Limitation of the PKP balloon in the treatment of painful thoracolumbar vertebral body compression fractures and the alternative solution

Objective To evaluate the limitation of the PKP balloon in the treatment of painful thoracolumbar vertebral body compression fractures and to explore alternative solution.Methods Fourty three cases of thoracolumbar vertebral body carried out by PKP operation from March 2009 to December 2011 were analyzed.Kyphoplasty was performed via a unilateral transpedicular approach.Then bone cement was injected after a single balloon expansion.The injury vertebral standard lateral slides were collected at three time points:before injection,after balloon expansion and after bone cement injection,respectively.The posterior vertebral height and midline height were measured,and their ratios were calculated at the selected three time points.The height gain ratio after balloon expansion and the height loss ratio after bone cement injection were also calculated.Results The operations were successful in all of the 43 cases.The height of the mid portion of the vertebral body after the balloon inflation was elevated by 40.0%±14.2%.However,the elevated height of the mid portion of the vertebral body after PMMA injection was decreased by 34.4%±19.4%.The difference between them was of statistically significance(the t values were 8.66 and 7.68,respectively,and the Pvalue was less than 0.05).Conclusion The height loss was found in the PKP procedure,which resulted in the failure of height elevation the fractured vertebral body.Therefore,new balloon was needed to solve this problem.