1. 2019;22;177-185Office-Based Kyphoplasty: A Viable Option Using Local Anesthesia with Oral Sedation
   Observational Study
   Phillip R. Worts, MS, and Gilbert S. Chandler III, MD.

BACKGROUND: Vertebral compression fractures (VCFs) can be conservatively treated with pain management, bracing, and bed rest, or treated surgically with a kyphoplasty or vertebroplasty procedure.

OBJECTIVES: The objective of this retrospective review was to assess the viability, safety, and efficacy of using local anesthesia with oral sedation for an office-based kyphoplasty procedure.

STUDY DESIGN: A retrospective review.

SETTING: Private orthopedic clinic.

METHODS: Ninety-nine consecutive patients (9 office-based and 90 ambulatory surgical centers [ASC]) between January 2015 to May 2017 receiving their first percutaneous balloon kyphoplasty (PBK) with our physician in an office-based setting or at an ASC. Clinical outcomes observed were rates of surgical complications, 6-month re-fracture rates, adjacent fracture rates, and postprocedure medical management.

RESULTS: No intraoperative complications were observed during the PBK procedure. No re-fractures occurred during the 6-month follow-up window. A total of 6% of the patients experienced an adjacent vertebral compression fracture, but there were no significant differences between facility type. Level-specific verbal pain score at the postoperative follow-up visit was significantly lower than at the preoperative visit for the cohort (5.3 ± 3.1 vs.7.5 ± 2.0) (P = 0.001) and the ASC group (5.5 ± 3.1 vs. 7.5 ± 2.0) (P = 0.002).

LIMITATIONS: Only 9 single-level office-based PBKs were performed by a single physician and
followed for at least 6 months suggesting these findings cannot be generalized to all patients, practitioners, facilities, or vertebral augmentation procedures (VAPs).

CONCLUSIONS: To the best of our knowledge, this study of a continuous series of primary PBKs was the first to report the safety of an office-based procedure. The cohort reported significantly lower pain at their first postoperative follow-up visit when compared to their preoperative visit, adding to the body of evidence that PBKs are an effective treatment for pain associated with VCFs. The overall adjacent fracture rate in this series (6%) was slightly lower than previously reported for VAPs performed in a hospital under local anesthesia (7%-13%).

KEY WORDS: Osteoporosis, vertebral compression fracture, kyphoplasty, local anesthesia, office- based, oral sedation: