• AbdelgawaadAhmed ShawkyASSpine Center, Helios Klinikum Erfurt, Erfurt, Germany; Department of Orthopedics and Traumatology, Assiut University Hospitals, Assiut, Egypt. Electronic address: ahsh313@yahoo.com., Ali Ezzati, Ramachandran Govindasamy, Branko Krajnovic, Belal Elnady, and SaidGalal ZakiGZDepartment of Orthopedics and Traumatology, Assiut University Hospitals, Assiut, Egypt..
• Spine Center, Helios Klinikum Erfurt, Erfurt, Germany; Department of Orthopedics and Traumatology, Assiut University Hospitals, Assiut, Egypt. Electronic address: ahsh313@yahoo.com.
• Spine J. 2018 Jul 1; 18 (7): 1143-1148.

Background ContextCement augmentation techniques are standard treatments for osteoporotic vertebral fractures. Compared with vertebroplasty, kyphoplasty is associated with lower rates of cement leak and better deformity correction; however, posterior wall fractures are relative, but not absolute; contraindications for both techniques and hence treatment practices vary among spine centers.PurposeThe primary aim of this study was to assess our center's incidence of posterior cement leakage in osteoporotic vertebral fractures with posterior wall injury treated by balloon kyphoplasty (BKP). Secondarily, physiological results, pain relief, complication rates, and non-posterior cement leakage were also evaluated.Study DesignThis is a prospective cohort study done in a high-volume spine center in Germany.Patient SampleEighty-two patients with 98 osteoporotic vertebral fractures with posterior wall cortical injury were studied from 2012 to 2016.Outcome MeasuresThe following were the outcome measures: (1) physiological measures: standing plain x-rays (anteroposterior and lateral views), with the following parameters evaluated: cement leak behind the posterior vertebral body border, Cobb angle for local sagittal deformity, vertebral wedge angle, and anterior vertebral height; (2) cement volume injected in each vertebra; and (3) self-report measures: visual analog scale (VAS).MethodsAll patients underwent BKP using a bipedicular approach. Preoperative clinical and neurologic evaluations were done. Radiological evaluations included plain X-ray images, computed tomography scans and magnetic resonance imaging. The average follow-up period was 18 months.ResultsNo cement leakage into the spinal canal occurred in any of the patients. Asymptomatic leakage into other sites was seen in 22 vertebrae (22.45%). There was significant improvement in the Cobb angle, the vertebral wedge angle, and the anterior vertebral height in all cases. The mean preoperative VAS was 8.1, and this improved to 2.3 on the third postoperative day.ConclusionBalloon kyphoplasty is a viable option for the treatment of osteoporotic vertebral fractures even with posterior wall involvement.Copyright © 2017 Elsevier Inc. All rights reserved.

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