Center for Musculoskeletal Surgery, Spine Unit, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Arch Orthop Trauma Surg. 2014 Aug;134(8):1083-91. doi: 10.1007/s00402-014-2035-3. Epub 2014 Jun 29.
Randomized clinical trials have generated doubts regarding the therapeutic effectiveness of spinal kyphoplasty to reduce pain and improve quality of life in patients with vertebral fractures. There is a paucity of data on the influence of kyphoplasty on spinal range of motion. To quantify early postoperative changes following kyphoplasty in spinal motion, a noninvasive, radiation-free measurement method was used and results related to clinical and radiological parameters.
The study group included 30 patients with an overall number of 54 symptomatic pathological vertebral compression fractures. All patients were treated with balloon kyphoplasty. Clinical results were recorded using the visual analog scale, SF 36, Roland Morris Score and the Oswestry Disability Index, at three time points; preoperative, 2 days postoperative, and at 12 weeks postoperative. The kyphosis angle/sagittal index were determined with biplanar X-rays. Amplitude/velocity of motion in extension/flexion was measured at each time point by use of the EpionicsSPINE(©) system (Epionics Medical GmbH; Potsdam, Germany) using two external sensor strips.
Preoperative magnetic resonance imaging scans showed bone marrow edema in all vertebral bodies indicative of a recent, non-consolidated fracture. Pain and quality of life was significantly improved by kyphoplasty, both for the immediate postoperative period, as well as at 12 weeks postoperative. Radiological parameters also showed significant improvement following surgery. Total ROM did not significantly change 2 days after kyphoplasty, but amplitude and velocity were found to be increased 12 weeks postoperatively. Significant positive correlations were observed between increased range of motion and improved clinical/radiological scores.
Significant clinical and radiological improvement following kyphoplasty supports the rational for cement augmentation in patients with pathological vertebral body fractures. To the knowledge of the authors, no prior study has assessed the influence of preservation and improvement of spinal range of motion on clinical outcome following kyphoplasty.
随机临床试验对脊柱后凸成形术治疗椎体骨折患者疼痛和改善生活质量的疗效产生了怀疑。关于后凸成形术对脊柱活动范围的影响的数据很少。为了量化后凸成形术后脊柱运动的早期变化，使用了一种非侵入性、无辐射的测量方法，并将结果与临床和影像学参数相关联。
研究组包括 30 例共 54 例症状性病理性椎体压缩骨折患者。所有患者均采用球囊后凸成形术治疗。临床结果采用视觉模拟评分、SF-36、Roland Morris 评分和 Oswestry 残疾指数在术前、术后 2 天和术后 12 周 3 个时间点进行记录。采用双平面 X 线测量后凸角/矢状指数。在每个时间点使用 EpionicsSPINE（©）系统（德国波茨坦的 Epionics Medical GmbH）通过两个外部传感器条测量伸展/屈曲时的运动幅度/速度。
术前磁共振成像扫描显示所有椎体均有骨髓水肿，表明存在近期非愈合性骨折。后凸成形术可显著改善疼痛和生活质量，无论是在术后即刻还是在术后 12 周。影像学参数也显示手术后有显著改善。后凸成形术后 2 天总 ROM 无明显变化，但振幅和速度在术后 12 周增加。增加的运动范围与临床/影像学评分的改善呈显著正相关。
后凸成形术后的显著临床和影像学改善支持病理性椎体骨折患者进行骨水泥强化的合理性。据作者所知，尚无研究评估脊柱活动范围的保持和改善对后凸成形术后临床结果的影响。
