Department of Spine Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland; Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
World Neurosurg. 2019 May;125:e764-e773. doi: 10.1016/j.wneu.2019.01.167. Epub 2019 Feb 5.
Preoperative magnetic resonance imaging with fat suppression (FS-MRI) is useful to detect bone marrow edema in osteoporotic vertebral fractures (OVFs) and thus can improve diagnostic accuracy and influence surgical strategy for percutaneous augmentation. The role of preoperative FS-MRI in preventing subsequent fractures after balloon kyphoplasty has not been investigated in initially subclinical fractures or fractures without obvious morphologic changes.
From January 2010 to December 2017, 214 consecutive patients underwent balloon kyphoplasty for painful OVFs. We defined 2 groups based on preoperative imaging (100 patients had preoperative FS-MRI and 114 patients had no MRI) and then compared baseline and surgical characteristics. The primary end point was incidence of subsequent fractures within 12 months after treatment.
The 214 patients underwent kyphoplasty of 414 vertebrae. Comparing FS-MRI with no-MRI groups, spontaneous fractures occurred significantly more (58% vs. 26.3%; P < 0.001) and fractures were more often multilevel (≥ 4 levels) (15% vs. 2.6%; P = 0.001), respectively. Overall incidence of subsequent vertebral fractures was 25.7% (32% in FS-MRI, 20.2% in no-MRI groups; P = 0.048). Average time to diagnosis of subsequent fractures did not differ between the 2 groups (9.3 FS-MRI vs. 11.5 weeks no-MRI; P = 0.411). Age ≥80 years at the time of balloon kyphoplasty was associated with a higher odds ratio (2.3) for subsequent fractures within 12 months (P = 0.039).
Surgical treatment according to preoperative FS-MRI did not reduce occurrence of subsequent OVFs and did not prolong fracture-free intervals within 12 months after kyphoplasty.
术前磁共振成像（MRI）联合脂肪抑制（FS）技术有助于检测骨质疏松性椎体骨折（OVF）患者的骨髓水肿，从而提高诊断准确率，并影响经皮椎体强化术的手术策略。然而，术前 FS-MRI 在预防球囊扩张椎体后凸成形术后初始亚临床骨折或形态无明显变化的骨折方面的作用尚未得到研究。
2010 年 1 月至 2017 年 12 月，连续 214 例因 OVF 疼痛而行球囊扩张椎体后凸成形术的患者。我们根据术前影像学表现（100 例行 FS-MRI，114 例行 MRI 检查）将患者分为两组，比较两组的基线和手术特点。主要终点是治疗后 12 个月内的再发骨折发生率。
214 例患者共行 414 个椎体的球囊扩张椎体后凸成形术。与无 FS-MRI 组相比，FS-MRI 组自发性骨折发生率明显更高（58% vs. 26.3%；P<0.001），骨折多为多节段（≥4 个节段）（15% vs. 2.6%；P=0.001）。总的再发性椎体骨折发生率为 25.7%（FS-MRI 组 32%，无 FS-MRI 组 20.2%；P=0.048）。两组再发性骨折的平均诊断时间无差异（FS-MRI 组 9.3 周，无 FS-MRI 组 11.5 周；P=0.411）。球囊扩张椎体后凸成形术时年龄≥80 岁与 12 个月内再发性骨折的比值比（OR）增加（2.3）相关（P=0.039）。
根据术前 FS-MRI 进行手术治疗并不能降低 OVF 的再发率，也不能延长球囊扩张椎体后凸成形术后 12 个月内的无骨折间隔。
