Introduction: Vertebral compression fracture (VCF) is one of the most frequent osteoporotic fractures, with increasing number of patients in the present aging society. On the other hand, many patients are being left behind without adequate diagnostic procedure and treatment. We present our clinical experiences of the Balloon Kyphoplsaty (BKP; Medtronic Sofamor Danek, Memphis, TN) for the patients with multiple VCFs.
Methods: Since introduction of the BKP to our clinical practice in July 2011, 48 patients (61 vertebrae) were treated in our institute. BKP was conducted after at least 2 weeks of conservative treatment. There were 14 male and 34 female patients of 72.5 years old on average. (61 to 89 years old). L1 (16 cases) was the most frequent site of VCF, followed by L4 (13 cases), T12 (8 cases). Twelve patients (25.0%) were suffered from multiple fresh VCFs at their first visit to our outpatient service; 2 VCFs in 8 patients, 3 and 4 VCFs in 2 patients each. The most painful fracture was detected and marked immediately before the operation by knocking on the spinous process.
Results: Nine of the 12 patients complained unsolved back pain after the initial BKP, and received consequent BKP within a month. Sufficient pain relief was obtained in 3 patients, and those patients were observed with subcutaneous administration of teriparatide. Complete symptom relief was obtained in 1 month, and improvement in their magnetic resonance images was noted in 12 months.
Conclusions: Admitting minimally invasiveness of the BKP, this surgical procedure of 30 minutes requires general anesthesia, and treatment of only one VCF is indicated for single operation. For the patients with multiple fresh VCFs, it may be desirable to carry out BKP only for the most painful fracture, and follow up the patients with lumbar orthosis and teriparatide.
Patient Care: Ballon Kyphoplasty is an effective and less invasive treatment for vertebral compression fracture, but adequate postoperative treatment with teriparatide will reduce unnecessary surgical intervention to the elderly patients with osteoporotic multiple compression fractures.
Learning Objectives: By the conclusion of this presentation, participants are able to reconsider: 1) adequate surgical treatment for osteoporotic multiple vertebral compression fractures, and 2) importance of postoperative administration of teriparatide to reduce the risk of consequent fractures.