SHORT-TERM EFFECTIVENESS OF SELECTIVE TREATMENT OF SENILE OSTEOPOROTIC THORACOLUMBAR BURST FRACTURES OF Denis TYPE B WITH KYPHOPLASTY AND Jack VERTEBRAL DILATOR_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FENG Yuxu , ZHANG Jue , SHEN Yimin , REN Yongxin , YIN Guoyong , ZHANG Ning.

Department of Orthopaedics, the First Affiliated Hospital, Nanjing Medical University, Nanjing Jiangsu, 210029, P.R.China. Corresponding author: REN Yongxin, E-mail: renyongxin@yahoo.com.cn;

Corresponding author：

Keywords：

Thoracolumbar burst fracture; Kyphoplasty; Jack vertebral dilator

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Objective To investigate the feasibility and effectiveness of selective treatment of senile osteoporotic thoracolumbar burst fractures of Denis type B with kyphoplasty and Jack vertebral dilator. Methods Between August 2007 and May 2011, 30 patients (32 vertebra) with osteoporotic thoracolumbar burst fractures of Denis type B were treated with kyphoplasty and Jack vertebral dilator. There were 7 males and 23 females, aged 57-85 years (mean, 76.9 years). The injured vertebrae included T11 in 2 vertebrae, T12 in 11 vertebrae, L1 in 7 vertebrae, L2 in 5 vertebrae, L3 in 3 vertebrae, and L4 in 4 vertebrae. The visual analogue scale (VAS) score, Oswestry disability index (ODI), the anterior and middle height of the vertebral body, and the Cobb angle were assessed before and after operation. Results The operation was completed smoothly in all cases; no cement leakage or intraoperative complication was found. Obvious back pain relief was achieved in all patients after operation. Thirty patients were followed up at 1 week and 6 months after operation. The VAS score was decreased from 8.2 ± 1.3 before operation to 1.5 ± 0.9 at 1 week after operation and 1.9 ± 0.5 at 6 months after operation; the ODI was decreased from 82.4% ± 15.0% to 17.8% ± 9.5% and 23.0% ± 8.6%; the anterior height of the vertebral body was increased from (19.5 ± 3.2) mm to (24.8 ± 3.0) mm and (24.0 ± 2.6) mm; the middle height of the vertebral body was increased from (18.5 ± 3.4) mm to (23.7 ± 3.7) mm and (22.8 ± 3.5) mm; the Cobb angle was decreased from (14.9± 7.5)° to (7.6 ± 6.0)° and (8.3 ± 6.0)°; and there were significant differences in the VAS score, ODI, the anterior and middle height of the vertebral body, and the Cobb angle between at pre- and at post-operation (P lt; 0.05), but no significant difference between at 1 week and at 6 months after operation (P gt; 0.05). Conclusion Kyphoplasty with Jack vertebral dilator for selective treatment of senile osteoporotic thoracolumbar burst fractures of Denis type B can restore the anterior and middle height of the vertebral body, correct the Cobb angle, and relieve pain, and it has good short-term effectiveness and safety.

Citation： FENG Yuxu,ZHANG Jue,SHEN Yimin,REN Yongxin,YIN Guoyong,ZHANG Ning.. SHORT-TERM EFFECTIVENESS OF SELECTIVE TREATMENT OF SENILE OSTEOPOROTIC THORACOLUMBAR BURST FRACTURES OF Denis TYPE B WITH KYPHOPLASTY AND Jack VERTEBRAL DILATOR. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(8): 972-976. doi: Copy

1.	Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976), 1983, 8(8): 817-831.
2.	Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976), 2001, 26(9): 1038-1045.
3.	Ross PD, Davis JW, Epstein RS, et al. Pain and disability associated with new vertebral fractures and other spinal conditions. J Clin Epidemiol, 1994, 47(3): 231-239.
4.	Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine (Phila Pa 1976), 1987, 12(2): 160-166．.
5.	Panjabi MM, Goel V, Oxland T, et al. Human lumbar vertebrae: quantitative three-dimensional anatomy. Spine (Phila Pa 1976), 1992, 17(3): 299-306．.
6.	Ebraheim NA, Rollins JR Jr, Xu R, et al. Projection of the lumbar pedicle and its morphometric analysis. Spine (Phila Pa 1976), 1996, 21(11): 1296-1300．.
7.	殷国勇, 张子韬, 张宁, 等. 应用Jack椎体扩张器行后凸成形术治疗骨质疏松性胸腰椎压缩骨折. 中国脊柱脊髓杂志, 2010, 20(9): 711-715.
8.	张宁, 殷国勇, 沈国蔚, 等. 椎体内复位扩张器在经皮后凸成形术治疗中的研究现状. 实用老年医学, 2010, 24(5): 367-371.
9.	Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976), 2001, 26(14): 1511-1515.
10.	Marlin E, Nathoo N, Mendel E. Use of percuatneous kyphoplasty and vertebroplasty in spinal surgery. J Neurosurg Sci, 2012, 56(2): 105-112.
11.	Phillips FM. Minimally invasive treatments of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2003, 28(15): S45-53.
12.	Krappinger D, Kastenberger TJ, Schmid R. Augmented posterior instrumentation for the treatment of osteoporotic vertebral body fractures. Oper Orthop Traumatol, 2012, 24(1): 4-12.
13.	Poynton AR. Point of view. Spine (Phila Pa 1976), 2002, 27(5): 548.
14.	郭金库, 丁文元, 申勇, 等. 球囊扩张后凸椎体成形术治疗老年骨质疏松性胸腰椎爆裂骨折. 中国修复重建外科杂志, 2010, 24(11): 1341-1344.
15.	Gan M, Yang H, Zhou F, et al. Kyphoplasty for the treatment of painful osteoporotic thoracolumbar burst fractures. Orthopedics, 2010, 33(2): 88-92.
16.	Shen GW, Wu NQ, Zhang N, et al. A prospective comparative study of kyphoplasty using the Jack vertebral dilator and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. J Bone Joint Surg (Br), 2010, 92(9): 1282-1288.
17.	Renner SM, Tsitsopoulos PP, Dimitriadis AT, et al. Restoration of spinal alignment and disk mechanics following polyetheretherketone wafer kyphoplasty with StaXx FX. AJNR Am J Neuroradiol, 2011, 32(7): 1295-1300.
18.	Tzermiadianos MN, Renner SM, Phillips FM. Altered disc pressure profile after an osteoporotic vertebral fracture is a risk factor for adjacent vertebral body fracture. Eur Spine J, 2008, 17(11): 1522-1530.
19.	王静成, 冯新民, 杨建东, 等. Jack椎体扩张器和球囊扩张后凸成形术的比较研究. 中华骨科杂志, 2010, 30(9): 842-847.

1. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976), 1983, 8(8): 817-831.
2. Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976), 2001, 26(9): 1038-1045.
3. Ross PD, Davis JW, Epstein RS, et al. Pain and disability associated with new vertebral fractures and other spinal conditions. J Clin Epidemiol, 1994, 47(3): 231-239.
4. Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine (Phila Pa 1976), 1987, 12(2): 160-166．.
5. Panjabi MM, Goel V, Oxland T, et al. Human lumbar vertebrae: quantitative three-dimensional anatomy. Spine (Phila Pa 1976), 1992, 17(3): 299-306．.
6. Ebraheim NA, Rollins JR Jr, Xu R, et al. Projection of the lumbar pedicle and its morphometric analysis. Spine (Phila Pa 1976), 1996, 21(11): 1296-1300．.
7. 殷国勇, 张子韬, 张宁, 等. 应用Jack椎体扩张器行后凸成形术治疗骨质疏松性胸腰椎压缩骨折. 中国脊柱脊髓杂志, 2010, 20(9): 711-715.
8. 张宁, 殷国勇, 沈国蔚, 等. 椎体内复位扩张器在经皮后凸成形术治疗中的研究现状. 实用老年医学, 2010, 24(5): 367-371.
9. Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976), 2001, 26(14): 1511-1515.
10. Marlin E, Nathoo N, Mendel E. Use of percuatneous kyphoplasty and vertebroplasty in spinal surgery. J Neurosurg Sci, 2012, 56(2): 105-112.
11. Phillips FM. Minimally invasive treatments of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2003, 28(15): S45-53.
12. Krappinger D, Kastenberger TJ, Schmid R. Augmented posterior instrumentation for the treatment of osteoporotic vertebral body fractures. Oper Orthop Traumatol, 2012, 24(1): 4-12.
13. Poynton AR. Point of view. Spine (Phila Pa 1976), 2002, 27(5): 548.
14. 郭金库, 丁文元, 申勇, 等. 球囊扩张后凸椎体成形术治疗老年骨质疏松性胸腰椎爆裂骨折. 中国修复重建外科杂志, 2010, 24(11): 1341-1344.
15. Gan M, Yang H, Zhou F, et al. Kyphoplasty for the treatment of painful osteoporotic thoracolumbar burst fractures. Orthopedics, 2010, 33(2): 88-92.
16. Shen GW, Wu NQ, Zhang N, et al. A prospective comparative study of kyphoplasty using the Jack vertebral dilator and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. J Bone Joint Surg (Br), 2010, 92(9): 1282-1288.
17. Renner SM, Tsitsopoulos PP, Dimitriadis AT, et al. Restoration of spinal alignment and disk mechanics following polyetheretherketone wafer kyphoplasty with StaXx FX. AJNR Am J Neuroradiol, 2011, 32(7): 1295-1300.
18. Tzermiadianos MN, Renner SM, Phillips FM. Altered disc pressure profile after an osteoporotic vertebral fracture is a risk factor for adjacent vertebral body fracture. Eur Spine J, 2008, 17(11): 1522-1530.
19. 王静成, 冯新民, 杨建东, 等. Jack椎体扩张器和球囊扩张后凸成形术的比较研究. 中华骨科杂志, 2010, 30(9): 842-847.

Chinese Journal of Reparative and Reconstructive Surgery

SHORT-TERM EFFECTIVENESS OF SELECTIVE TREATMENT OF SENILE OSTEOPOROTIC THORACOLUMBAR BURST FRACTURES OF Denis TYPE B WITH KYPHOPLASTY AND Jack VERTEBRAL DILATOR

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