Effect of hyperextension application on kyphosis reduction during percutaneous kyphoplasty application in osteoporotic vertebral fractures

Effect of Hyperextension Application on Kyphosis Reduction During Percutaneous Kyphoplasty Application in Osteoporotic Vertebral Fractures Introduction: Our study investigates the effect of hyperextension positioning during percutaneous kyphoplasty on kyphosis reduction in osteoporotic vertebral fractures. This research aims to evaluate the effectiveness of the percutaneous kyphoplasty technique in different surgical positions and to enhance patient comfort. Materials and Methods: In this prospective study, 100 randomly selected patients who presented with osteoporotic vertebral fractures at Çukurova University Balcalı Hospital between January 2024 and October 2024, and who were diagnosed as suitable candidates for percutaneous kyphoplasty, were randomly divided into two groups. In the first group of 50 patients, reverse flexion was applied during balloon inflation and cementation, while the other 50 patients underwent the standard balloon kyphoplasty procedure. Spinal MRIs and scoliosis radiographs were taken before the procedure, and post-procedure scoliosis radiographs were obtained for evaluation. Measurements were conducted based on these images. Comparisons between the control and study groups were made according to the AO Spine-DGOU Osteoporotic Fracture Classification and bone density tests. Parameters such as anterior vertebral height, sagittal index, COBB angle,sagital vertical axis,VAS score and kyphotic angulation were assessed. Results: The clinical characteristics of the patients included in the study were evaluated by group, and the results were analyzed. The mean age in the control group was determined as 70.2 ± 11.8, while in the study group, it was 66.9 ± 12.5. There was no statistically significant difference between the groups in terms of gender distribution and fracture levels. Anterior vertebral heights, sagittal indices, Cobb angles, kyphotic angulation, sagittal vertical axis, and Visual Analog Scale (VAS) scores were compared, and significant improvements were observed in both groups from the preoperative to the postoperative period. Measurements revealed statistically significant differences between the control and study groups in terms of kyphotic angulation correction and sagittal index changes. A significant difference was found between the control and study groups in sagittal index changes from the preoperative to the postoperative period (Z=-3.744; p<0.001). Additionally, a significant difference was observed between the two groups in terms of postoperative kyphotic angle values (Z=-2.782; p<0.05). These findings suggest that kyphoplasty performed in the hyperextension position is more beneficial than that performed in the prone position in terms of kyphotic angulation correction and sagittal index improvement. Conclusion: Our study results indicate that balloon kyphoplasty performed in the hyperextension position, which was examined as the study group, yielded significantly better outcomes in terms of kyphotic angle and sagittal index compared to balloon kyphoplasty performed in the prone position, which was analyzed as the control group. This conclusion is based on all evaluated parameters, including Cobb angles, kyphotic angles, sagittal index, anterior vertebral heights, sagittal vertical axis, and Visual Analog Scale (VAS) scores, demonstrating a significant advantage in favor of the hyperextension position.In the event of planning a similar study, we believe that research incorporating a broader range of parameters, extended follow-up periods with control imaging, and a larger patient population would contribute more substantially to the clarity and reliability of the findings. Keywords: Hyperextension, Kyphoplasty, Kyphosis, Osteoporotic, Percutaneous