Gaitanis Ioannis N, Hadjipavlou Alexander G, Katonis Pavlos G, Tzermiadianos Michael N, Pasku Dritan S, Patwardhan Avinash G
Department of Orthopaedic Surgery and Traumatology, University of Crete Medical School, 71110 Heraklion, Crete, Greece.
Eur Spine J. 2005 Apr;14(3):250-60. doi: 10.1007/s00586-004-0767-4. Epub 2004 Oct 8.
Previous clinical studies have shown the safety and effectiveness of balloon kyphoplasty in the treatment of pathological vertebral compression fractures (VCFs). However, they have not dealt with the impact of relatively common comorbid conditions in this age group, such as spinal stenosis, and they have not explicitly addressed the use of imaging as a prognostic indicator for the restoration of vertebral body height. Neither have these studies dealt with management and technical problems related to surgery, nor the effectiveness of bone biopsy during the same surgical procedure. This is a prospective study comparing preoperative and postoperative vertebral body heights, kyphotic deformities, pain intensity (using visual analogue scale) and quality of life (Oswestry disability questionnaire) in patients with osteoporotic vertebral compression fractures (OVCFs) and osteolytic vertebral tumors treated with balloon kyphoplasty.
Thirty-two consecutive patients, 27 OVCFs (49 vertebral bodies [VBs]) and 5 patients suffering from VB tumor (12 VBs) were treated by balloon kyphoplasty. The mean age was 68.2 years. All patients were assessed within the first week of surgery, and then followed up after one, three and six months; all patients (27 OVCFs and 5 tumor patients) were followed up for 12 months, 17 patients (14 OVCFs and 3 tumors) were followed up for 18 months and 9 patients (8 OVCFs and 1 tumor) were followed up for 24 months (mean follow up 18 months). The correction of kyphosis and vertebral heights were measured by comparing preoperative and postoperative radiographic measurements.
Thirty-one patients (96.9%) exhibited significant and immediate pain improvement: 90% responded within 24 h and 6.3% responded within 5 days. Daily activities improved by 53% on the Oswestry scale. In the OVCF group, kyphosis correction was achieved in 24/27 patients (89.6%) with a mean correction of 7.6 degrees . Anterior wall height was restored in 43/49 VBs (88%) (mean increment of 4.3 mm), and mid vertebral body height was restored in 45/49 VBs (92%) (mean increment of 4.8 mm). Edema (high intensity signal) on short tau inversion recovery (STIR) was evidenced in all OVCF patients who experienced symptoms for less than nine months and was associated with correction of deformity. Cement leakage was the only technical problem encountered; it occurred in 5/49 VBs (10.2%) of the osteoporotic group and 1/12 VBs (8.3%) of the tumor group but had no clinical consequences. The incidence of leakage to the anterior epidural space was 2%. Spinal stenosis was present in three patients (11.1%) who responded successfully to subsequent laminectomy. Retrieval of tissue samples for biopsy was successful in 10/15 cases (67%). New fractures occurred in the adjacent level in 2/27 OVCF patients (7.4%).
Associated spinal stenosis with OVCF should not be overlooked; STIR MRI is a good predictor of deformity correction with balloon kyphoplasty. The prevalence of a new OVCF in the adjacent level is low.
先前的临床研究已表明球囊后凸成形术治疗病理性椎体压缩骨折(VCF)的安全性和有效性。然而,这些研究未涉及该年龄组中相对常见的合并症的影响,如椎管狭窄,也未明确将影像学作为椎体高度恢复的预后指标。这些研究也未涉及与手术相关的管理和技术问题,以及在同一手术过程中进行骨活检的有效性。这是一项前瞻性研究,比较经球囊后凸成形术治疗的骨质疏松性椎体压缩骨折(OVCF)和溶骨性椎体肿瘤患者术前和术后的椎体高度、后凸畸形、疼痛强度(使用视觉模拟量表)和生活质量(Oswestry功能障碍问卷)。
连续32例患者,其中27例OVCF(49个椎体[VB])和5例椎体肿瘤患者(12个VB)接受了球囊后凸成形术治疗。平均年龄为68.2岁。所有患者在术后第一周内进行评估,然后在1、3和6个月后进行随访;所有患者(27例OVCF和5例肿瘤患者)随访12个月,17例患者(14例OVCF和3例肿瘤)随访18个月,9例患者(8例OVCF和1例肿瘤)随访24个月(平均随访18个月)。通过比较术前和术后的影像学测量来评估后凸畸形和椎体高度的矫正情况。
31例患者(96.9%)疼痛立即得到显著改善:90%在24小时内有反应,6.3%在5天内有反应。Oswestry量表显示日常活动改善了53%。在OVCF组中,24/27例患者(89.6%)实现了后凸畸形矫正,平均矫正7.6度。43/49个VB(88%)的前壁高度得到恢复(平均增加4.3毫米),45/49个VB(92%)的椎体中部高度得到恢复(平均增加4.8毫米)。所有症状持续时间少于9个月的OVCF患者在短tau反转恢复(STIR)序列上均显示水肿(高信号),且与畸形矫正相关。骨水泥渗漏是唯一遇到的技术问题;在骨质疏松组49个VB中的5个(10.2%)和肿瘤组12个VB中的1个(8.3%)发生,但未产生临床后果。渗漏至硬膜外前间隙的发生率为2%。3例患者(11.1%)存在椎管狭窄,随后行椎板切除术成功缓解症状。10/15例(67%)成功获取组织样本进行活检。2/27例OVCF患者(7.4%)在相邻节段出现新骨折。
OVCF合并椎管狭窄不应被忽视;STIR序列MRI是球囊后凸成形术矫正畸形的良好预测指标。相邻节段新发OVCF的发生率较低。