Sanada Kyoichi, Tanaka Jun, Ohta Hideki, Kida Yoshikuni, Shiokawa Teruaki, Shibata Tatsuya, Hagihara Shusuke, Yamamoto Takuaki
Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Oita Orthopaedic Hospital, Oita, Japan.
Asian Spine J. 2024 Apr;18(2):244-250. doi: 10.31616/asj.2023.0316. Epub 2024 Mar 8.
A retrospective cohort study.
To investigate the outcomes of balloon kyphoplasty (BKP) for vertebral compression fractures (VCFs) at the distal end or adjacent vertebra of the fused segments in patients with diffuse idiopathic skeletal hyperostosis (DISH).
Vertebral fractures in the midportion of the fused segments in patients with DISH are generally unstable; thus, immobilization is recommended. However, VCFs classified as type A in the AO classification are observed at the distal end and adjacent vertebra of the fused segments, and treatment strategies for VCFs associated with DISH remain controversial.
The outcomes of 72 patients who underwent BKP for VCFs between 2015 and 2021 were retrospectively investigated. Patients with DISH were assigned to group D (n=21), whereas those without DISH were assigned to group ND (n=51). Back pain, incidence of subsequent adjacent fractures, reoperation rates, and local kyphosis were statistically analyzed.
VCFs in group D occurred at the distal end or adjacent vertebra of the fused segments, and no fractures occurred in the midportion of the fused segment. Back pain improved in both groups, with no significant differences between them. Subsequent adjacent fractures were observed in three of the 21 patients in group D and 11 of the 51 patients in group ND, with no significant difference between them. Reoperation was performed in one patient each in groups D and ND, with no significant difference between the groups. Postoperatively, local kyphosis progressed significantly in group D.
Although local kyphosis is more advanced in patients with DISH, BKP is effective for VCFs at the distal end or adjacent vertebra of the fused segments and may be useful in older patients with high complication rates.
一项回顾性队列研究。
探讨球囊后凸成形术（BKP）治疗弥漫性特发性骨肥厚（DISH）患者融合节段远端或相邻椎体的椎体压缩骨折（VCF）的疗效。
DISH患者融合节段中部的椎体骨折通常不稳定；因此，建议进行固定。然而，在AO分类中被归类为A型的VCF在融合节段的远端和相邻椎体被观察到，与DISH相关的VCF的治疗策略仍存在争议。
回顾性研究2015年至2021年间72例行BKP治疗VCF的患者的疗效。患有DISH的患者被分配到D组（n = 21），而没有DISH的患者被分配到ND组（n = 51）。对背痛、随后相邻骨折的发生率、再次手术率和局部后凸进行统计学分析。
D组的VCF发生在融合节段的远端或相邻椎体，融合节段中部未发生骨折。两组背痛均有改善，两组间无显著差异。D组21例患者中有3例观察到随后相邻骨折，ND组51例患者中有11例观察到随后相邻骨折，两组间无显著差异。D组和ND组各有1例患者进行了再次手术，两组间无显著差异。术后，D组局部后凸明显进展。
尽管DISH患者的局部后凸更严重，但BKP对融合节段远端或相邻椎体的VCF有效，可能对并发症发生率高的老年患者有用。
