Yokoyama Kunio, Kawanishi Masahiro, Yamada Makoto, Tanaka Hidekazu, Ito Yutaka, Kawabata Shinji, Kuroiwa Toshihiko
Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-machi, Fushimi, Kyoto, Kyoto, 601-1495, Japan,
Eur Spine J. 2015 Apr;24(4):744-9. doi: 10.1007/s00586-014-3678-z. Epub 2014 Nov 18.
The influence of vertebral cement augmentation on spinal sagittal balance is unknown. The present study aimed to analyze the changes in total spinal alignment after Kyphoplasty in VCF patients.
The study involved 21 VCF patients who underwent Kyphoplasty. In all patients, lateral radiographs of the entire spine were taken preoperatively and 1 month after surgery, to measure the pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), and spinosacral angle (SSA). These parameters were compared between VCF patients and 30 healthy volunteers. In VCF patients, the parameters were compared before and after Kyphoplasty.
In VCF patients, preoperative SVA was 7.00 ± 3.9 cm, showing a significant shift to anterior sagittal balance as compared to the healthy group (1.45 ± 2.7 cm) (P < 0.0001). Preoperative SS was smaller and PT was larger in VCF group than in the healthy group (P < 0.05). After Kyphoplasty, SVA decreased to 5.02 ± 2.91 (P = 0.0007) and LL and SSA increased (LL P = 0.028; SSA P = 0.0031). Postoperative decrease of SVA was correlated with the kyphotic change of treated vertebra (r = 0.792, P < 0.01). VAS score decreased from 7.98 ± 1.8 before Kyphoplasty to 2.38 ± 2.3 postoperatively (P < 0.0001).
Total spinal alignment is shifted to anterior sagittal balance in VCF patients. Kyphoplasty plays a role not only in reducing pain associated with fractures but also in improving sagittal imbalance in the treatment of painful vertebral compression fracture.
椎体强化术对脊柱矢状面平衡的影响尚不清楚。本研究旨在分析椎体成形术治疗椎体压缩性骨折（VCF）患者后脊柱整体排列的变化。
本研究纳入21例行椎体成形术的VCF患者。所有患者术前及术后1个月均拍摄全脊柱侧位X线片，测量骨盆入射角（PI）、骶骨倾斜角（SS）、骨盆倾斜度（PT）、腰椎前凸（LL）、矢状垂直轴（SVA）和棘骶角（SSA）。将这些参数在VCF患者与30名健康志愿者之间进行比较。在VCF患者中，对椎体成形术前和术后的参数进行比较。
VCF患者术前SVA为7.00±3.9 cm，与健康组（1.45±2.7 cm）相比，矢状面前方平衡有明显偏移（P<0.0001）。VCF组术前SS较健康组小，PT较健康组大（P<0.05）。椎体成形术后，SVA降至5.02±2.91（P = 0.0007），LL和SSA增加（LL P = 0.028；SSA P = 0.0031）。术后SVA的降低与治疗椎体的后凸变化相关（r = 0.792，P<0.01）。视觉模拟评分（VAS）从椎体成形术前的7.98±1.8降至术后的2.38±2.3（P<0.0001）。
VCF患者的脊柱整体排列向矢状面前方平衡偏移。椎体成形术不仅在减轻骨折相关疼痛方面发挥作用，而且在治疗疼痛性椎体压缩骨折时改善矢状面失衡方面也发挥作用。
