Comparison of three techniques in the surgical management of metastatic vertebral fracture with posterior wall damage: a retrospective study

Background To retrospectively compare the safety and efficacy of percutaneous kyphoplasty (PKP), internal fixation (IF), and kyphoplasty combined with internal fixation (KP + IF) in treating metastatic vertebral fracture (MVF) with posterior wall damage. Methods 87 patients with MVF with posterior wall damage underwent surgery. In Group PKP, 36 patients underwent PKP; in Group IF, 20 patients underwent pedicle screw fixation; and in Group KP + IF, 31 patients underwent kyphoplasty combined with pedicle screw fixation. Operative time, intraoperative blood loss, clinical and radiological results, and complication rate in each group were evaluated and compared. Results Significant improvement on the VAS, ODI scores, vertebral height and local kyphotic angle (LKA) was noted in each group ( P < 0.001). Group PKP and Group KP + IF achieved better pain relief than Group IF ( P < 0.05). At postoperative 3 days, Group PKP had better pain relief than Group KP + IF ( P < 0.05). At other follow-up time points, there were no differences between Group PKP and KP + IF ( P > 0.05). Group KP + IF and Group IF were more efficacious than Group PKP in terms of height restoration and LKA correction ( P < 0.05). Group KP + IF had a higher incidence of postoperative complications than Group PKP and Group IF( P < 0.05). Conclusions PKP was safe and effective in treating MVF with posterior wall damage. It can achieve similar clinical outcomes compared to KP + IF, but associated with less operative time, less blood loss and fewer complications. IF alone should not be the first treatment option for its poorer analgesic effect.