SIR 2024
Pain Management/MSK
Clark R. Restrepo, MD (he/him/his)
Resident Physician
Medstar Georgetown University Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Jacob Leslie, MD, MBA
Resident Physician
Medstar Washington Hospital Center
Disclosure information not submitted.
Angela Zhou, BS
Medical student
Georgetown University School of Medicine
Disclosure information not submitted.
Recently, curved balloon/needle system was introduced as an aid to improve cement distribution throughout the vertebral body during unipedicular kyphoplasty. The goal of this study was to retrospectively compare the cement distribution and vertebral body height (VBH) restoration after unipedicular curved balloon and bipedicular balloon kyphoplasty for vertebral body compression fracture.
Materials and Methods:
From 2019 to 2023, seventy-five patients (71 ± 13 years, 41/75 female) underwent fluoroscopic guided balloon kyphoplasty for vertebral body compression fractures in the interventional radiology department. Kyphoplasty was performed from a bipedicular approach, using a straight trocar/balloon, or a unipedicular approach, using a curved trocar/balloon. Pre-procedure VBH was measured on initial lateral fluoroscopic image from the center of the vertebral body. Post-procedure vertebral body and cement measurements of height and AP length were taken on lateral view and width was taken on AP view. A cement distribution ratio was calculated by dividing the volume of cement, which was assumed to be a rectangle, by the volume of the vertebral body. VBH restoration was calculated as a percentage of increased vertebral body gained after the procedure. Student’s t-test was performed to determine statistical significance.
Results:
A total of 100 vertebral body compression fractures underwent balloon kyphoplasty (53 unipedicular, 47 bipedicular). Twenty-three of the vertebral body fractures were pathologic (19 treated with bipedicular approach) while the other 77 occurred secondary to osteoporosis (49 treated with unipedicular approach). Seventy of the 100 vertebral body fractures occurred at the lumbar level (37 unipedicular, 33 bipedicular) and 30/100 occurred at the thoracic level (16 unipedicular, 14 bipedicular). The average cement distribution ratio was significantly greater for the fractures treated with bipedicular balloon kyphoplasty compared to unipedicular curved balloon kyphoplasty (58.0% versus 51.5%, p=0.02). The average VBH restoration was significantly greater for bipedicular compared to unipedicular curved balloon kyphoplasty (11.9% versus 5.4%, p=0.02). No clinically significant cement leakage occurred during any of the cases.
Conclusion:
Despite improved vertebral body cement filling with unipedicular kyphoplasty using a curved balloon, bipedicular balloon kyphoplasty demonstrates better cement distribution and VBH restoration. Further studies are needed to determine if the clinical outcomes of these two approaches are comparable.