A comparative study of percutaneous kyphoplasty alone and percutaneous pedicle instrumentation combined with percutaneous kyphoplasty for osteoporotic type-A3 thoracolumbar fractures in elderly patients

Objective To compare the therapeutic effect of percutaneous kyphoplasty alone and percutaneous pedicle instrumentation combined with percutaneous kyphoplasty for osteoporotic type-A3 thoracolumbar fractures in elderly patients.Methods From January 2007 to December 2008,43 patients older than 65 years with osteoporotic type-A3 thoracolumbar fracture without nerve damage were randomly divided into two groups:percutaneous kyphoplasty alone group (1) and percutaneous pedicle instrumentation combined with percutaneous kyphoplasty group (2).Then percutaneous kyphoplasty and percutaneous pedicle instrumentation combined with percutaneous kyphoplasty were performed in patients of each group,respectively.Before operation,there were no statistical differences in many parameters between two groups,such as age,gender,body mass index,affected segments and bone density.Results All patients were followed up for 24 to 59 months (average,34.1 months).One week after operation,visual analogue scales (VAS),Oswestry disability index (ODI) and Cobb angle were respectively 2.9±0.8,29.2％±8.1％ a nd 7.7°±4.5° in group 1,and 0.9±0.6,17.9％±4.7％ and 3.0°±5.8° in group 2.At final follow-up,VAS score,ODI and Cobb angle were respectively 1.4±1.2,14.6％±8.4％ and 10.4°±4.7° in group 1,and 0.4±0.6,8.1％±5.0％ and 4.7°±6.4° in group 2.There were significant differences between two groups at two time points.In percutaneous kyphoplasty alone group,adjacent vertebral fracture occurred in 1 patient,and vertebral refracture in 2 patients.Conclusion For elderly patients with osteoporotic type-A3 thoracolumbar fracture,compared with percutaneous kyphoplasty alone,percutaneous pedicle instrumentation combined with percutaneous kyphoplasty is more effective in correcting deformity,relieving pain,maintaining vertebral height and restoring spinal stability. Key words: elderly;  thoracic;  lumbar;  fractures;  fracture fixation