Spine Center, Helios Klinikum Erfurt, Erfurt, Germany; Department of Orthopedics and Traumatology, Assiut University Hospitals, Assiut, Egypt.
Spine Center, Helios Klinikum Erfurt, Erfurt, Germany.
Spine J. 2018 Jul;18(7):1143-1148. doi: 10.1016/j.spinee.2017.11.001. Epub 2017 Nov 14.
Cement augmentation techniques are standard treatments for osteoporotic vertebral fractures. Compared with vertebroplasty, kyphoplasty is associated with lower rates of cement leak and better deformity correction; however, posterior wall fractures are relative, but not absolute; contraindications for both techniques and hence treatment practices vary among spine centers.
The primary aim of this study was to assess our center's incidence of posterior cement leakage in osteoporotic vertebral fractures with posterior wall injury treated by balloon kyphoplasty (BKP). Secondarily, physiological results, pain relief, complication rates, and non-posterior cement leakage were also evaluated.
This is a prospective cohort study done in a high-volume spine center in Germany.
Eighty-two patients with 98 osteoporotic vertebral fractures with posterior wall cortical injury were studied from 2012 to 2016.
The following were the outcome measures: (1) physiological measures: standing plain x-rays (anteroposterior and lateral views), with the following parameters evaluated: cement leak behind the posterior vertebral body border, Cobb angle for local sagittal deformity, vertebral wedge angle, and anterior vertebral height; (2) cement volume injected in each vertebra; and (3) self-report measures: visual analog scale (VAS).
All patients underwent BKP using a bipedicular approach. Preoperative clinical and neurologic evaluations were done. Radiological evaluations included plain X-ray images, computed tomography scans and magnetic resonance imaging. The average follow-up period was 18 months.
No cement leakage into the spinal canal occurred in any of the patients. Asymptomatic leakage into other sites was seen in 22 vertebrae (22.45%). There was significant improvement in the Cobb angle, the vertebral wedge angle, and the anterior vertebral height in all cases. The mean preoperative VAS was 8.1, and this improved to 2.3 on the third postoperative day.
Balloon kyphoplasty is a viable option for the treatment of osteoporotic vertebral fractures even with posterior wall involvement.
骨水泥强化技术是骨质疏松性椎体骨折的标准治疗方法。与经皮椎体成形术相比，球囊后凸成形术与较低的骨水泥渗漏率和更好的畸形矫正率相关；然而，后柱骨折是相对的，而不是绝对的；这两种技术都有禁忌证，因此脊柱中心的治疗实践也有所不同。
本研究的主要目的是评估我们中心在骨质疏松性椎体骨折伴后壁损伤患者中应用球囊后凸成形术（BKP）治疗时后壁骨水泥渗漏的发生率。其次，还评估了生理结果、疼痛缓解、并发症发生率和非后壁骨水泥渗漏。
这是在德国一家高容量脊柱中心进行的前瞻性队列研究。
2012 年至 2016 年期间，共研究了 82 例 98 例骨质疏松性椎体骨折伴后壁皮质损伤患者。
（1）生理指标：站立位平片（前后位和侧位），评估参数包括：后椎体边界后骨水泥渗漏、局部矢状面畸形 Cobb 角、椎体楔变角和前缘椎体高度；（2）每节椎体注射的骨水泥量；（3）自我报告测量：视觉模拟评分（VAS）。
所有患者均采用经皮双侧入路行 BKP。行术前临床和神经学评估。影像学评估包括平片、CT 扫描和 MRI。平均随访时间为 18 个月。
所有患者均未发生椎管内骨水泥渗漏。22 个椎体（22.45%）出现无症状性其他部位渗漏。所有病例 Cobb 角、椎体楔变角和前缘椎体高度均有显著改善。术前 VAS 平均为 8.1，术后第 3 天降至 2.3。
即使伴有后壁受累，球囊后凸成形术也是治疗骨质疏松性椎体骨折的可行选择。
