W-shape fractures have the best indications for kyphoplasty

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A study published in the Journal of Spinal Disorders and Techniques has found that kyphoplasty has significant advantages over vertebroplasty in terms of kyphosis correction for W-shape fractures.

Kyung-Hyun Kim, Department of Neurosurgery, Gangnam Severance Spine Hospital, Spine and Spinal Cord Institute, Yonsei University College of medicine, and others reviewed the efficacy of kyphoplasty, compared with vertebroplasty, for different types of vertebral fractures: V-shape; flat (F-shape); and wedge shape (W shape). They wrote that they: “hypothesised that kyphoplasty yields better results in initially collapsed anterior vertebral height (eg, F-shape or W-shape fractures) than in initially preserved anterior vertebral height (V-shape fractures).”

In the retrospective review, Kim et al found that kyphoplasty, compared with vertebroplasty, had better results regarding kyphosis correction, anterior and middle vertebral height restoration, and preventing cement leakage in patients with W-shape vertebral fractures. It also significantly improved middle vertebral body height restoration and significantly reduced cement leakage in patients with V-shaped fractures and was associated with significantly better anterior and middle vertebral body height restoration and reduced cement leakage in patients with F-shape fractures.

However, there were no significant differences between in kyphoplasty and vertebroplasty in posterior body height restoration for patients with W-shape fractures, nor were there any differences in anterior and posterior height restoration and kyphosis correction in V-shape fractures, and kyphoplasty did not significantly improve posterior height restoration or kyphosis correction in patients with F-shape fractures.

Kim et al reported that although previous studies have shown superior results with kyphoplasty over vertebroplasty, their study was the first to compare surgical outcomes according to fracture shape. They added that W-shape fractures have more potential for restoration of anterior body height (because they have more preoperative kyphotic angles) and, thus, intravertebral ballooning during kyphoplasty could correct the kyphotic deformity more effectively than in other fractures. They said: “We suggest that W-shape fractures have the best indications for kyphoplasty.”

They concluded: “Further studies to evaluate optimal treatments for specific subtypes of vertebral body fracture and long-term follow-up studies with a greater number of patients for correlations of clinical outcomes and radiologic changes are warranted.”