Introduction:

Osteoporotic vertebral compression fractures (OVCF), not responsive to conservative management are often treated with vertebral augmentation procedures (VAP) like vertebroplasty and kyphoplasty. Both these procedures, however, carry a risk of cement leakage causing pulmonary embolism or spinal cord compression. Vesselplasty is a new modification of percutaneous vertebroplasty (PVP) which involves the use of a polyethylene terephthalate (PET) balloon container which serves the dual purposes of creating space within the vertebral body as well as containing the injected cement, theoretically eliminating the risk of cement leakage. We aimed to compare the safety and efficacy of vesselplasty and PVP in patients with chronic, non-healing, symptomatic cases of thoracolumbar OVCF who did not respond to conservative management.

Methods:

Forty-four consecutive patients with chronic thoracolumbar OVCF (duration ≥ 8 weeks) causing severe pain (Visual analogue scale; VAS ≥ 7) and disability attributable to OVCF who were not responding to conservative treatment, were included in the study. Twenty-eight patients underwent vertebroplasty (Group A) and 16 patients underwent vesselplasty (Group B) using a standardized technique. The two groups were compared for difference in the post-procedure physical functionality (SF-36 physical function) and post-procedure VAS scores at one week and three months post procedure. Comparative analysis was also done for reduction in analgesic requirement, volume of cement injected, change in the vertebral body height and rate of complications, including cement leakage.

Results:

A total of 44 patients (31 females; 13 males) with a mean age of 69 years (range: 51 – 83 years) underwent 49 VAPs. Twenty-eight patients underwent vertebroplasty involving 33 vertebrae (Group A) and 16 patients underwent vesselplasty in 16 vertebrae (Group B). The distribution of the fractures by location was as follows: D11 = 9, D12 = 15, L1 = 17, L2 = 8. The two groups did not differ with respect to baseline demographic or clinical characteristics. The mean VAS score at one week (Group A: 3.13, 95% CI – 2.65/3.61 v/s Group B: 3.07, 95% CI – 2.31/3.32) and 3 months post-procedure (Group A: 2.81, 95% CI – 2.31/3.32 v/s Group B: 2.72, 95% CI – 2.36/3.06) was comparable between the two groups. Patients in Group B (vesselplasty) however had a significantly better post-procedure SF-36 physical functionality score at one week and 3 months follow-up. The quantity of cement injected (Group A: 3.84 ml v/s Group B: 4.68 ml), mean increase in anterior vertebral height (Group A: 0.635 mm v/s Group B: 2.472 mm, mean increase in central vertebral height (Group A: 0.63mm v/s Group B: 1.96mm) also differed significantly between the two groups. Cement leakage, though asymptomatic, was seen in 14 patients (50%) in Group A whereas no patient in Group B had a cement leak.

Discussion:

Vesselplasty significantly reduces the incidence of cement leakage in thoracolumbar OVCF with similar or better relief in pain, improvement in disability scores and vertebral body height. It can be a safer alternative to PVP especially in patients with posterior cortical breach.