Liu Hao, Zhou Quan, Zhang Junxin, Deng Lei, Hu Xiayu, He Wei, Liu Tao, Yang Huilin
Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China.
Front Surg. 2022 Jul 29;9:962723. doi: 10.3389/fsurg.2022.962723. eCollection 2022.
Intravertebral vacuum phenomenon (IVP) is a special sign after vertebral fractures, which is common in patients with ankylosing spondylitis (AS) and may indicate pseudarthrosis and bone nonunion that lead to spinal instability. The objective of this study is to evaluate the efficacy and safety of kyphoplasty (KP) in treating such types of vertebral fractures with AS.
Sixteen patients with AS suffering from thoracic or lumbar fractures with IVP received KP from 2015 to 2020 and were monitored for more than 1 year. The visual analog scale (VAS) score was used to evaluate back pain relief. The Oswestry Disability Index (ODI) questionnaire was used to assess the improvement of the patients' living quality. The anterior and middle vertebral height restoration ratio (AVH, MVH) and the kyphotic angle (KA) were used to evaluate the radiographic results.
The mean follow-up period was 20.8 months (12-28 months). The VAS and ODI significantly reduced at 3 days, 3 months after surgery, and at the last follow-up compared with the preoperative outcomes (< 0.05). The AVH and MVH were significantly increased compared with the preoperative outcomes (< 0.05). There was a significant correction in the KA between pre- and postoperative assessments (< 0.05). Asymptomatic intradiscal polymethylmethacrylate (PMMA) cement leakage was found in two patients.
For thoracic or lumbar fractures with IVP in AS patients, KP may be safe and effective, which achieves pain relief and satisfying functional improvement, restores the anterior and middle height, and corrects the kyphotic angle of the fractured vertebra.
椎体内真空现象（IVP）是椎体骨折后的一种特殊征象，在强直性脊柱炎（AS）患者中较为常见，可能提示假关节形成和骨不连，进而导致脊柱不稳定。本研究的目的是评估椎体后凸成形术（KP）治疗此类AS椎体骨折的疗效和安全性。
2015年至2020年，16例患有胸腰椎骨折伴IVP的AS患者接受了KP治疗，并进行了超过1年的随访。采用视觉模拟评分（VAS）评估背痛缓解情况。采用Oswestry功能障碍指数（ODI）问卷评估患者生活质量的改善情况。采用椎体前中高度恢复率（AVH、MVH）和后凸角（KA）评估影像学结果。
平均随访时间为20.8个月（12 - 28个月）。与术前相比，术后3天、3个月及末次随访时VAS和ODI显著降低（<0.05）。与术前相比，AVH和MVH显著增加（<0.05）。术前和术后评估的KA有显著矫正（<0.05）。2例患者发现无症状的椎间盘内聚甲基丙烯酸甲酯（PMMA）骨水泥渗漏。
对于AS患者的胸腰椎骨折伴IVP，KP可能是安全有效的，可实现疼痛缓解和功能改善，恢复椎体前中高度，并矫正骨折椎体的后凸角。
