J Korean Soc Spine Surg.  2018 Jun;25(2):41-46. 10.4184/jkss.2018.25.2.41.

Radiological Results of the Double-Balloon Inflation Technique during Kyphoplasty

• Ha DH
• Shim DM
• Kim TK
• Oh SK
• Kim SM

• KMID: 2421609
• DOI: http://doi.org/10.4184/jkss.2018.25.2.41

Abstract

STUDY DESIGN: Retrospective case-control study.
OBJECTIVES
We analyzed the radiological results of the double-balloon inflation technique in terms of its ability to reduce cement leakage, to increase bone cement bonding, and to promote anterior column height recovery. SUMMARY OF LITERATURE REVIEW: Various methods, such as the egg-shell technique, have been proposed to prevent leakage of cement during kyphoplasty in cases of osteoporotic compression fracture.
MATERIALS AND METHODS
This study analyzed 18 patients diagnosed with osteoporotic compression fracture of the lumbar spine who underwent the double-balloon inflation technique after April 2015, and 30 consecutive patients with the same diagnosis who were treated using the conventional method prior to April 2015. We analyzed the radiological results on immediate postoperative simple X-rays in the anteroposterior and lateral views, 6-week postoperative lateral X-rays, and 6-month postoperative lateral X-rays to detect changes in anterior vertebral height and the cement leakage rate.
RESULTS
The average anterior vertebral height increased by 7.58 mm in the double-balloon inflation group, and by 5.8 mm in the conventional group on the immediate postoperative radiographs (p=0.044). On average, a decrease of 3.08 mm was observed at 6 weeks postoperatively in the double-balloon inflation group, in contrast to a decrease of 4.68 mm in the conventional group (p=0.149). At the 6-month postoperative follow-up, an average decrease of 1.45 mm was found in the double-balloon inflation technique group, while a decrease of 1.40 mm was found in the conventional group (p=0.9110). The cement leakage rate was 22% in the double-balloon inflation group and 27% in the conventional group (p=0.730).
CONCLUSIONS
Compared to the conventional method, the double-balloon inflation technique can be done more safely, and also promotes a greater recovery of anterior vertebral height.

Keyword

Thoracolumbar spine; Osteoporosis; Kyphoplasty

MeSH Terms

Case-Control Studies
Diagnosis
Follow-Up Studies
Fractures, Compression
Humans
Inflation, Economic*
Kyphoplasty*
Methods
Osteoporosis
Retrospective Studies
Spine

Figure

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  Fig. 1. Double-balloon technique in kyphoplasty. (A, B) Balloon insertion into the dough state of the cement core. (C) Expansion to make an internal cast and to increase cement bone interdigitation. (D) Removal of the balloon, followed by reinsertion of the cement into the core.

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  Fig. 2. Graph showing anterior vertebral height recovery.

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  Fig. 3. Cement leakage into the inferior endplate of a fractured vertebra.

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