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Preventing Loss of Correction After Balloon Kyphoplasty for Vertebral Compression Fractures

Scientists are looking for good ways to surgically treat acute lumbar fractures. Balloon kyphoplasty has been used by some, but there are a few problems with this procedure.

During kyphoplasty, a long, thin needle is inserted through the skin and soft tissues into the fractured vertebral body. A deflated balloon is pushed through the needle and placed inside the collapsed bone. The balloon is inflated in order to restore the vertebral height.

The balloon is deflated and removed. Once the balloon is removed, then cement is injected through the needle into the open space. Patients experience rapid pain relief and return of function after kyphoplasty.

But without proper support along the front of the vertebrae, the results may not last. Loss of correction has been reported. In this study, surgeons from Greece used balloon kyphoplasty along with pedicle screw fixation to fuse the segment. The use of hardware to fuse the spine is referred to as instrumentation. Patients included all had a lumbar compression fracture. They were operated on within two days after the fracture.

Screws were placed through the pedicles (upright columns of supporting bone) at the level of the fracture and above and below the fractured bone. Biocompatible self-hardening calcium phosphate cements were used. This type of cement doesn't increase the heat inside the bone and can stimulate the growth of new bone.

Results of fusion were assessed using X-rays and CT scans. Pain levels before and after the procedure were also recorded. Pain improved after surgery up to six months after the procedure was done. No further improvement in pain was reported after six months. Physical function improved during this same time frame.

The formation of bone bridging was seen on X-ray as early as three months after surgery. No further bone development was seen after eight months. Solid fusion was seen eight to 10 months after surgery. There was increased stiffness at the level of the segmental fixation.

Although the results of this study support the use of balloon kyphoplasty with instrumentation, long-term results must be studied. Loss of correction and increased deformity might occur later (after 10 months). Short-term results support the use of this technique to treat burst and compression lumbar fractures.

Panagiotis Korovessis, MD, PhD, et al. Minimal Invasive Short Posterior Instrumentation Plus Balloon Kyphoplasty with Calcium Phosphate for Burst and Severe Compression Lumbar Fractures. In Spine. March 15, 2008. Vol. 33. No. 6. Pp. 658-667.


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