骨粗鬆症性脊椎圧迫骨折に対する balloon kyphoplasty (BKP) : 治療経験と短期手術成績

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Vertebral compression fractures (VCFs) are the most common form of osteoporotic fracture with significant morbidity. Osteoporotic VCFs are a major health concern owing to the increasing population of elderly people. These fractures have traditionally been treated with conventional therapies such as analgesics, bed rest and bracing. In the last few decades, vertebroplasty, and subsequently kyphoplasty, have emerged as minimally invasive treatment options. Balloon kyphoplasty (BKP) is a recent modification of percutaneous vertebroplasty that can be considered in those patients who do not respond to initial treatment. Between February 2011 and July 2011, 7 patients with pain refractory to conservative therapy underwent single-level kyphoplasty. We prospectively assessed the results of the kyphoplasties by clinical and radiological methods. We evaluated clinical outcome using the visual analog scale (VAS), Japanese Orthopedic Association (JOA) and Oswestry Disability Index (ODI) scores. Radiological measurements included anterior, middle and posterior vertebral body height, local kyphotic angle and sagittal vertical axis (SVA). All patients were female. The mean age was 77.7, with a range from 73 to 85. The fractures were located at the thoracolumbar junction, T12 : 5 cases, L1 : 2 cases, respectively. The length of conservative treatment ranged from 4 to 6 months (mean 4.7 months). The mean VAS pain score decreased from 7.4±1.1 before surgery to 2.5±3.2 after surgery (p=0.03). The mean JOA score increased from 11.8±5.8 before surgery to 17.8±4.2 after surgery (p=0.007). The mean ODI score decreased from 34.0±9.0 before surgery to 21.4±12.2 after surgery (p=0.007). The mean anterior height was 7.7±2.0 before treatment and 16.0±2.3 after treatment (p=0.007). The mean middle height was 8.7±2.6 before treatment and 15.7±1.4 after treatment (p=0.007). The mean posterior height was 25.0±2.1 before treatment and 25.8±2.6 after treatment (p=0.18). The mean preoperative and postoperative local kyphotic angle at VCF were 21.2±4.6° and 12.4±3.7°, respectively (p=0.007). The mean preoperative and postoperative SVA were 83.1±19.1 and 73.8±24.9, respectively (p=0.15). BKP demonstrated rapid back pain relief in all patients associated with statistically significant restoration of vertebral body height and improvement of local kyphosis. However, the angular reduction attained at the level of VCF did not translate to similar correction of overall sagittal alignment. Cement extravasation was not observed, nor were complications such as pulmonary embolism or spinal compression. Only one patient developed subsequent vertebral body fracture adjacent to treated vertebra one month after the procedure. In our experience, kyphoplasty was found to be an effective and safe alternative in the treatment of osteoporotic VCFs.
2012-12-20

骨粗鬆症性脊椎圧迫骨折に対する balloon kyphoplasty (BKP) : 治療経験と短期手術成績

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