Spinal sagittal imbalance in patients with osteoporotic vertebral compression fractures

doi:10.3969/j.issn.2095-4344.2014.26.023

Abstract

Abstract:

BACKGROUND: The reasons for spinal imbalance include spinal deformity, spinal degenerative disease osteoporotic vertebral compression fractures. We believe that the power factor (back muscle) plays a key role in spinal sagittal imbalance.
OBJECTIVE: To analyze the reasons for spinal sagittal imbalance by observing clinical manifestations and therapeutic outcomes in patients with osteoporotic vertebral compression fractures.
METHODS: A total of 41 patients with osteoporotic compression fractures combined with spinal sagittal imbalance were retrospectively analyzed from January 2012 to May 2013. All patients were subjected to percutaneous balloon vertebroplasty under local anesthesia. Before treatment, they received bone density, standing full-spine lateral X-ray, CT and MR imaging with injured vertebrae as the center. Using standing full-spine radiographs, the height of anterior border of the injured vertebrae, Cobb angle of kyphosis and improved angle, wedging angle of the injured vertebrae and improved angle were measured. The patients underwent weight loading test and walking test. Preoperative and postoperative data were compared.
RESULTS AND CONCLUSION: The patients affected spinal sagittal imbalance symptoms, so the walking distance was significantly shorter than that postoperatively (P < 0.05). Moreover, the time of weight loading test was significantly shorter than that postoperatively (P < 0.05). In standing full-spine radiographs, the average difference of Cobb angle was (10.01±0.76)°. The mean difference of vertebral wedging improvement was (4.84±0.40)° (P < 0.05). All patients were followed up. Low back pain and sagittal imbalance symptoms were relieved. No severe complications appeared after percutaneous balloon vertebroplasty. Results indicated that patients with osteoporosis compression fractures can affect the symptoms of spinal sagittal imbalance, which is not only induced by wedging of the injured vertebra. In addition, after percutaneous balloon vertebroplasty, imbalance symptoms are apparently improved, suggesting that back pain after spinal fracture limits back muscle strength and is an important cause for spinal sagittal imbalance.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: osteoporosis, spinal fractures, kyphosis, vertebroplasty

CLC Number:

R318

Zhang Xiang-wei, Sun Jian-min, Cui Xin-gang, Jiang Zhen-song, Dong Jun. Spinal sagittal imbalance in patients with osteoporotic vertebral compression fractures[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(26): 4224-4228.

Figures/Tables 2

References

[1]Ettinger MP. Aging bone and osteoporosis: strategies for preventing fractures in the elderly. Arch Intern Med. 2003; 163(18):2237-2246.
[2]安珍,杨定焯,张祖君,等.骨质疏松性脊椎压缩性骨折流行病学调查分析[J].中国骨质疏松杂志, 2002,8(1):82-83.
[3]李宁华,区品中,朱汉民,等.中国部分地区中老年人群原发性骨质疏松患病率的研究[J].中华骨科杂志,2001,21(5):275-278.
[4]谢晓勇,李平生,李玉茂,等.骨质疏松性脊柱多发性骨折后凸成形术近期疗效分析[J].中国矫形外科杂志,2008,16(7): 467-468.
[5]Schofer MD,Efe T,Timmesfeld N,et al.Comparison of kyphoplasty and vertebroplasty in the treatment of fresh vertebral compression fractures. Arch Orthop Trauma Surg. 2009;129(10):1391-1399.
[6]Legaye J,Duval-Beaupre G,Hecquet J,et al. Pelvic incidence:A fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 1998;7(2):99-103.
[7]Vaz G,Roussouly P,Berthonnaud E,et al. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J. 2002;11(1): 80-87.
[8]Voutsinas SA,MacEwen GD．Sagittal profiles of the spine．Clin Orthop Relat Res. 1986;210:235-242.
[9]Kouwenhoven JM,Castelein RM. The pathogenesis of adolescent idiopathic scoliosis:review of the literature. Spine. 2008;33(26):2898-908.
[10]Cho KJ,Suk SI,Park SR,et al. Risk factors of sagittal decompensation after long posterior instrumentation and fusion for degenerative lumbar scoliosis. Spine. 2010;35(17): 1595-1601.
[11]Barrey C,Roussouly P,Perrin G,et al. Sagittal balance disorders in severe degenerative spine:Can we identify the compensatory mechanisms. Eur Spine J. 2011;20(Suppl 5):626-633.
[12]Le Huec JC,Charosky S,Barrey C,et al. Sagittal imbalance cascade for simple degenerative spine and consequences: algorithm of decision for appropriate treatment. Eur Spine J. 2011;20(Suppl 5):699-703.
[13]Schwab FJ,Smith VA,Biserni M,et al. Adult scoliosis:a quantitative radiographic and clinical analysis．Spine(Phila Pa 1976). 2002;27(4):387-392.
[14]Shipp KM, Purser JL, Gold DT, et al.Timed Loaded Standing: A Measure of Combined Trunk and Arm Endurance Suitable for People with Vertebral Osteoporosis.Osteoporos Int. 2000; 11:914-922.
[15]Alanay A, Pekmezci M, Karaeminogullari O, et al. Radiographic measurement of the sagittal plane deformity in patients with osteoporotic spinal fractures evaluation of intrinsic error. Eur Spine J. 2007;16:2126-2132.
[16]韦以宗.脊柱机能解剖学研究[J].中国中医骨伤科杂志,2003, 11(1): 1-9.
[17]Naylor A. Intervertabral disk prolapse and degeneration. Spine.1976;1:108.
[18]Kanis J A. Diagnosis of osteoporosis and assessment of fracture risk. Lancet.2002;359(9321): 1929-1936.
[19]Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359(9319):1761-1767.
[20]Kado DM, Browner WS, Palermo L, et al. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Int Med.1999; 159(11):1215-1220.
[21]Beahonnaud E,Labelle H,Roussouly P,et al.A variability study of computerized sagittal spinopelvie radiologic measurements of trunk balance. Spine Disord Tech. 2005;1:66-71.
[22]Min K,Hahn F,Ziebarth K. Short anterior correction of the thoracolumbar/lumber curve in King 1 idiopathic scoliosis:the behaviour of the instrumented and non-instrumented curves and the trunk balance. Eur Spine J. 2007;16(1):65-72.
[23]Yin G, Qiu Y,Sun X, et al. The influence of different arm position on the spinal sagittal profile in normal adolescents and adolescent idiopathic scoliosis. Chin J Orthop. 2008; 28(9): 726-730.
[24]Debarge R,Demey G,Roussouly P.Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Spine. 2009;34(8):785-791.
[25]Roussouly P, Nnadi C. Sagittal plane deformity:an overview of interpretation and management.Eur Spine J. 2010;19(1): 1824-1836.
[26]Lee C, Chung S, Kang K, et al. Normal patterns of sagittal alignment of the spine in young adults radiological analysis in a korean population.Spine. 2011;36(25):E1648-1654.
[27]Cotton A,Boutry N,Cortet B,et al.Percutaneous vertebroplasty state of the art.Radiographics. 1998;18:311-320.
[28]Tohmeh A,Dewatre F,Cortet B,et al.Biomechanical efficacy of osteoporotic compression fractures.Spine. 1999;24: 1772-1776.
[29]Deramond H,Wright NT,Belkoff SM.Temperature elevation caused by bone cement polymerization during vertebroplasty. Bone. 1999;25(2):17-21S.
[30]Miyazaki M,Hymanson HJ,Morshita Y,et al.Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine.Spine. 2008;23:870-876.