Israel Medical Association Journal

Background: Cement vertebroplasty has been performed for over a decade to treat painful osteoporotic vertebral compression fractures (OVCFs). Kyphoplasty is considered a further step in the evolution of vertebral augmentation.

Objectives: To evaluate the efficiency and safety of the Confidence Vertebroplasty (CV) system in comparison with the Sky Kyphoplasty (SK) system in treating OVCF.

Methods: This prospective study included 45 patients with OVCF. Fourteen were treated with CV[1] and 31 with SK[2]. An imaging evaluation using a compression ratio (height of anterior vs. posterior wall) and local kyphotic deformity (Cobb angle) was performed prior to the procedure and 12 months later. Evaluation of pain was carried out using a visual analogue scale.

Results: The mean compression repair was 12% in the CV group compared to 25% in the SK group.

Mean kyphotic deformity restoration achieved using CV was 41% compared to 67% using SK. In both groups the pain severity was equally reduced by a mean of 43%.

Conclusions: The SK system has a technical superiority in restoring the vertebral height and repairing the kyphotic deformity, an advantage that was not manifested in pain relief – the most important variable. Both systems have a high level of safety. The cost-benefit balance clearly favors the CV system.

 Background: The prevalence of vertebral fractures in systemic lupus erythematosus (SLE) ranges between 20% and 21.4%, and patients with these fractures have impaired walking and activities of daily living. Moreover, clinical and radiological vertebral fractures have been associated with increased mortality.
 Objectives: To compare the quality of life of patients with SLE[1] with and without vertebral fractures.

Methods: The study group comprised 140 women with SLE undergoing screening for vertebral fractures using a standardized method. SLE disease activity and organ damage were measured by the Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) and Systemic International Collaborating Clinics/American College of Rheumatology damage index (SLICC), respectively. The QUALEFFO and Center for Epidemiologic Studies Depression Scale were used to measure health-related quality of life and depression, respectively.

Results: The median age of the 140 patients was 43 years (range 18–76); disease duration was 72 months (range 6–432); 49.7% were menopausal. Thirty-four patients (24.8%) had vertebral fractures (≥ 1), mostly in the thoracic spine. Patients with vertebral fractures had a higher mean age (49.5 ± 13.4 vs. 41 ± 13.2 years, P = 0.001) and disease damage (57.1% vs. 34.4%, P = 0.001). The global QUALEFFO score was not different between the vertebral fractures group and the non-vertebral group. The only significant difference in the QUALEFFO items was in physical function (P = 0.04). A significant correlation was found between the severity of vertebral fractures and the QUALEFFO pain (r = 0.27, P = 0.001) and physical function (r = 0.37, P = 0.02) scores. The number of vertebral fractures correlated only with physical function (r = 0.01).

Conclusions: The HRQOL of women with SLE is low, regardless of whether they have vertebral fractures or not, but patients with vertebral fractures have worse physical function compared to those without. Strategies to improve the HRQOL of patients with SLE with or without vertebral fractures are necessary.

In recent years the survival of patients with systemic lupus erythematosus has increased markedly. Consequently, long-term complications, such as osteoporosis, are currently of paramount importance. SLE[1] is known to increase the risk of bone fractures, and numerous studies have found that SLE patients have osteoporosis. Of the various risk factors associated with osteoporosis in SLE, disease duration, the use of corticosteroids and chronic disease-related damage are consistently reported, with differences between studies probably due to the different populations studied. The role of chronic inflammation in osteoporosis is also important. On the other hand, little attention has been paid to osteoporotic fractures, especially of the vertebra, which are associated with reduced quality of life, increased mortality rates and increased risk of new vertebral and non-vertebral fractures in the general population.