The Clinical Study Of Osteoporotic Vertebral Fracture Nonunion Treated By Kyphoplasty

Objective: To analyze the clinical efficacy of osteoporotic vertebral fracture(OVF)nonunion managed by kyphoplasty, and explore effective method of reducing leakage,and summarize the clinical characteristics and image characteristics of OVF nonunion.Methods: We retrospectively analyzed all the patients who were diagnosed as OVF and underwent PKP from August 2012 to March 2014. We remove some cases which suffered from spine surgery, tumorous diseases and nerve or spinal cord compression. 27 patients were diagnosed as OVF nonunion in the study, which contained 5 men and 22 women, and their average age was 69.70±9.26 year. Before operation, all patients were performed by X-ray, CT scan and MRI. All patients were managed by the key key procedure that was used to block the defect to protect against anterior leakage in kyphoplasty,and cement was injected as different phase. Patients were performed by X-ray or CT scan after operation. The anterior and middle vertebral height, local kyphotic angle, visual analogue scale(VAS), oswestry disability index(ODI) scores were recorded preoperatively and postoperatively, and which were also recorded in the follow-up. We also collected cement volume, cement leakage and cement status. We compared these datas by statistical methods.Results: 27 patients showed special back pain that was more serious when they standed up, however, the pain was almost completely relieved by rest. Imaging characteristics of the nonunion are intravertebral clefts or so-called edge hardening phenomenon. MRI images showed an area of high signal intensity on T2-weighted MR images and short time inversion recovery, and an area of low signal intensity on T1-weighted MR images. All patients tolerated the procedure well. There were only two vertebraes with asymptomatic cement leakage by the key procedure in PKP. 27 patients had a follow-up of 16.11±5.19 m. The anterior vertebral height, middle vertebral height, kyphotic angle, VAS and ODI from 53.01±21.10, 57.61±18.59, 17.75±14.38, 8.48±0.64, 84.61±5.39 before operation to 77.70±12.92, 75.61±13.68, 9.86±12.16, 2.33±0.62, 32.48±6.04 after operation respectively( P<0.05), and no statistically significant differences in the last follow-up.Conclusion: OVF nonunion was a disease that occured in thoracolumbar junction, which shows showed special back pain that was more serious when they standed up, however, the pain was almost completely relieved by rest. Image examination showed intravertebral vacuum cleft and pseudarthrosis activity. PKP is a minimally invasive and effective procedure for treating OVF nonunion. It is effective to reduce the occurrence of bone cement leakage by the key operative techniques of PKP.