Efficacy of postural reduction in osteoporotic vertebral compression fractures followed by percutaneous vertebroplasty

OBJECTIVE: Vertebroplasty in the symptomatic osteoporotic vertebral fracture has become increasingly popular. However, there have been some limitations in restoring the height of the collapsed vertebrae and in preventing the leaking of cement. In the severely collapsed vertebrae of more than two thirds of their original height, vertebroplasty is regarded as a contraindication. We tried postural reduction using a soft pillow under the compressed level. This study was undertaken to investigate the effectiveness of the combination of postural reduction and vertebroplasty for re-expansion and stabilization of the osteoporotic vertebral fractures. METHODS: A total of 75 patients with single level vertebral compression fracture were treated with postural reduction followed by vertebroplasty. In 30 patients, the vertebral body was severely collapsed more than two-thirds of its original height. We calculated the compression ratio (anterior height/posterior height) and measured the Cobb angle. We analyzed the degree of re-expansion according to the onset duration. RESULTS: The mean compression ratio was 0.60 +/- 0.15 initially and increased to 0.75 +/- + 0.17 after vertebroplasty. The mean Cobb angle was 16.14 +/- 11.29 degrees and corrected to 10.71 +/- 12.08 degrees. The degree of re-expansion showed significant relation with the onset duration. Twenty-eight of 30 (93%) severely collapsed vertebrae re-expanded after postural reduction, which made vertebroplasty possible. CONCLUSION: This new method of vertebroplasty leads to significant restoration of height and correction of kyphosis. The re-expansion was closely related with onset duration. In cases of severely collapsed vertebrae which is able to be re-expanded by postural reduction, vertebroplasty could be applied safely.