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      Comparison of Percutaneous Kyphoplasty with or without Pedicle Screw Fixation in Osteoporotic Thoracolumbar Vertebral Fractures: A Retrospective Study

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          Abstract

          Background

          Osteoporotic thoracolumbar compression fractures have become a great social burden due to the aging tendency of population. This study is aimed at comparing the clinical and radiological outcomes of percutaneous kyphoplasty with or without pedicle screw fixation in patients with osteoporotic thoracolumbar fractures. Hypothesis. There is a difference in clinical outcomes between percutaneous kyphoplasty with pedicle screw fixation and percutaneous kyphoplasty.

          Methods

          This retrospective study included 87 patients who received percutaneous kyphoplasty with or without pedicle screw fixation between October 2015 and October 2017 at Ningbo No.6 Hospital and were followed for 2 years. A total of 40 patients received percutaneous kyphoplasty with pedicle screw fixation (PKPF group), and the other 47 patients had percutaneous kyphoplasty only (PKP group). The outcomes were measured using the visual analogue scale (VAS), Oswestry Disability Index (ODI), Cobb angle (CA), and anterior vertebra height rate (AVHr), which were calculated at preoperative admission and each follow-up visit. Complications including postoperative back pain, refracture, and fixation failure were collected from medical records.

          Results

          There was no significant difference in baseline characteristics or preoperative data between the two groups ( p < 0.05) but significantly better improvements in VAS, ODI, CA, and AVHr at 12- and 24-month follow-up visits in the PKPF group compared with those of the PKP group. 23 (48.9%) patients in the PKP group had complications, whereas only 5 (12.5%) patients in the PKPF group presented complications including 2 postoperative back pain and 1 fixation failure ( p = 0.04).

          Conclusions

          PKPF obtained longer correction and better improvement in VAS, ODI, and CA in patients with osteoporotic thoracolumbar vertebral fractures than PKP.

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          Most cited references33

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          An estimate of the worldwide prevalence and disability associated with osteoporotic fractures.

          O. Johnell, J Kanis (2006)
          The aim of this study was to quantify the global burden of osteoporotic fracture worldwide. The incidence of hip fractures was identified by systematic review and the incidence of osteoporotic fractures was imputed from the incidence of hip fractures in different regions of the world. Excess mortality and disability weights used age- and sex-specific data from Sweden to calculate the Disability Adjusted Life Years (DALYs) lost due to osteoporotic fracture. In the year 2000 there were an estimated 9.0 million osteoporotic fractures of which 1.6 million were at the hip, 1.7 million at the forearm and 1.4 million were clinical vertebral fractures. The greatest number of osteoporotic fractures occurred in Europe (34.8%). The total DALYs lost was 5.8 million of which 51% were accounted for by fractures that occurred in Europe and the Americas. World-wide, osteoporotic fractures accounted for 0.83% of the global burden of non-communicable disease and was 1.75% of the global burden in Europe. In Europe, osteoporotic fractures accounted for more DALYs lost than common cancers with the exception of lung cancer. For chronic musculo-skeletal disorders the DALYs lost in Europe due to osteoporosis (2.0 million) were less than for osteoarthrosis (3.1 million) but greater than for rheumatoid arthritis (1.0 million). We conclude that osteoporotic fractures are a significant cause of morbidity and mortality, particularly in the developed countries.
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            Measurement Properties of Visual Analogue Scale, Numeric Rating Scale, and Pain Severity Subscale of the Brief Pain Inventory in Patients With Low Back Pain: A Systematic Review

            Alessandro Chiarotto, Lara J Maxwell, Raymond W. Ostelo … (2019)
            The Visual Analogue Scale (VAS), Numeric Rating Scale (NRS), and Pain Severity subscale of the Brief Pain Inventory (BPI-PS) are the most frequently used instruments to measure pain intensity in low back pain. However, their measurement properties in this population have not been reviewed systematically. The goal of this study was to provide such systematic evidence synthesis. Six electronic sources (MEDLINE, EMBASE, CINAHL, PsycINFO, SportDiscus, Google Scholar) were searched (July 2017). Studies assessing any measurement property in patients with nonspecific low back pain were included. Two reviewers independently screened articles and assessed risk of bias using the COSMIN checklist. For each measurement property, evidence quality was rated as high, moderate, low, or very low (GRADE approach) and results were classified as sufficient, insufficient, or inconsistent. Ten studies assessed the VAS, 13 the NRS, 4 the BPI-PS. The 3 instruments displayed low or very low quality evidence for content validity. High-quality evidence was only available for NRS insufficient measurement error. Moderate evidence was available for NRS inconsistent responsiveness, BPI-PS sufficient structural validity and internal consistency, and BPI-PS inconsistent construct validity. All VAS measurement properties were underpinned by no, low, or very low quality evidence; likewise, the other measurement properties of NRS and BPI-PS. PERSPECTIVES: Despite their broad use, there is no evidence clearly suggesting that one among VAS, NRS, and BPI-PS has superior measurement properties in low back pain. Future adequate quality head-to-head comparisons are needed and priority should be given to assessing content validity, test-retest reliability, measurement error, and responsiveness.
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              Diagnosis and Management of Vertebral Compression Fractures.

              Jason McCarthy, Amy Davis (2016)
              Vertebral compression fractures (VCFs) are the most common complication of osteoporosis, affecting more than 700,000 Americans annually. Fracture risk increases with age, with four in 10 white women older than 50 years experiencing a hip, spine, or vertebral fracture in their lifetime. VCFs can lead to chronic pain, disfigurement, height loss, impaired activities of daily living, increased risk of pressure sores, pneumonia, and psychological distress. Patients with an acute VCF may report abrupt onset of back pain with position changes, coughing, sneezing, or lifting. Physical examination findings are often normal, but can demonstrate kyphosis and midline spine tenderness. More than two-thirds of patients are asymptomatic and diagnosed incidentally on plain radiography. Acute VCFs may be treated with analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, narcotics, and calcitonin. Physicians must be mindful of medication adverse effects in older patients. Other conservative therapeutic options include limited bed rest, bracing, physical therapy, nerve root blocks, and epidural injections. Percutaneous vertebral augmentation, including vertebroplasty and kyphoplasty, is controversial, but can be considered in patients with inadequate pain relief with nonsurgical care or when persistent pain substantially affects quality of life. Family physicians can help prevent vertebral fractures through management of risk factors and the treatment of osteoporosis.
              Article 0 comments Cited 62 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Yunqiang Zhuang:
                ORCID: https://orcid.org/0000-0003-1956-4255
                Long Zhou:
                ORCID: https://orcid.org/0000-0003-4474-8232
                Journal
                Journal ID (nlm-ta): Dis Markers
                Journal ID (iso-abbrev): Dis Markers
                Journal ID (publisher-id): DM
                Title: Disease Markers
                Publisher: Hindawi
                ISSN (Print): 0278-0240
                ISSN (Electronic): 1875-8630
                Publication date Collection: 2021
                Publication date (Electronic): 29 June 2021
                Volume: 2021
                Electronic Location Identifier: 4745853
                Affiliations
                Ningbo No.6 Hospital, Zhejiang, Ningbo 315000, China
                Author notes

                Academic Editor: Zhongjie Shi

                Author information
                https://orcid.org/0000-0002-0113-2932
                https://orcid.org/0000-0002-4226-160X
                https://orcid.org/0000-0002-9046-0718
                https://orcid.org/0000-0001-5891-9894
                https://orcid.org/0000-0002-8660-6075
                https://orcid.org/0000-0003-2311-7175
                https://orcid.org/0000-0003-1956-4255
                https://orcid.org/0000-0003-4474-8232
                Article
                DOI: 10.1155/2021/4745853
                PMC ID: 8263273
                PubMed ID: 34306254
                SO-VID: 84c08f95-36e9-4ea0-86c8-d94d71e06bfc
                Copyright © Copyright © 2021 Dichao Huang et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 April 2021
                Date revision received : 21 May 2021
                Date accepted : 18 June 2021
                Categories
                Subject: Research Article

                Data availability:

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