Clinical Outcomes and Safety Comparison of Vertebroplasty, Balloon Kyphoplasty, and Vertebral Implant for Treatment of Vertebral Compression Fractures

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FIG 1.
Sample radiographic measurements. A 72-year-old man with a history of osteoporosis presented with severe midthoracic back pain. Anterior-posterior (A) and lateral (B) projections of fluoroscopic images of the thoracic spine with the needle at the level of T8 demonstrate a preprocedural T8 vertebral compression fracture, as shown by an increased LKA formed by solid white lines along the superior and inferior endplates and decreased midvertebral (dashed arrow) and anterior-vertebral (solid arrow) body heights. Following vertebral augmentation with SJ, anterior-posterior (C) and lateral (D) projections show postprocedural changes with improvement in LKA and VH at T8.
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FIG 2.
Pain score comparison. A, Distribution of patient-reported pain scores on a scale between 0 and 10 at rest for 3 procedure types pre- (red) and postprocedure (blue). B, The same pain score distribution reported at worst. Shown are median and interquartile ranges.
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FIG 3.
Vertebral augmentation radiologic changes. A, Distribution of changes in radiographic vertebral augmentation measurements for anterior vertebral length for the 3 procedures B, The same distribution of changes for middle vertebral length. C, The same distribution of changes for local kyphotic angle. Shown are median and interquartile ranges.

Table 1:

Patient demographics

Table 2:

Patient-reported outcomes

Pain Score at Rest (0–10)	KP	VP	SJ	P Value^{^a}
Pre (mean)	5.2	4.9	4.8	>.05
Post (mean)	2.5	2.9	2.1
Δ 95% CI	(1.9–3.5)	(1.3–2.7)	(2.1–3.3)
P value^{^b}	<.001	<.001	<.001
Pain score at worst (0–10)
Pre (mean)	8.3	7.8	8.6	<.001
Post (mean)	4.1	4.1	3.7
Δ 95% CI	(3.4–5.1)	(2.9–4.4)	(4.3–5.5)
P value^{^b}	<.001	<.001	<.001

Table 3:

Augmentation measurement outcomes

	KP	VP	SJ	P Value^{^a}
Anterior vertebral length (mm)
Pre (mean)	18.4	20.6	13.0	<.001
Post (mean)	18.6	21.0	17.3
Δ 95% CI	(0.03–0.4)	(0.09–0.79)	(3.1–5.6)
% Increase (mean)	1.1	2.2	32.4
% CI	(0.14–2.59)	(0.4–3.9)	(23.5–43.6)
Middle vertebral length (mm)
Pre (mean)	15.9	17.9	12.7	<.001
Post (mean)	16.6	19.5	17.2
Δ 95% CI	(0.4–1.1)	(0.4–6.5)	(3.0–6.0)
% Increase (mean)	4.5	5.0	35.6
% CI	(2.3–7.1)	(2.1–36.8)	(24.0–46.4)
LKA
Pre (mean)	7.6°	6.8°	8.9°	<.001
Post (mean)	6.9°	6.1°	6.9°
Δ Angle
Δ 95% CI	(0.09°–1.38°)	(0.15°–1.33°)	(1.24°–2.80°)

Table 4:

Adjacent level fracture statistics

	KP	VP	SJ
By visit^{^a}
Total No. of procedures	44	46	37
No. of visits with adj. fracture	1	3	1
Total No. of individuals with adj. fracture	1	3	1
No. of levels with adj. fractures	6	8	9
By level^{^b}
Total No. of levels	113	132	102
Total No. of individuals with adj. fracture	5	8	4