Korean J Radiol.  2008 Oct;9(5):420-425. 10.3348/kjr.2008.9.5.420.

Preliminary Results for the Treatment of a Pain-Causing Osteoporotic Vertebral Compression Fracture with a Sky Bone Expander

• Liu JB
• Tang XM
• Xu NW
• Bao HT

• KMID: 1385400
• DOI: http://doi.org/10.3348/kjr.2008.9.5.420

Abstract

OBJECTIVE
Vertebral compression fractures (VCFs) are common complications of osteoporosis. The expansion of VCFs with a Sky Bone Expander is a new procedure which improves kyphotic deformities and decreases pain associated with VCFs. The purpose of this study was to investigate the preliminary results for the treatment of painful osteoporotic VCFs with a Sky Bone Expander. MATERIALS AND METHODS: Twenty-six patients with pain-causing VCFs were treated with a Sky Bone Expander. This operation involved the percutaneous insertion of the Sky Bone Expander into a fractured vertebral body transpedicularly. Following the expansion, the Sky Bone Expander was contracted and removed, resulting in a cavity to be filled with bone cement. All fractures were analyzed for improvement in sagittal alignment. Clinical complications, pain relief and ambulation status were evaluated 1 day, 1 week, 1 month, and 3 months after the operation. RESULTS: Twenty-four hours after the operation, all the patients treated experienced some degree of pain relief. In addition, no postoperative neurologic complications were noted. The average operative time was 42.4 +/- 15.5 min per vertebra. Moreover, an average cement volume of 3.5 mL (range, 2.5 +/- 5.0 mL) was injected per vertebra. The average anterior height was 18.4 +/- 5.1 mm preoperatively and 20.5 +/- 5.3 mm postoperatively (p < 0.01). Furthermore, the average midline height was 15.5 +/- 5.2 mm preoperatively and 18.9 +/- 4.0 mm postoperatively (p < 0.01). The Cobb angle improved from 18.5 +/- 8.2 degrees preoperatively to 9.2 +/- 4.0 degrees postoperatively (p < 0.01). The Visual Anabog Scale scores decreased from 7.7 +/- 1.8 points preoperatively to 3.1 +/- 2.0, 2.9 +/- 1.7, 2.6 +/- 1.5 and 2.9 +/- 11.3 after 1 day, 1 week, 1 month and 3 months after the operation, respectively. Cement extrusion was observed in four patients without any neurologic symptoms. CONCLUSION: As a result of this study, we can postulate that the expansion of compressed vetrebra with a Sky Bone Expander is a safe and minimally invasive procedure resulting in the restoration of vertebral body height and the relief of pain associated with VCFs.

Keyword

Osteoporosis; Vertebral compression fracture; Kyphoplasty

MeSH Terms

Aged
Aged, 80 and over
Bone Cements
Female
Fractures, Compression/etiology/radiography/*surgery
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Osteoporosis/*complications
Pain/etiology/*surgery
Postoperative Complications
Prospective Studies
Radiography, Thoracic
Spinal Fractures/etiology/radiography/*surgery
*Tissue Expansion Devices
Treatment Outcome

Figure

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  Fig. 1 Configurations of a Sky-bone expander. A. Before expansion B. After full expansion

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  Fig. 2 Images of expansion of T11 osteoporotic vertebral compression fracture with Sky Bone Expander. A. Radiopaque polymer Expander was ideally situated under collapsed endplate in contracted configuration. B. Expander was unsheathed to elevate endplates. C, D. Lateral (C) and anteroposterior (D) radiographs showing vertebrae was filled with bone cement after Expander was resheathed and removed.

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  Fig. 3 Measurement of Cobb angle, anterior, middle, posterior vertebral height (AH, MH, PH).

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  Fig. 4 Mean VAS (Visual Analog Scale) pain scores at all points.

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  Fig. 5 Categorical ambulation status at all points.

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  Fig. 6 Measurement of anterior, middle, posterior vertebral height at all points.

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  Fig. 7 Anteroposterior digital radiographs showing cement in paravertebral veins.

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