Perez Jennifer L, Ozpinar Alp, Agarwal Nitin, Hacker Emily, Alan Nima, Gerszten Peter C
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Int J Spine Surg. 2021 Apr;15(2):353-358. doi: 10.14444/8046. Epub 2021 Apr 1.
Percutaneous balloon kyphoplasty (BK) is widely accepted as both a safe and effective method for the treatment of symptomatic benign vertebral compression fractures (VCFs) of the thoracic and lumbar spines. A disruption in the posterior wall of the affected vertebra is often considered to be a relative or an absolute contraindication to BK. This study was performed to determine the safety as well as the efficacy of BK for vertebral body compression fractures associated with posterior wall disruption.
This was a retrospective, nonrandomized clinical cohort investigation of patients with VCF and posterior wall disruption treated with BK between 2010 and 2018. All cases were performed using a bipedicular technique. Each case was examined for cement leakage, anterior vertebral body height restoration, improvement in pain (determined by VAS) from baseline and 6-week postprocedure, and clinical sequelae from cement leakage.
Ninety-eight consecutive patients with 157 VCF levels who underwent BK were evaluated. There was a significant improvement in anterior vertebral height, vertebral wedge angle, and local kyphotic angle in all cases. The mean preoperative VAS improved from 8.7 preprocedure to 2.5 postprocedure ( = .001). There were 14 (9%) cases with asymptomatic cement leakage outside of the vertebral body, and no patients experienced postprocedure neurological symptoms at the 6-week follow up.
BK in the setting of posterior wall disruption was found to be a safe and highly effective treatment for patients with benign compression fractures. Posterior wall disruption should not be considered an absolute contraindication to BK.
经皮球囊椎体后凸成形术（BK）被广泛认为是治疗胸腰椎有症状的良性椎体压缩骨折（VCF）的一种安全有效的方法。受累椎体后壁的破坏通常被视为BK的相对或绝对禁忌证。本研究旨在确定BK治疗伴有后壁破坏的椎体压缩骨折的安全性和有效性。
这是一项对2010年至2018年间接受BK治疗的VCF伴后壁破坏患者的回顾性、非随机临床队列研究。所有病例均采用双侧椎弓根技术。检查每个病例的骨水泥渗漏情况、椎体前缘高度恢复情况、术后6周与基线相比疼痛（通过视觉模拟评分法确定）的改善情况以及骨水泥渗漏的临床后遗症。
对98例连续接受BK治疗的157个VCF节段的患者进行了评估。所有病例的椎体前缘高度、椎体楔角和局部后凸角均有显著改善。术前平均视觉模拟评分从术前的8.7改善至术后的2.5（P =.001）。有14例（9%）出现椎体外无症状骨水泥渗漏，在术后6周随访时无患者出现神经症状。
对于良性压缩骨折患者，BK治疗伴有后壁破坏的情况被发现是一种安全且高效的治疗方法。后壁破坏不应被视为BK的绝对禁忌证。
