Prognostic factors of balloon kyphoplasty for osteoporotic vertebral fractures with diffuse idiopathic skeletal hyperostosis

Abstract

OBJECTIVE The authors aimed to determine the poor prognostic factors of balloon kyphoplasty for the treatment of fractures of the most distal or distal-adjacent vertebrae in ankylosing spines with diffuse idiopathic skeletal hyperostosis (DISH). METHODS Eighty-nine patients with fractures of the most distal or distal-adjacent vertebrae of ankylosing spines with DISH were included and divided into two groups: those with (n = 51) and without (n = 38) bone healing 6 months postoperatively. Clinical evaluation included age, sex, time from onset to surgery, the visual analog scale score for low-back pain, and the Oswestry Disability Index (ODI). The VAS scores and ODI were measured both preoperatively and at 6 months postoperatively. Radiological evaluations included bone density; wedge angles of the fractured vertebrae in the supine and sitting positions on lateral radiographs; differences in the wedge angles (change in wedge angle); and the amount of polymethylmethacrylate used. RESULTS The preoperative ODI, vertebral wedge angles in the supine and sitting positions, change in wedge angle, and amount of polymethylmethacrylate were significantly different between the two groups and were significantly associated with delayed bone healing in univariate logistic regression analysis. Multivariate logistic regression analysis showed that only a change in the wedge angle was significantly associated with delayed healing, with a cutoff value of 10°, sensitivity of 84.2%, and specificity of 82.4%. CONCLUSIONS Treatment with balloon kyphoplasty alone should be avoided in patients with a difference ≥ 10° in the wedge angle of the fractured vertebrae between the supine and sitting positions.

Minimally Invasive Approach for Diffuse Idiopathic Skeletal Hyperostosis (DISH)-Related Vertebral Fractures: A Case Report on Combining Vertebral Cement Augmentation and Cement-Augmented Pedicle Screw Instrumentation

“…The VBS procedure, introduced as a new option for vertebral cement augmentation, has an advantage over BKP in that the stent maintains the restored vertebral body height after intravertebral reduction [11]. Some reports have demonstrated the usefulness of cement augmentation for vertebral fractures in ankylosing spines, including DISH [12][13][14]. Tsuchikawa et al reported improved VAS and Oswestry Disability Index (ODI) scores in patients undergoing BKP surgery for fractures of the distal or distally adjacent vertebrae of DISH [14].…”

“…Some reports have demonstrated the usefulness of cement augmentation for vertebral fractures in ankylosing spines, including DISH [12][13][14]. Tsuchikawa et al reported improved VAS and Oswestry Disability Index (ODI) scores in patients undergoing BKP surgery for fractures of the distal or distally adjacent vertebrae of DISH [14]. Even without posterior fixation, cement augmentation procedures contribute effectively to stabilizing vertebral fractures in some DISH patients.…”

Management of Thoracolumbar Vertebral Fractures and Dislocations in Patients with Ankylosing Conditions of the Spine

“…62 These results were also demonstrated when kyphoplasty was used instead of vertebroplasty. 63,64 Additionally, bracing with anti-osteoporotic treatment is believed to contribute to improved quality of life for the patient. 63 However, Tsuchikawa et al recommend avoiding this technique in patients with a difference ≥ 10° in the wedge angle of the fractured vertebrae between the supine and sitting positions as it was associated with delayed healing.…”