Who benefits more in osteoporotic fractures: Pedicle screw instrumentation or kyphoplasty for American Society of Anesthesiologists II/III patients?

Purpose: Osteoporotc fractures with posterior wall injury are commonly treated with a pedicle srcrew instrumentation (PSI) or a ballonkyphoplasty (BKP). A predictor for complications for these patients is the American Society of Anesthesiologists (ASA) class. Clinical results in ASA II/III patients who underwent BKP and PSI due to OF were evaluated to find the optimal treatment regimen.

Materials and Methods: In a retrospective study design, ASA Class II and III patients with OF type OF 2 and OF 3 according to the German Society of Orthopedics and Trauma Surgery classification who underwent surgery between 2011 and 2016 were enrolled. Perioperative data such as time of surgery, cement leakage, adjacent level fractures, screw loosening, wound infections, and segmental kyphosis correction were measured and a statistical analysis was conducted.

Results: Ninety-nine patients met the inclusion criteria, 17 were classified as ASA II and 82 patients were classified as ASA III. Twenty-eight individuals were treated by PSI, whereas 71 underwent BKP. Not only a longer average operation (120 min) and hospital stay (21 days) were documented in the PSI group but also a better kyphosis correction (7.5°). In comparison, the BKP group required an average operation time of 35.5 min with a mean kyphosis correction of 2.1°. A statistical analysis revealed the surgical procedure and not the ASA class to be a relevant factor for complication and revision surgery.

Conclusions: BKP is a safe and effective therapy including also fractures with posterior wall defects while PSI showed advantages in restoring the sagittal realignment but higher complication and revision risk.