Three different procedures were shown to demonstrate equivalent height restoration in patients with vertebral compression fractures, and one procedure in particular may exhibit less height loss in highly physical patients, according to a new study.
“We set out to evaluate three procedures used for treating vertebral compression fractures, using a clinically relevant cadaveric model,” said Allan L. Brook, MD, FSIR, and Derek Holyoak, PhD, lead presenters of “Height Restoration and Sustainability with Bilateral Vertebral Augmentation for Vertebral Compression Fractures.”
“Specifically, we evaluated a traditional balloon kyphoplasty technique (or BKP), a balloon kyphoplasty technique with the use of a directional assist instrument, and a titanium implantable vertebral augmentation device (or TIVAD).”
The abstract, which was named one of the SIR 2022 Featured Abstracts, provides data on how these three techniques restore and maintain height after surgery.
“Vertebral augmentation procedures have shown to be effective in pain reduction and lowering complication rates, mortality rates and morbidity rates,” said Drs. Brook and Holyoak. “A previous cadaveric study suggested the TIVAD achieved superior height restoration compared to the traditional BKP technique. However, since that study was performed, directional assist instruments were developed for the BKP technique.”
According to Drs. Brook and Holyoak, the previous study may have had less physiological relevance because the experimental setup involved only a single vertebral body with no adjacent discs or vertebrae, and height sustainability after surgery in response to physiologic loading was not assessed in the previous study.
“In this abstract, we expanded upon the previous study by analyzing the directional assist instruments with BKP and used a more physiologically relevant model, called a functional spinal unit, that retained the interverbal discs.” In addition, the investigators analyzed the effects of cyclic loading after surgery.
Investigators utilized five cadaver thoracolumbar spines, which were dissected into 30 two-functional spine units and given vertebral wedge compression fractures by reducing the anterior height of the vertebrae. They then performed surgery using the three techniques.
“Our findings demonstrate equivalent height restoration among all three techniques evaluated, contrary to the findings in the previous study,” said Drs. Brook and Holyoak. “This implies that all three treatments can restore height similarly after a vertebral compression fracture, which may lead to pain reduction and decreased mortality.”
In addition, researchers discovered a second interesting finding. “Less anterior height loss in response to high-level cyclic loading was observed with BKP with directional assist instruments compared to TIVAD,” they said. “Therefore, with the addition of directional assist instruments, the BKP procedure may exhibit less height loss in higher-demand patients who engage in physical activities that involve increased weight resistance.”
According to Drs. Brook and Holyoak, there are further paths to investigate. “The cyclic loading applied in this study recapitulated short-term loading after surgery. Although cyclic loading was performed for a total of 20,000 cycles, the study did not address long-term biomechanical performance.” As a result, long-term sustainability may be better understood with physiological loading for 100,000 cycles or more.
