Lee Jung-Hoon, Kwon Jeong-Taik, Kim Young-Baeg, Suk Jong-Sik
Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea.
J Korean Neurosurg Soc. 2007 Nov;42(5):371-6. doi: 10.3340/jkns.2007.42.5.371. Epub 2007 Nov 20.
Balloon kyphoplasty can effectively relieve the symptomatic pain and correct the segmental deformity of osteoporotic vertebral compression fractures. While many articles have reported on the effectiveness of the procedure, there has not been any research on the factors affecting the deformity correction. Here, we evaluated both the relationship between postoperative pain relief and restoration of the vertebral height, and segmental kyphosis, as well as the various factors affecting segmental deformity correction after balloon kyphoplasty.
Between January 2004 and December 2006, 137 patients (158 vertebral levels) underwent balloon kyphoplasty. We analyzed various factors such as the age and sex of the patient, preoperative compression ratio, kyphotic angle of compressed segment, injected PMMA volume, configuration of compression, preoperative bone mineral density (BMD) score, time interval between onset of symptom and the procedure, visual analogue scale (VAS) score for pain rating and surgery-related complications.
The mean postoperative VAS score improvement was 4.93+/-0.17. The mean postoperative height restoration rate was 17.8+/-1.57% and the kyphotic angle reduction was 1.94+/-0.38 degrees . However, there were no significant statistical correlations among VAS score improvement, height restoration rate, and kyphotic angle reduction. Among the various factors, the configuration of the compressed vertebral body (p=0.002) was related to the height restoration rate and the direction of the compression (p=0.006) was related with the kyphotic angle reduction. The preoperative compression ratio (p=0.023, p=0.006) and injected PMMA volume (p<0.001, p=0.035) affected both the height restoration and kyphotic angle reduction. Only the preoperative compression ratio was found to be as an independent affecting factor (95% CI : 1.064-5.068).
The two major benefits of balloon kyphoplasty are immediate pain relief and local deformity correction, but segmental deformity correction achieved by balloon kyphoplasty does not result in additional pain relief. Among the factors that were shown to affect the segmental deformity correction, configuration of the compressed vertebral body, direction of the most compressed area, and preoperative compression ratio were not modifiable. However, careful preoperative consideration about the modifiable factor, the PMMA volume to inject, may contribute to the dynamic correction of the segmental deformity.
球囊椎体后凸成形术可有效缓解症状性疼痛并纠正骨质疏松性椎体压缩骨折的节段性畸形。虽然许多文章报道了该手术的有效性，但尚未有关于影响畸形矫正因素的研究。在此，我们评估了术后疼痛缓解与椎体高度恢复以及节段性后凸之间的关系，以及球囊椎体后凸成形术后影响节段性畸形矫正的各种因素。
2004年1月至2006年12月期间，137例患者（158个椎体节段）接受了球囊椎体后凸成形术。我们分析了各种因素，如患者的年龄和性别、术前压缩率、压缩节段的后凸角度、注入的聚甲基丙烯酸甲酯（PMMA）体积、压缩形态、术前骨密度（BMD）评分、症状出现与手术之间的时间间隔、疼痛评分的视觉模拟量表（VAS）评分以及手术相关并发症。
术后VAS评分平均改善4.93±0.17。术后平均高度恢复率为17.8±1.57%，后凸角度减小1.94±0.38度。然而，VAS评分改善、高度恢复率和后凸角度减小之间无显著统计学相关性。在各种因素中，压缩椎体的形态（p = 0.002）与高度恢复率相关，压缩方向（p = 0.006）与后凸角度减小相关。术前压缩率（p = 0.023，p = 0.006）和注入的PMMA体积（p < 0.001，p = 0.035）对高度恢复和后凸角度减小均有影响。仅术前压缩率被发现是一个独立的影响因素（95%可信区间：1.064 - 5.068）。
球囊椎体后凸成形术的两大益处是立即缓解疼痛和局部畸形矫正，但球囊椎体后凸成形术实现的节段性畸形矫正并不会带来额外的疼痛缓解。在显示影响节段性畸形矫正的因素中，压缩椎体的形态、最压缩区域的方向和术前压缩率是不可改变的。然而，术前仔细考虑可改变的因素，即注入的PMMA体积，可能有助于节段性畸形的动态矫正。
