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Vertebral augmentation treatment of painful osteoporotic compression fractures with the Kiva VCF Treatment System

Luis M. Rosales Olivarez, MD,1 Juan M. Dipp, MD,2 Ricardo Flores Escamilla, MD,3 Guillermo Bajares, MD,4 Alejandro Perez, MD,4 Harrison A. Stubbs, PhD,5 Jon E. Block, PhD5
1Division de Cirugia Especial-Columna Vertebral, Instituto Nacional de Rehabilitacion/Ortopedia, Mexico City, Mexico 2Hospital del Prado, Tijuana, Mexico 3Hospital Almater, Mexicali, Mexico 4Instituto de Columna Caracas, Caracas, Venezuela 5The Jon Block Group, San Francisco, CA

Abstract 

Background

Vertebral compression fractures (VCFs) can cause significant pain and functional impairment, and their cumulative effect can lead to progressive morbidity. This single-arm, prospective feasibility trial, conducted at 4 clinical sites, was undertaken to evaluate the clinical outcomes associated with the use of an innovative vertebral augmentation device, the Kiva VCF Treatment System (Benvenue Medical, Santa Clara, California), in the management of symptomatic VCFs associated with osteoporosis.

Methods

Vertebral augmentation treatment was performed for persistent back pain symptoms in 57 patients (mean age, 71.9 ± 10.4 years), including 46 women, with radiologically confirmed VCFs; 36 of these patients (63%) had reached 12 months of follow-up at this data analysis. There were 51 one-level cases, 5 two-level cases, and 1 three-level case, representing 64 treated levels. Back pain severity and condition-specific functional impairment were evaluated with a standard 100-mm visual analog scale and the Oswestry Disability Index (ODI), respectively, before device implantation as well as at 6 weeks, 3 months, and 12 months.

Results

Marked clinical improvements were realized in back pain severity and functional impairment through 12 months of follow-up. The mean back pain score on the visual analog scale improved from 79.3 ± 17.2 before treatment to 21.9 ± 21.3, 21.9 ± 24.6, and 23.2 ± 23.3 at 6 weeks, 3 months, and 12 months, respectively. The mean decrease at 12 months was 49.9 ± 30.3 mm, or approximately 66% (P < .0001). Similarly, the mean ODI score improved from 68.1% ± 16.9% before treatment to 27.4% ± 17.2%, 23.8% ± 18.7%, and 23.3% ± 15.5% at 6 weeks, 3 months, and 12 months, respectively, representing a mean change of 39.2 ± 19.6 percentage points, or approximately 63%, at 12 months. Overall clinical success rates based on a 30% improvement in pain severity or greater and maintenance or improvement in the ODI were 91%, 88%, and 89% at 6 weeks, 3 months, and 12 months, respectively. The vertebral augmentation procedure required injection of a mean of 2.2 ± 0.12 mL of cement per vertebral body. There were 5 levels (8%) where cement extravasation was identified radiographically, and none were related to clinical symptoms.

Conclusions

These pilot findings are encouraging, suggesting robust and durable clinical improvement after this novel vertebral augmentation procedure in patients with painful VCFs.

keywords: 
Vertebral compression fracture, Osteoporosis, Cement augmentation, Kiva
Volume 5 Issue 4
doi: 
10.1016/j.esas.2011.06.001