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Open Access Research article

Reduction of the domino effect in osteoporotic vertebral compression fractures through short-segment fixation with intravertebral expandable pillars compared to percutaneous kyphoplasty: a case control study

Jui-Yang Hsieh1, Chung-Ding Wu3, Ting-Ming Wang1, Hsuan-Yu Chen1, Chui-Jia Farn1 and Po-Quang Chen12*

Author Affiliations

1 Department of Orthopedics, National Taiwan University & Hospital, No. 7, Chung-Shan South Rd., 100, Taipei, Taiwan

2 Department of Orthopaedics, Min-Sheng General Hospital, 168, Jingguo Rd., 330, Taoyuan City, Taoyuan County, Taiwan

3 Department of Orthopaedics, Cathay General Hospital, No. 280, Sec. 4, Ren’ai Rd., Xinyi Dist., 110, Taipei City, Taiwan

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BMC Musculoskeletal Disorders 2013, 14:75  doi:10.1186/1471-2474-14-75

Published: 2 March 2013

Abstract

Background

Osteoporotic vertebral compression fracture is the leading cause of disability and morbidity in elderly people. Treatment of this condition remains a challenge. Osteoporotic vertebral compression fractures can be managed with various approaches, but each has limitations. In this study, we compared the clinical outcomes obtained using short-segment fixation with intravertebral expandable pillars (I-VEP) to those obtained with percutaneous kyphoplasty in patients who had suffered vertebral compression fractures.

Methods

The study included 46 patients with single-level osteoporotic thoracolumbar fractures. Twenty-two patients in Group I underwent short-segment fixation with I-VEP and 24 patients in Group II underwent kyphoplasty. All patients were evaluated pre- and postoperatively using a visual analogue scale, anterior height of the fractured vertebra, and kyphotic angle of the fractured vertebra. The latter 2 radiological parameters were measured at the adjacent segments as well.

Results

There was no significant difference between the groups in terms of gender or fracture level, but the mean age was greater in Group II patients (p = 0.008). At the 1-year follow-up, there were no significant differences in the visual analogue scale scores, anterior height of the fractured vertebra, or the value representing anterior height above the fractured vertebra and kyphotic angle below the fractured vertebra, after adjusting for the patients’ gender, fracture level, and age. When considered separately, the anterior height below the fractured vertebra was significantly higher and the kyphotic angle above the fractured vertebra was significantly smaller in Group I than in Group II (p = 0.029 and p = 0.008, respectively). The kyphotic angle of the fractured vertebra was significantly smaller in Group II than in Group I (p < 0.001).

Conclusions

In older individuals with vertebral compression fractures, kyphoplasty restored and maintained the collapsed vertebral body with less kyphotic deformity than that induced by short-segment fixation with I-VEP. Short-segment fixation with I-VEP was more effective in maintaining the integrity of adjacent segments, which prevented the domino effect often observed in patients with osteoporotic kyphotic spines.

Keywords:
Short-segment fixation; Intravertebral expandable pillar; Percutaneous kyphoplasty; Vertebral compression fracture