The case demonstrated in Figure 18.10 is an average result. The patient had good pain relief (similar to PV) and a modest amount of height was restored (approximately 3-4 mm; Figure 18.10B). The clinical significance of this amount of height restoration still needs review. PV may also be associated with mild height restoration and is excellent at relieving pain. With pain relief following both PV and KP, patients get reduction in kyphosis and are able to support their body weight without pain (allowing them to stand straighter). Reproducible outcome analysis is needed to understand the significance (or lack thereof) of the differences between PV and KP.
Kyphoplasty is a relatively new procedure and, as such, peer-reviewed reports of clinical results are few. One early outcome study of 70 vertebral bodies treated in 30 patients reported average restoration of 2.9 mm of height.13 When the treated vertebrae were separated into two groups, 70% gained an average of 4.1 mm (46.8% height restoration), whereas 30% regained no height. Asymptomatic cement extravasations occurred in 8.6% of the levels treated, a rate similar to that reported for PV used for osteoporotic VCFs. Perioperative complications for KP include one myocardial infarction (3.3%) and two patients who sustained rib fracture during positioning (6.7%).
In another small report, the average vertebral body height restoration obtained in 24 procedures was as follows: anterior, 3.7 mm; middle, 4.7 mm; and posterior, 1.5 mm.16 The findings were similar to the amount of height restoration in the clinical series reported by Lieber-man et al.13
Reporting on preliminary results from 340 patients from a multicenter registry, Garfin et al.17 indicated a height restoration similar to that reported earlier.13 There was a serious complication rate of 1.2% that included permanent cord damage associated with cement leak-age.17 It should be noted, however, that these results were anecdotally reported in a literature review regarding KP and PV.
These early clinical reports do not offer substantial data for complete evaluation of the procedure's efficacy. Although KP appears to be able to restore height in some cases (Figure 18.10), it is unknown whether the typically 3 to 4 m of height restoration results in clinically significant benefit. Furthermore, it is unknown whether height restoration results in kyphosis reduction and subsequently in increased lung capacity. A long-term follow-up study determining the benefits of KP versus PV is needed but in reality will be a difficult task. Both procedures provide similar pain relief and, in experienced hands, similar risk. In the presence of pain relief, the benefits of height restoration will most likely remain empirical. Although the exact mechanism of pain relief is unknown, it is believed that both procedures provide pain relief secondary to fracture stabilization via cement injection.
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