Wick M, Petraschka C, Kronawitter P, Cidlinsky K, Heyer C
Chirurgie, Rottal-Inn Kliniken Standort Eggenfelden.
Z Orthop Unfall. 2010 Dec;148(6):641-5. doi: 10.1055/s-0030-1250559. Epub 2010 Dec 15.
In a retrospective study we examined the reliability of conventional radiographs to detect osteoporotic vertebral fractures. Furthermore, we analysed clinical and radiological results 4 weeks and one year after balloon kyphoplasty.
Between April 2007 and December 2008, 68 patients with 77 vertebral fractures were allocated to kyphoplasty. All patients could be evaluated 4 weeks after the operation and 50 patients (74%) for the one-year follow-up. In all patients conventional radiographs of the spine were performed. Persisting or increasing pain after one week led to an MRI. Under consideration of the pain situation and the result of the MRI a balloon kyphoplasty was performed.
In 19 patients (25.3%) a cement leakage without any neurological symptoms was observed. After the operation we did not find any neurological disturbances, infection or haematoma. 13 thoracic spine fractures (38%) and 21 lumbar spine fractures (51%) could not be detected with conventional X-rays and could be observed only with the MRI. Preoperatively the kyphosis angle was measured with 13.3°, 4 weeks after the operation it was 5.2° (p = 0.001) and one year after the surgical procedure 4.8°. After kyphoplasty, the compression index was improved with 26% (p ≤ 0.001). Using the visual analogue scale there was a pain reduction of 52.3% (p ≤ 0.001) which was still detectable after one year. We did not find any correlation between the restored height of the vertebra and the reduction of pain. Furthermore, we did not find any correlation concerning pain reduction in the visual analogue scale irrespective of whether the fracture was detected initially with conventional X-rays or later with MRI. In 5 patients (7.3%) there were subsequent vertebral fractures without any trauma. All of these fractures were treated again operatively by a kyphoplasty.
Especially in geriatric patients with osteoporosis, vertebral fractures can be underdiagnosed with conventional X-rays. Persisting or increasing pain should lead to an MRI to detect and to determine the age of the fracture. In acute fractures, patients profit very well with a significant long-term pain reduction and as a result with an increased mobility after balloon kyphoplasty.
