Clinical and radiographic outcome of pillow reduction prior to vertebroplasty on patients with vertebral compression fracture

Background/Introduction: Vertebroplasty has been proved to be effective in relieving the pain caused by osteoporotic vertebral fracture. However, there have been some limitations in restoring the vertebral body height and regaining lumbar lordosis. For this reason, postural reduction combined with subsequent vertebroplasty was reported to have a significant effect on height restoration. Purpose: To compare vertebroplasty combined with postural reduction to ordinary vertebroplasty with respect to effective restoration of vertebrae height and lumbar lordosis. Materials and methods: We reviewed patients with a single-level thoracolumbar vertebrae compression fracture who received vertebroplasty between November 2009 and December 2010. All patients had received routine radiographic examination and results of their magnetic resonance imaging scan were studied. Patients who underwent postural reduction with a soft pillow were assigned to Group A; all others were assigned to Group B. After the surgery, the radiographic outcome was recorded with follow-up for 1 year. The compression ratio (anterior height/posterior height) and Cobb angle were measured to analyze the degree of re-expansion. In addition, clinical outcome was also assessed using a visual analog scale (VAS). Results: There were 13 males and 33 females, and their mean age was 77.4 years. The average preoperative compression ratio was 0.48±0.18 and 0.51±0.18, and Cobb angle was 20.2°±6.8° and 19.1°±7.7° among patients in Group A and Group B, respectively. Patients in each group were divided into either Group 1 (preoperative compression ratio<0.40) or Group 2 (preoperative compression ratio>0.40). The difference between the compression ratio prior to and after vertebroplasty was 0.36±0.06 and 0.17±0.48 in Group A-1 and Group B-1, respectively (p<0.01) and 0.3±0.13 and 0.26±0.11 in Group A-2 and Group B-2, respectively (p>0.05). Their average VAS after the vertebroplasty was 1.9±0.8 and 1.7±0.65 in Group A and Group B, respectively (p>0.1). Conclusion: Pillow reduction prior to vertebroplasty provided good efficacy to restore anterior height, especially in patients with greater anterior height loss.