Is balloon kyphoplasty better than percutaneous vertebroplasty for osteoporotic vertebral biconcave-shaped fractures?

Background Osteoporotic vertebral biconcave-shaped fractures are not commonly seen in clinical practice. Some articles have been published showing the outcome of vertebroplasty (PV) and balloon kyphoplasty (BKP), but few comparative studies have been performed. Purpose To compare the effect and safety of PV and BKP in treating osteoporotic vertebral biconcave-shaped fractures. Material and Methods In this retrospective comparative study, 38 patients with osteoporotic vertebral biconcave-shaped fractures were treated by PV, and 41 patients were treated by BKP from May 2005 to July 2011. The heights of the compromised vertebral body and the kyphotic angles were measured. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate pain and functional activity, respectively. The occurrence of refracture and cement leakage were determined, and the costs were recorded. Results The mean VAS and ODI scores significantly improved for both procedures at postsurgical measurements (P<0.05), and the improvement sustained at the final follow-up. In both groups, there were no significant differences in terms of restoration of the anterior vertebral height and correction of the kyphotic deformity. However, BKP was more effective in restoring the middle vertebral height than PV. Cement leakages were observed in nine (23.7%) treated vertebral bodies in PV group and in three (7.4%) treated vertebral bodies in BKP group, which was a statistically significant difference (P<0.05). There were four new osteoporotic vertebral fractures in the PV group and two in the BKP group during the follow-up period. The mean cost in the BKP group (6200122.1 USD) was higher than the PV group (2100 +/- 112.5 USD) (P<0.05). Conclusion Both PV and BKP achieved similar improvements in pain and functional outcomes for the treatment of osteoporotic vertebral biconcave-shaped fractures. BKP had a significant advantage over PV in terms of the restoration of the middle vertebral height and fewer cement leakages than PV.