J Korean Neurosurg Soc.  2014 Jun;55(6):337-342. 10.3340/jkns.2014.55.6.337.

The Effect of Postural Correction and Subsequent Balloon Inflation in Deformity Correction of Acute Osteoporotic Vertebral Fractures

• Liu HX
• Xu C
• Shang P
• Shen Y
• Xu HZ

• KMID: 2191113
• DOI: http://doi.org/10.3340/jkns.2014.55.6.337

Abstract

OBJECTIVE
To determine deformity correction by postural correction and subsequent balloon inflation in acute vertebral compression fractures (OVCFs) and to examine the effect of bone mineral density on deformity correction.
METHODS
A totol of 50 acute OVCFs received balloon kyphoplasty. Lateral radiographs were taken and analyzed at five different time points : 1) preoperative, 2) after placing the patient in prone hyperextended position, 3) after balloon inflation, 4) after deposition of the cement, and 5) postoperative. All fractures were analyzed for height restoration of anterior (Ha), middle (Hm) and posterior (Hp) vertebra as well as Cobb angle and Kyphotic angle. The bone mineral density (BMD) of lumbar spine was measured by dual-energy X-ray absorptiometry. According to the T-score, the patients were divided into two groups which were osteoporosis group and osteopenia group.
RESULTS
Postoperative measurements of Ha, Hm and the Cobb angle demonstrated significant reduction of 4.62 mm, 3.66 mm and 5.34degrees compared with the preoperative measurements, respectively (each p<0.05). Postural correction significantly increased Ha by 5.51 mm, Hm by 4.35 mm and improved the Cobb angle by 8.32degrees (each p<0.05). Balloon inflation did not demonstrate a significant improvement of Ha, Hm or the Cobb angle compared with baseline prone hyperextended. Postural correction led to greater improvements of Ha, Hm and Cobb angle in osteoporosis group than osteopenia group (each p<0.05).
CONCLUSION
In acute OVCFs, the height restoration was mainly attributed to postural correction rather than deformity correction by balloon inflation. BMD affected deformity correction in the process of postural correction.

Keyword

Osteoporosis; Bone mineral density; Vertebral fracture; Balloon kyphoplasty; Height restoration

MeSH Terms

Absorptiometry, Photon
Bone Density
Bone Diseases, Metabolic
Congenital Abnormalities*
Fractures, Compression
Humans
Inflation, Economic*
Kyphoplasty
Osteoporosis
Spine

Figure

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  Fig. 1 Measurement of anterior (Ha), middle (Hm), and posterior (Hp) vertebral height and Cobb angle, and Kyphotic angle.

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  Fig. 2 Vertebral height restoration during the kyphoplasty procedure. p<0.001 for prone vs. preoperative (Ha, Hm, Hp); postoperative vs. preoperative (Ha, Hm). p<0.01 for postoperative vs. cement (Ha, Hm, Hp). Ha : anterior vertebral height, Hm : middle vertebral height, Hp : posterior vertebral height.

• 

  Fig. 3 Sagittal realignment during the kyphoplasty procedure. p<0.001 for prone vs. preoperative and postoperative vs. preoperative (Kyphotic angle, Cobb angle). p<0.05 for postoperative vs. cement (Kyphotic angle, Cobb angle).

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