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| WANG Genlin,YANG Huilin,ZHU Xuesong.Determination and kyphoplasty for osteoporotic vertebral osteonecrosis[J].Chinese Journal of Spine and Spinal Cord,2013,(3):228-232. |
| Determination and kyphoplasty for osteoporotic vertebral osteonecrosis |
| Received:August 25, 2012 Revised:November 11, 2012 |
| English Keywords:Osteonecrosis Kyphoplasty Osteoporosis Vertebral fractures |
| Fund:国家自然科学基金项目资助（编号：81271960） |
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| English Abstract: |
| 【Abstract】 Objectives： To explore the preliminary diagnosis of osteoporotic vertebral osteonecrosis and its intervention by percutaneous balloon kyphoplasty. Methods： The clinical data of 39 patients with osteoporotic vertebral osteonecrosis treated by balloon kyphoplasty were analyzed retrospectively from January 2006 to June 2010. There were 17 males and 22 females in this study. The mean age of the patients at surgery was 69.4 years(range, 61-80 years). The back pain duration was 3.2 months(range, 3 weeks-10 years). The T value of preoperative lumbar spine bone mineral density was -2.69 to -6.73(average, -3.17). All cases received radiography, MRI and CT examination before operation. Diseased level sited in T7 in 1 case, T9 in 2 cases, T11 in 5 cases, T12 in 13 cases, L1 in 9 cases, L2 in 5 cases, L3 in 3 cases and L4 in 1 case. Biopsies were performed for final determination. The clinical and imaging characteristics of these patients were analyzed. The anterior vertebral height of diseased level was measured on a standing lateral radiograph at pre-operation, two days after operation, and at the final follow-up, respectively. Visual analog scale(VAS) and Oswestry disability index(ODI) were chosen to evaluate pain status and functional activity at the same time points. Results： All patients had back pain lasting more than three weeks before surgery. Increased spinal load would make the pain worse, such as sitting, standing or walking. Spinal vertebral compression was evidenced on X-ray films. 64%(25 cases) of vertebral osteonecrosis showed intervertebral cleft in X-ray, 79%(31cases) showed intervertebral cleft in CT. All vertebral osteonecrosis showed well-margional signal intensity in the cleft in MRI. The mean follow-up was 26.3 months(range, 13-48 months). The anterior vertebral body height restored from preoperative (31.7±11.1)% to postoperative (69.4±12.7)%, and (67.2±15.5)% at final follow-up. which showed significant improvement between preoperation and postoperation(P<0.05) while no difference between postoperation and final follow-up(P>0.05). The VAS was 8.2±1.4 at preoperation, 1.8±0.6 at two days after surgery, 1.9±0.5 at final follow-up; and the ODI was (80.1±8.7)% at preoperation, (25.7±8.1)% at two days after surgery, (26.1±7.9)% at final follow-up. There was statistically significant improvement in the VAS and ODI between post-operative assessments and the pre-operative ones(P<0.05), while no significant differences existed between postoperation and final follow-up(P>0.05). Asymptomatic bone cement leakage occurred in five cases. Onset of vertebral fracture occurred in three cases. Conclusions: Osteoporotic vertebral osteonecrosis can be initially diagnosed based on the imaging and clinical presentation. Balloon kyphoplasty is a minimally invasive, safe and effective intervention for this disease. |
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