Comparison of hyperextension reduction and balloon dilation method combined with vertebroplasty in treatment of osteoporotic vertebral compressive fractures

Vertebroplasty is often used to treat osteoporotic vertebral compression fractures (OVCF). The number of affected vertebrae can be reduced to a certain extent by some reduction methods including hyperextension and balloon dilation. There have been only a few studies on the effectiveness of vertebroplasty combined with hyperextension or balloon dilation. We collected data of 216 OVCF patients who underwent vertebroplasty between January 2010 and September 2014. These patients were divided into the balloon dilation group (66 patients) and hyperextension group (150 patients). Balloon dilation or hyperextension was performed under C-arm fluoroscopic guidance. Vertebroplasty was then carried out by injecting bone cement. After surgery, the degree of reduction, bone cement distribution, presence of bone cement leakage, anterior vertebral body height, Cobb angle, visual analog scale (VAS) score, and Oswestry Disability Index (ODI) score were measured. The results showed that both balloon dilation and hyperextension can relieve pain and improve the quality of life, and that there were no significant differences between the two groups in VAS score or ODI score. However, the outcomes of vertebral height restoration and improvement of kyphosis were significantly better in the balloon dilation group compared with the hyperextension group. intervertebral or anterior extravertebral cement leakage occurred in 19 patients, 6 were in the balloon dilation group and 13 were in the hyperextension group. There were no complications such as spinal cord injury, infection, and pulmonary embolism. In conclusion, both hyperextension and balloon dilation are safe and effective when combined with vertebroplasty. Balloon dilation is more effective for restoring vertebral height and improving spinal kyphosis.