor a sudden drop in blood pressure, arrhythmia, sudden cardiac arrest, and other adverse events. When any of these symptoms occurs, surgery should be stopped immediately.

Observation indices

The image indices, pain degree, daily life disturbance, and occurrence rate of complications of the two groups were observed. The image indices included the trailing edge height, leading edge height, midcourt line, and upper thoracic kyphosis. The pain degree of the two groups was assessed using VAS scoring through the visual simulation method. A high VAS score reflected a high pain degree. The daily life disturbance was evaluated using the Barthel index scoring method. A high score implied a serious daily life disturbance.

Statistical analysis

All experimental data were processed using SPSS 22.0 (IBM, China). Measurement data were expressed by “–x±s” and examined using t-test. Enumeration data were expressed by “%” and examined using χ2-test. P < 0.05 indicated statistically significant difference.


   Results Top


Image indices

The observation group showed a significantly higher trailing edge, leading edge, and midcourt line and a larger upper thoracic kyphosis compared with the control group (P < 0.05). Results are shown in [Table 1].
Table 1: Comparison of image indices between the two groups

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Pain degree and daily life disturbance

Before the treatment, no statistically significant differences were observed between the two groups in terms of VAS and daily life disturbance scores (P > 0.05). However, the VAS and daily life disturbance scores of the two groups decreased sharply after the treatment (P < 0.05). Moreover, the VAS and daily life disturbance scores of the observation group were significantly lower than those of the control group (P < 0.05). Results are shown in [Table 2].
Table 2: Comparison of the pain degree and daily life disturbance between the two groups

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Occurrence rate of complications

Only one patient had bone cement leakage in the observation group. Hence, the occurrence rate of complications of the observation group was 1.72%. The control group had one case of venous embolism, four cases of decubitus, and four cases of infection. The occurrence rate of complications of the control group was 15.52%, which was significantly higher than that of the observation group (χ2 = 12.088, P < 0.05). The observation group had a far lower occurrence rate of complications than the control group (P < 0.05). Results are shown in [Table 3].
Table 3: Comparison of the occurrence rate of complications between the two groups

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   Discussion Top


Osteoporosis is a disease that causes the bones to become brittle, making them break easily. Most spinal fractures are caused by osteoporosis. In the case of vertebral fracture and breakage, spinal fracture or compression fracture of the vertebral body occurs.[4] The incidence rate of osteoporosis among the elderly population is high, and age is one of the important reasons for the occurrence of spinal fracture. Relevant clinical research literature shows that, currently, the population with osteoporosis is approximately 88 million. Given the social development and progress and factors such as accelerated aging, the occurrence rate of osteoporotic spinal fracture is expected to continuously increase. In most cases, there are no obvious symptoms during the progression of osteoporosis.[5] As a result, people do not realize having the disease until the occurrence of fracture. Multiple spinal fractures cause the shortening and bending forward of the spine, which may further develop into scoliosis or humpback. Patients with spine fracture induced by multiple osteoporosis are frequently accompanied by severe pains at the waist, and kyphosis not only renders walking and reaching for objects even more difficult, but it also causes chronic back pain and height reduction over time.[6] Patients with spinal fracture induced by multiple osteoporosis will lose their ability to stand and walk on their own and even present with pulmonary dysfunction, which may cause death.

Clinical treatments mainly involve surgical and nonsurgical treatments. The traditional therapeutic regimen for spinal fracture induced by multiple osteoporosis includes cushioning the waist with pillows, fixation treatment with waist orthosis, and drug analgesia therapy.[7] Related clinical studies have shown that reduction of bone substance in the spine easily occurs when using pillows to cushion the waist or fixation treatment with waist orthosis as these practices will result in severe osteoporosis. Moreover, patients with spinal fracture induced by multiple osteoporosis do not achieve a good therapeutic outcome from drug analgesia, and the therapy time is very long, which significantly adds more burden to other organs.[8] In contrast, balloon kyphoplasty is a kind of minimally invasive spine surgery. The treatment involves placing an inflatable balloon inside a collapsed vertebral body and recovering the collapsed end plate. Then, bone cement is injected into an intensified vertebral body. The operator recovers the vertebral height by balloon dilatation inside the vertebral body to ensure that the fracture is reduced.[9] A rigid internal fixation of the fracture is performed to achieve rapid analgesia, and the biomechanical stability of the fracture sites can be restored. This procedure enhances the stability and strength of the vertebral body, prevents collapse, and relieves pain by injecting bone cement from the pedicle of a vertebral arch. Compared with conservative treatment, balloon kyphoplasty holds several advantages, such as decreased trauma, lowered pain intensity, and low incidence of complications. Related clinical literature revealed that after patients with multiple senile spine fractures induced by multiple osteoporosis underwent balloon kyphoplasty, the risk of reoccurrence of vertebral body fracture was effectively reduced, and the vertebral height and angle were restored.[10] In this study, the clinical effect of balloon kyphoplasty in treating spinal fracture induced by multiple osteoporosis was observed and analyzed. The results showed that the patients in the observation group exhibited a significantly higher posterior height, anterior height, middle-line height, and kyphotic angle than those of the control group (P < 0.05). Before treatment, the patients of both groups did not display significant difference in VAS scores and daily life disability scale (P > 0.05). After treatment, the VAS and daily life disability scores of patients in both groups were significantly lower than those before treatment (P < 0.05). The VAS and daily life disability scores of patients in the observation group were significantly lower than those of the control group (P < 0.05). The patients in the observation group showed a significantly lower incidence of complications than those in the control group (P < 0.05). These findings indicate that balloon kyphoplasty can significantly reduce patients' daily life disability, relieve pain, and enhance vertebral indexes.


   Conclusions Top


In conclusion, balloon kyphoplasty is recommended in treating spinal fractures induced by multiple senile osteoporosis. This procedure can significantly improve patient imaging indicators, relieve pain, and ameliorate daily life disabilities. Besides its safety and reliability, it also reduces the incidence of complications. Therefore, the use of this procedure should be promoted clinically.

Financial support and sponsorship

Nil

Conflict of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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