Effectiveness of ultra-early balloon kyphoplasty at one year after osteoporotic vertebral fracture.

Introduction: Balloon kyphoplasty (BKP) for osteoporotic vertebral fracture (OVF) has been reported to maintain quality of life (QOL). This study aimed to investigate the effectiveness of ultra-early BKP performed within two weeks of injury (ultra-early group) to cases after two to four weeks post-injury (early group) and over four weeks (conventional group), assessing radiographic assessment such as subsequent fracture etc, questionarre such as QOL and back pain-related activities of daily living (ADL) one year after surgery.

Methods: Ninety cases of OVF treated with BKP (23 males, 67 females, average age 78.0 years) were included. Radiographic assessments were examined and QOL parameters (SF-36 and EQ-5D-5L) and back pain-related ADL (ODI score) were assessed using self-administered questionnaires before and one year after surgery. Analysis of Variance (ANOVA) was used to compare changes in evaluation parameters among 3 groups. When significant differences were detected, post-hoc multiple comparisons were performed using the Steel-Dwass test.

Results: The mean follow-up duration was 16.6 months. The ultra-early group consisted of 29 cases (10 males, 19 females, average age 77.0 years), the early group consisted of 39 (6 males, 33 females, average age 79.3 years), while the conventional group consisted of 22 cases (7 males, 15 females, average age 80.0 years). There was no significant difference in the preoperative score of SF-36, EQ-5D-5L, and ODI score. At the 1 year follow up, presence of subsequent fracture was significantly difference among 3 groups (3.4 % vs. 10.3 % vs. 31.8 %) (ANOVA, p < 0.05). Moreover, subsequent Steel-Dwass multiple comparisons also revealed that ultra-early group showed significantly less subsequent fracture compared to the conventional group (p < 0.05). Furthermore, Significant differences were observed in the changes of bodily pain in SF-36, EQ-5D-5L and ODI among 3 groups (ANOVA, p < 0.05). Steel-Dwass multiple comparisons also revealed that ultra-early group showed significantly greater improvement in EQ-5D-5L compared to the early group and conventional group (p < 0.05). ODI scores in ultra-early group also showed greater recover compared to the conventional group (p < 0.005).

Conclusions: Ultra early BKP within two weeks of OVF demonstrates effectiveness for less complication such as subsequent fracture, QOL and back pain-related ADL one year post-surgery, enabling early return to society.