König M A, Panzer S, Schulz J, Bierschneider M, Boszczyk B M
The Centre for Spinal Studies and Surgery, Queens Medical Centre Nottingham, Nottingham, UK,
Eur Spine J. 2015 Apr;24(4):724-33. doi: 10.1007/s00586-014-3244-8. Epub 2014 Mar 25.
Minimal-invasive cement augmentation techniques gained popularity recently. Long-term studies, however, are still not available focusing on the effect of possible acceleration of intervertebral disc degeneration.
Fifteen patients (average age 67.1 ± 6.9 years, range 58-77; 10 female, 5 male) with acute or osteoporotic fractures were included in this study and MRI scans were performed before surgery and after a mean follow-up period of 15.2 months (range 8-27 months). Out of these patients, seven were available for a long-term MRI scan after a mean of 94.3 months (range 84-96 months). Disc degeneration and injuries were graded according to published Pfirrmann and Oner scales.
A total of 43 intervertebral discs with moderate initial degeneration were examined pre-operatively and at the first follow-up. Twenty were available for the long-term-follow-up. At the first follow-up, 3 (1.3 %) discs showed a degenerative progression of 1 grade compared to the pre-operative MRI. Only one injured and one uninjured disc (0.4 %) showed progressive degeneration of 1 grade in the long-term follow up. No intervertebral disc in-between bisegmental cement augmentation showed acceleration of degenerative changes.
Despite several limitations regarding patients' age and lack of performed perfusion MRI scans, this study suggests that vertebral cement augmentation through kyphoplasty has no significant influence on disc degeneration even after a long period. The absence of severe disc degeneration after vertebral augmentation supports further clinical trials, which should incorporate endplate perfusion studies for detailed information regarding disc perfusion.
微创骨水泥强化技术近来颇受关注。然而，关于其是否可能加速椎间盘退变的长期研究仍未见报道。
本研究纳入15例急性或骨质疏松性骨折患者（平均年龄67.1±6.9岁，范围58 - 77岁；女性10例，男性5例），于术前及平均随访15.2个月（范围8 - 27个月）后行MRI扫描。其中7例患者在平均94.3个月（范围84 - 96个月）后接受了长期MRI扫描。根据已发表的Pfirrmann和Oner分级标准对椎间盘退变及损伤进行分级。
术前及首次随访时共检查了43个初始为中度退变的椎间盘。其中20个可供长期随访。首次随访时，与术前MRI相比，3个（1.3%）椎间盘退变进展1级。长期随访中仅有1个损伤椎间盘和1个未损伤椎间盘（0.4%）退变进展1级。双侧节段性骨水泥强化之间的椎间盘未见退变加速。
尽管本研究在患者年龄方面存在若干局限性且未进行灌注MRI扫描，但结果表明，即使经过较长时间，经皮椎体后凸成形术进行椎体骨水泥强化对椎间盘退变并无显著影响。椎体强化后未出现严重椎间盘退变支持进一步开展临床试验，并应纳入终板灌注研究以获取有关椎间盘灌注的详细信息。
