Mooney James H, Amburgy John, Self Mitchell, Agee Bonita S, Schoel Leah, Pritchard Patrick R, Chambers Melissa Rene
Department of Neurological Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.
School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.
J Spine Surg. 2019 Jun;5(2):194-200. doi: 10.21037/jss.2019.04.02.
Kyphoplasty is a minimally invasive surgery developed to restore height and stabilize painful vertebral compression fractures (VCFs). Only small retrospective studies have addressed the correlation between the degree of vertebral height restoration as it relates to pain relief and postoperative activity levels. No definitive correlations have been established. The objective of this analysis is to determine how height restoration correlates with improvements in pain, disability and quality of life.
We assessed outcomes following kyphoplasty in 59 Medicare-eligible patients with 1-3 painful VCFs between T5 and L5 due to osteoporosis or cancer. Pre and postoperative lateral radiographs were available for fifty-nine patients and were used to measure anterior, middle and posterior vertebral body (VB) heights. The Visual Analog Scale (VAS) [range: 0 (none) to 10 (worst)] was used to prospectively measure back pain pre and post-operatively in all patients. Pre and post-operative measurements of disability and quality of life were retrospectively collected using the Roland Morris Disability Index (RMDI) [range: 0 (no disability) to 24 (high disability)] and EuroQol5-Domain scale (EQ5D) [range: -0.11 (poor quality of life) to 1.0 (perfect health)]. Pearson correlations and linear regression models were analyzed for association of VB height improvement with outcomes.
Neither Pearson correlations (r coefficient range: 0.001-0.152) nor linear regression models (R value range: 0.0002-0.1133) revealed correlation or association between VB height improvements and outcomes.
This is one of the largest studies to date assessing associations of VB height restoration following kyphoplasty with prospective measurements of pain and retrospective evaluation of disability and quality of life using validated instruments. Although a majority of patients in this cohort demonstrated increased vertebral heights and significant improvements in outcomes, none of the outcomes showed association with height improvements. Regardless of vertebral height improvements, most patients had improved pain, function and quality of life.
椎体后凸成形术是一种用于恢复椎体高度并稳定疼痛性椎体压缩骨折（VCF）的微创手术。仅有少量回顾性研究探讨了椎体高度恢复程度与疼痛缓解及术后活动水平之间的相关性，尚未建立明确的关联。本分析的目的是确定高度恢复与疼痛、残疾及生活质量改善之间的相关性。
我们评估了59例符合医疗保险条件、因骨质疏松或癌症导致T5至L5节段有1至3个疼痛性VCF的患者接受椎体后凸成形术后的结果。59例患者均有术前和术后的侧位X线片，用于测量椎体前、中、后缘高度。采用视觉模拟评分法（VAS）[范围：0（无疼痛）至10（最严重疼痛）]对所有患者术前和术后的背痛进行前瞻性测量。使用罗兰·莫里斯残疾指数（RMDI）[范围：0（无残疾）至24（高度残疾）]和欧洲五维健康量表（EQ5D）[范围：-0.11（生活质量差）至1.0（完美健康）]回顾性收集术前和术后的残疾及生活质量测量数据。分析Pearson相关性和线性回归模型，以确定椎体高度改善与结果之间的关联。
Pearson相关性分析（r系数范围：0.001至0.152）和线性回归模型分析（R值范围：0.0002至0.1133）均未显示椎体高度改善与结果之间存在相关性或关联。
这是迄今为止规模最大的研究之一，评估了椎体后凸成形术后椎体高度恢复与使用经过验证的工具对疼痛进行前瞻性测量以及对残疾和生活质量进行回顾性评估之间的关联。尽管该队列中的大多数患者椎体高度增加且结果有显著改善，但没有任何结果显示与高度改善有关联。无论椎体高度是否改善，大多数患者的疼痛、功能和生活质量均有所改善。
