Distribution Pattern Making Sense: Patients Achieve Rapider Pain Relief with Confluent Rather Than Separated Bilateral Cement in Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures

BACKGROUND: It has been reported the distribution of bone cement in percutaneous kyphoplasty (PKP) has an impact on the curative effect. No studies have compared between confluent and separated cement pattern of bilateral bone cement in PKP for patients with osteoporotic vertebral compression fractures. METHODS: Between 2010 and 2016, 1341 patients were enrolled and divided into 2 groups. Group A (n = 723), bilateral cement was confluent; Group B (n = 618), bilateral cement was separated. The visual analogue scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), and local kyphotic angle (LKA) were obtained preoperatively, 2 days after surgery, and at the final follow-up to assess the functional and radiographic efficacy of the surgery. RESULTS: The VAS, ODI, AVH, and LKA 2 days after operation and at the final follow-up were significantly improved compared with the preoperative for both groups (P < 0.05). There existed no significant difference between groups at various time point in ODI, AVH, and LKA (P > 0.05). Group A showed better VAS than group B 2 days after surgery (1.91 +/- 0.98 vs. 2.35 +/- 0.78, P < 0.001), also with better pre-postoperative VAS change (6.23 +/- 0.76 vs. 5.75 +/- 1.02, P < 0.001). Multiple linear regression for pain relief degree revealed group A (P < 0.001), older age (P < 0.001), and more cement volume (P < 0.001) contribute to rapid improvement of back pain. The cement leakage rate was 3.7% in group A and 2.9% in group B, with no significant difference (P = 0.405). CONCLUSIONS: Patients achieved rapider pain relief with confluent rather than separated bilateral bone cement pattern in PKP for osteoporotic vertebral compression fracture.