Early or delayed operation, which is more optimal for kyphoplasty? A retrospective study on cement leakage during kyphoplasty

Purpose: To retrospectively assess the optimal operating time for kyphoplasty as far as the cement leakage during kyphoplasty is concerned.

Materials and methods: One hundred and six patients with a total of 117 osteoporotic vertebral compression fractures (VCFs) were enrolled in our study. According to the time of kyphoplasty, they were divided into two groups: group 1 (early operation group, who received the operation within 14 days after fracture, n=46) and group 2 (delayed operation group, who received the operation between 15 and 28 days after fracture, n=71). Preoperative and postoperative visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were compared 3 days after surgery within each group and between the two groups. The radiographic outcomes were evaluated by the restoration rate (RR) of the treated vertebrae. The outcome of cement leakage was assessed after surgery using X-ray and computed tomography (CT) scans. Leaks of cement were classified into three types: those via the basivertebral vein (type B), via the segmental vein (type S) and through a cortical defect (type C).

Results: The mean VAS and ODI scores decreased significantly from pre-surgery to post-surgery in each group, as did the RR (p>0.05). There was no significant difference postoperatively on VAS and ODI scores (p>0.05) between the two groups. However, significant differences were observed postoperatively on RR (p=0.045) and vertebrae with leakage (p=0.038). In addition, there was a significant difference on leakage site of type C between the two groups (p=0.032).

Conclusion: Both early and delayed operations of kyphoplasty can achieve satisfactory clinical and radiographic outcomes for osteoporotic VCFs. The risk of cement leakage during kyphoplasty will decrease obviously in delayed operation; so delayed operation, perhaps 2 weeks after fracture, is more safe and optimal than early operation as far as cement leakage is concerned, especially for vertebrae with cortical defects. But early operation of kyphoplasty is more effective in vertebral height restoration.