Kyphoplasty: 2 years of experience in a neurosurgery department Basar Atalay, MD T , Hakan Caner, MD, Cemal Gokce, MD, Nur Altinors, MD Department of Neurosurgery, Baskent University, Ankara, Turkey Abstract Background: Kyphoplasty is a new technique to treat collapsed vertebral body (VB) fractures. The technique is very effective for achieving rapid pain relief, restoring bone height, and consequent vertebral realignment, and thus stabilization of the vertebra. Methods: We reviewed 57 patients with vertebral compression fractures. All patients were neurologically intact and presented with severe low back pain or localized pain over the thoraco- lumbar region. Indications for kyphoplasty were osteoporotic and traumatic compression fractures, osteolytic tumor metastases, and aggressive hemangiomas without spinal canal compression. Results: In 57 patients, 77 levels were treated. Follow-up was 6.5 months. Patients were evaluated with a visual analog scale (VAS) preoperatively and postoperatively. The mean preoperative VAS score was 91.08 for pain, whereas the mean postoperative VAS score was 11.22. Percentage of mean pain relief was 87.9% during the first 6 months of follow-up. We achieved a 43.6% improvement in the height of the compressed VB and 6.38 of improvement in the kyphotic angle. No serious complications occurred. Mean hospital stay was 24 hours. Conclusions: Kyphoplasty carries significantly less morbidity than vertebroplasty or open surgery. Risk for embolization is low. Normal kyphotic angle can be restored or improved by this technique. In the hands of experienced surgeons, kyphoplasty is a safe and a minimally invasive technique for patients with neoplastic, traumatic, or osteoporotic lesions of the vertebra or sacrum. D 2005 Elsevier Inc. All rights reserved. Keywords: Kyphoplasty; Osteoporosis; Vertebral tumors; Vertebroplasty 1. Introduction Developed in France in the late 1980s, percutaneous vertebroplasty involves injection of PMMA into a fractured VB. Recently, a modification of this technique, percutane- ous balloon kyphoplasty, was developed by Mark Reilley [1,7,8]. Kyphoplasty involves inflation of a balloon within a collapsed VB to restore height and reduce kyphotic deformity before stabilization with PMMA. This new technique has been used for the treatment of osteoporotic compression fractures. It seems to be an effective way to stabilize compression fractures due to tumoral infiltration and reduce pain, thereby improving the quality of life in these patients. As many as 70% of patients with cancer and multiple myeloma initially present with osteolytic involve- ment of the spine. These lesions often lead to vertebral fractures and are associated with significant morbidity and mortality. The classic medical and surgical treatments for such spinal problems are often inadequate or too invasive for patients debilitated by cancer. In this technique, fracture of the VB is stabilized to decrease or eliminate pain and to prolong functional survival [5,8,12,13,16,17]. 2. Materials and methods Since June 2002, we have performed percutaneous balloon kyphoplasty to 77 vertebrae in 57 patients (19 men and 38 women; mean age, 67.5 years; range, 48-92 years) at Baskent University. All patients were neurologically intact and presented with severe low back or thoracic pain over the compressed vertebrae. Patients with osteoporotic compression fractures, traumatic com- pressions, and osteolytic vertebral tumors, including 0090-3019/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.surneu.2005.07.039 Abbreviations: PMMA, polymethylmethacrylate; VAS, visual analog scale; VB, vertebral body. T Corresponding author. 16 Sokak No. 24/4, Bahcelievler, Ankara 06500, Turkey. Tel.: +90 535 786 99 59; fax: +90 312 223 73 33. E-mail address: basara@baskent-ank.edu.tr (B. Atalay). Surgical Neurology 64 (2005) S2:72 – S2:76 www.surgicalneurology-online.com