Abstract
ObjectiveTo compare the effects of percutaneous kyphoplasty (PKP) with or without posterior pedicle screw fixation (PPSF) on spinal sagittal balance in elderly patients with severe osteoporotic vertebral compression fracture (sOVCF).MethodsFrom January 2016 to December 2018, 102 elderly patients with single-level thoracolumbar sOVCF were enrolled. Among them, 78 cases underwent PKP (Group A), and 24 cases underwent PPSF+KP (Group B). Clinical evaluation included perioperative parameters, Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back pain; Radiographic evaluation included anterior vertebral height (AVH) and rate (AVHr), local kyphotic angle (LKA), and spino-pelvic sagittal balance parameters.ResultsPerioperative parameters including operation time, blood loss, fluoroscopic time and hospital stay in Group A were less than those in Group B (p < 0.05). Compared with the pre-operative results, the ODI and VAS scores of both groups decreased significantly in the three follow-ups after surgery (p < 0.05). The post-operative ODI and VAS scores of Group A were significantly better than those of Group B, but the results were opposite at the final follow-up (p < 0.05). Compared with the pre-operative values, except that there was no significant difference in pelvic incidence (PI) (p > 0.05), other radiographic parameters of both groups were improved significantly in the three follow-ups after surgery (p < 0.05). The AVH, AVHr, LKA and lumbar lordosis (LL) in Group B were better than those in Group A in the three follow-ups after surgery (p < 0.05). At the final follow-up, the sacral slope (SS) and pelvic tilt (PT) differed significantly between the two groups (p < 0.05).ConclusionsBoth PPSF+KP and PKP can achieve favorable clinical outcomes and maintain the spinal sagittal balance. Compared with PPSF+KP, PKP showed more significant advantages in the early post-operative period. However, in the long-term follow-up, PPSF+KP showed better clinical outcomes and may be better than PKP in maintaining spinal sagittal balance.
Highlights
Spinal sagittal balance is a good state for an individual to maintain the body in a stable position, which plays a crucial role in maintaining the normal biomechanics and physiologic function of the spine [1]
Among the patients included in this study, the average age was 66.12 ± 5.21 years old, male patients (16.67%) were less than female patients (83.33%), and most patients (60.78%) developed severe OVCF (sOVCF) after slight trauma
The mean Bone mineral density (BMD) of all patients were −3.15 ± 0.41, and there was no significant difference between the two groups (p > 0.05)
Summary
Spinal sagittal balance is a good state for an individual to maintain the body in a stable position, which plays a crucial role in maintaining the normal biomechanics and physiologic function of the spine [1]. Percutaneous kyphoplasty (PKP) is one of the most widely used surgical methods for OVCF This minimally invasive technique can achieve some benefits on short-term prognosis by eliminating pain and restoring vertebral height immediately after surgery [9]. These advantages have been demonstrated, PKP is associated with a high risk of recollapse of fractured vertebrae or fractures in adjacent segments [10, 11]. For patients with severe OVCF (sOVCF), defined as an expected reduction of two-thirds or more in anterior vertebral height [12], PKP alone may not be able to effectively correct severe kyphosis and maintain spinal sagittal balance in the long term, which may increase the risk of adjacent segment fractures and vertebral recollapse. To more effectively reduce the risk of adjacent vertebral fractures, correct kyphosis and maintain spinal sagittal balance, posterior pedicle screw fixation combined with kyphoplasty (PPSF+KP) has been used in recent years
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