Radiographic and safety details of vertebral body stenting: results from a multicenter chart review
1 Department of Orthopaedic Surgery, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland
2 MEM Research Center, Institute for Evaluative Research in Orthopaedic Surgery, University of Bern, Stauffacherstrasse 78, CH-3014 Bern, Switzerland
3 Department of Trauma Surgery, University Hospital Münster, Domagkstraße 5, 48149 Münster, Germany
4 Center for Spinal Surgery and Neurotraumatology, BGU Hospital Frankfurt, Friedberger Landstraße 430, 60389 Frankfurt, Germany
5 Department of Spine Surgery, Mutterhaus der Borromäerinnen Hospital Trier, Feldstraße 16, 54290 Trier, Germany
6 Department of Spine Surgery, Aalborg University Hospital, Hobrovej18–22, 9100, Aalborg, Denmark
7 Department of Spine Surgery, Cantonal Hospital Fribourg, Chemin des Pensionnats 2, 1708 Fribourg, Switzerland
8 Department of Spine Surgery, University Hospital Rostock, Schillingallee 35, 18057 Rostock, Germany
9 Spine Center, Sonnenhof Hospital, Buchserstrasse 30, 3006 Bern, Switzerland
BMC Musculoskeletal Disorders 2013, 14:233 doi:10.1186/1471-2474-14-233Published: 8 August 2013
Up to one third of BKP treated cases shows no appreciable height restoration due to loss of both restored height and kyphotic realignment after balloon deflation. This shortcoming has called for an improved method that maintains the height and realignment reached by the fully inflated balloon until stabilization of the vertebral body by PMMA-based cementation. Restoration of the physiological vertebral body height for pain relief and for preventing further fractures of adjacent and distant vertebral bodies must be the main aim for such a method. A new vertebral body stenting system (VBS) stabilizes the vertebral body after balloon deflation until cementation. The radiographic and safety results of the first 100 cases where VBS was applied are presented.
During the planning phase of an ongoing international multicenter RCT, radiographic, procedural and followup details were retrospectively transcribed from charts and xrays for developing and testing the case report forms. Radiographs were centrally assessed at the institution of the first/senior author.
100 patients (62 with osteoporosis) with a total of 103 fractured vertebral bodies were treated with the VBS system. 49 were females with a mean age of 73.2 years; males were 66.7 years old. The mean preoperative anterior-middle-posterior heights were 20.3-17.6-28.0 mm, respectively. The mean local kyphotic angle was 13.1°. The mean preoperative Beck Index (anterior edge height/posterior edge height) was 0.73, the mean alternative Beck Index (middle height/posterior edge height) was 0.63. The mean postoperative heights were restored to 24.5-24.6-30.4 mm, respectively. The mean local kyphotic angle was reduced to 8.9°. The mean postoperative Beck Index was 0.81, the mean alternative one was 0.82. The overall extrusion rate was 29.1%, the symptomatic one was 1%. In the osteoporosis subgroup there were 23.8% extrusions. Within the three months followup interval there were 9% of adjacent and 4% of remote new fractures, all in the osteoporotic group.
VBS showed its strengths especially in realignment of crush and biconcave fractures. Given that fracture mobility is present, the realignment potential is sound and increases with the severity of preoperative vertebral body deformation.