Postoperative change in sagittal balance after Kyphoplasty for the treatment of osteoporotic vertebral compression fracture

• Published in: European spine journal Vol. 24; no. 4; pp. 744 - 749
• Main Authors: Yokoyama, Kunio, Kawanishi, Masahiro, Yamada, Makoto, Tanaka, Hidekazu, Ito, Yutaka, Kawabata, Shinji, Kuroiwa, Toshihiko
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2015; Springer Nature B.V
• Subjects: Adult; Aged; Back Pain - etiology; Back Pain - surgery; Bone Cements - therapeutic use; Female; Fractures, Compression - complications; Fractures, Compression - diagnostic imaging; Fractures, Compression - surgery; Humans; Kyphoplasty - methods; Kyphosis - diagnostic imaging; Kyphosis - etiology; Kyphosis - pathology; Kyphosis - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original Article; Osteoporotic Fractures - complications; Osteoporotic Fractures - diagnostic imaging; Osteoporotic Fractures - surgery; Pelvis - diagnostic imaging; Pelvis - pathology; Postoperative Period; Radiography; Spinal Fractures - complications; Spinal Fractures - diagnostic imaging; Spinal Fractures - surgery; Spine - diagnostic imaging; Spine - pathology; Spine - surgery; Surgical Orthopedics; Treatment Outcome; Vertebral compression fracture; Kyphoplasty; Sagittal balance
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-014-3678-z

Purpose The influence of vertebral cement augmentation on spinal sagittal balance is unknown. The present study aimed to analyze the changes in total spinal alignment after Kyphoplasty in VCF patients. Methods The study involved 21 VCF patients who underwent Kyphoplasty. In all patients, lateral radiographs of the entire spine were taken preoperatively and 1 month after surgery, to measure the pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), and spinosacral angle (SSA). These parameters were compared between VCF patients and 30 healthy volunteers. In VCF patients, the parameters were compared before and after Kyphoplasty. Results In VCF patients, preoperative SVA was 7.00 ± 3.9 cm, showing a significant shift to anterior sagittal balance as compared to the healthy group (1.45 ± 2.7 cm) ( P  < 0.0001). Preoperative SS was smaller and PT was larger in VCF group than in the healthy group ( P  < 0.05). After Kyphoplasty, SVA decreased to 5.02 ± 2.91 ( P  = 0.0007) and LL and SSA increased (LL P  = 0.028; SSA P  = 0.0031). Postoperative decrease of SVA was correlated with the kyphotic change of treated vertebra ( r  = 0.792, P  < 0.01). VAS score decreased from 7.98 ± 1.8 before Kyphoplasty to 2.38 ± 2.3 postoperatively ( P  < 0.0001). Conclusions Total spinal alignment is shifted to anterior sagittal balance in VCF patients. Kyphoplasty plays a role not only in reducing pain associated with fractures but also in improving sagittal imbalance in the treatment of painful vertebral compression fracture.