Retrospektiver Vergleich der Wirbelkörperaufrichtung nach Ballonkyphoplastie vs. Radiofrequenzkyphoplastie

Zusammenfassung

Hintergrund Neben schmerztherapeutischer Wirkung zielt die Kyphoplastie auf eine Aufrichtung osteoporotisch frakturierter Wirbelkörper (WK) ab. Ein neueres Verfahren ist die Radiofrequenzkyphoplastie (RFK). Unklar ist, wie gut sich mit dieser Methodik im Vergleich zur älteren Ballonkyphoplastie (BKP) wieder eine anatomische WK-Aufrichtung erreichen lässt. Ziel unserer retrospektiven Studie war daher der Vergleich beider Verfahren bez. der Grund-/Deckplattenwinkel post- vs. präoperativ.

Patienten und Methoden Anhand prä- und postoperativer Stehend-Röntgenaufnahmen wurden bei 87 Probanden (46 BKP und 41 RFK) bzw. 142 kyphoplastierten WK (67 BKP und 75 RFK) die Winkel von Grund- zu Deckplatte bestimmt. Hauptzielgröße war der Grad der Aufrichtung (Δpost−prä) bei der BKP vs. RFK. Außerdem wurden für die Bestimmung des sagittalen Alignments die angrenzenden gesunden Segmente ausgemessen.

Ergebnisse Sowohl bei der BKP (BKPprä: 11,5 ± 6,0°, BKPpost: 6,2 ± 4,6°, p < 0,001) als auch RFK (RFKprä: 9,9 ± 6,2°, RFKpost: 6,3 ± 4,4°, p < 0,001) kam es zu einer signifikanten Aufrichtung. Es zeigte sich im Verfahrensvergleich aber eine bessere Aufrichtung in der Gruppe BKP im Vergleich zur RFK (Δpost−prä BKP: − 5,3 ± 4,4°, Δpost−prä RFK: − 3,6 ± 4,4°, p = 0,03). Kein Verfahren führte aber im umgebenden Wirbelsäulensegment zu einer signifikanten Änderung des Winkels (Segment BKPprä: 13,8 ± 8,0°, Segment BKPpost: 12,5 ± 9,2°, p = 0,638; Segment RFKprä: 18,8 ± 14,3°, Segment RFKpost: 15,0 ± 13,2°, p = 0,330).

Schlussfolgerung Es konnte eine signifikant bessere Aufrichtung des Kyphosewinkels durch die BKP erreicht werden, wobei beide Verfahren für sich betrachtet zu einer hochsignifikanten Verbesserung des Kyphosewinkels geführt haben. Im angrenzenden Wirbelsäulensegment ist die Auswirkung auf den messbaren Winkel nicht signifikant ausgeprägt, sodass das Alignment durch den Eingriff tendenziell weniger beeinflusst wird.

Abstract

Background Kyphoplasty is used to alleviate pain and to restore the initial height of osteoporotic vertebral fractures (OVF). One of the most recent procedures is radiofrequency-targeted vertebral augmentation (RFTVA). We investigated whether restoration with this method is similar and as adequate as with the established procedure of balloon kyphoplasty (BKP), as assessed by the anatomical height of the vertebral body. The aim of our study was to compare the intravertebral angles (base-endplate) post- and preoperatively with these two procedures.

Patients and Methods The base and endplate angles were measured on 142 vertebral bodies treated by kyphoplasty (67 BKP and 75 RFTVA), on the basis of pre- and postoperative X-rays in the upright position in 87 volunteers (46 BKP and 41 RFTVA). The main object was to detect the degree of correction (Δpost−preop) with BKP compared to RFTVA. Furthermore, the sagittal alignment of the adjacent heathy levels were measured.

Results Significant correction was detected with both BKP (BKPpre: 11.5 ± 6.0°, BKPpost: 6.2 ± 4.6°, p < 0.001) and RFTVA (RFTVApre: 9.9 ± 6.2°, RFTVApost: 6.3 ± 4.4°, p < 0.001). Potential correction was greater with BKP than with RFTVA (Δpost−pre BKP: − 5.3 ± 4.4°, Δpost−pre RFK: − 3.6 ± 4.4°, p = 0.03). Neither procedures gave a significant change in the sagittal angle in the adjacent segment (segment BKPpre: 13.8 ± 8.0°, Segment BKPpost: 12.5 ± 9,2°, p = 0.638; Segment RFTVApre: 18,8 ± 14,3°, Segment RFTVApost: 15.0 ± 13.2°, p = 0.330).

Conclusion BKP gave significantly better correction, even though both methods were able to restore significant improvement in the kyphotic angle. In the adjacent levels, correction of the sagittal angle was not significant, although the influence of the intervention on alignment tended to be less.

Schlüsselwörter

Kyphoplastie - Osteoporose - Wirbelkörperfraktur - sagittales Alignment

Key words

kyphoplasty - osteoporosis - vertebral fracture - sagittal alignment

• Literatur

• 1 Kanis JA, Johnell O, Oden A. et al. Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 2000; 27: 585-590
• 2 Felsenberg D, Silman AJ, Lunt M. et al. Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 2002; 17: 716-724
• 3 Suzuki N, Ogikubo O, Hansson T. The prognosis for pain, disability, activities of daily living and quality of life after an acute osteoporotic vertebral body fracture: its relation to fracture level, type of fracture and grade of fracture deformation. Eur Spine J 2009; 18: 77-88
• 4 Ross PD. Clinical consequences of vertebral fractures. Am J Med 1997; 103: 30S-42S
• 5 Silverman SL. The clinical consequences of vertebral compression fracture. Bone 1992; 13: 27-31
• 6 Galibert P, Deramond H, Rosat P. et al. [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty]. Neurochirurgie 1987; 33: 166-168
• 7 Elgeti FA, Marnitz T, Kröncke TJ. et al. DFine radiofrequency kyphoplasty (RFK)-kyphoplasty with ultrahigh viscosity cement. Rofo 2010; 182: 803-805
• 8 Boonen S, Wahl DA, Nauroy L. et al. Balloon kyphoplasty and vertebroplasty in the management of vertebral compression fractures. Osteoporos Int 2011; 22: 2915-2934
• 9 Hallberg I, Rosenqvist AM, Kartous L. et al. Health-related quality of life after osteoporotic fractures. Osteoporos Int 2004; 15: 834-841
• 10 Hall SE, Criddle RA, Comito TL. et al. A case-control study of quality of life and functional impairment in women with long-standing vertebral osteoporotic fracture. Osteoporos Int 1999; 9: 508-515
• 11 Lyritis GP, Mayasis B, Tsakalakos N. et al. The natural history of the osteoporotic vertebral fracture. Clin Rheumatol 1989; 8: 66-69
• 12 Zhang H, Xu C, Zhang T. et al. Does percutaneous vertebroplasty or balloon kyphoplasty for osteoporotic vertebral compression fractures increase the incidence of new vertebral fractures? A meta-analysis. Pain Physician 2017; 20: E13-E28
• 13 Riesner HJ, Kiupel K, Lang P. et al. Clinical relevance of cement leakage after radiofrequency kyphoplasty vs. balloon kyphoplasty: a prospective randomised study. Z Orthop Unfall 2016; 154: 370-376
• 14 De Negri P, Tirri T, Paternoster G. et al. Treatment of painful osteoporotic or traumatic vertebral compression fractures by percutaneous vertebral augmentation procedures: a nonrandomized comparison between vertebroplasty and kyphoplasty. Clin J Pain 2007; 23: 425-430
• 15 Grohs JG, Matzner M, Trieb K. et al. Minimal invasive stabilization of osteoporotic vertebral fractures: a prospective nonrandomized comparison of vertebroplasty and balloon kyphoplasty. J Spinal Disord Tech 2005; 18: 238-242
• 16 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: 1391-1399
• 17 Liu JT, Liao WJ, Tan WC. et al. Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int 2010; 21: 359-364
• 18 Lovi A, Teli M, Ortolina A. et al. Vertebroplasty and kyphoplasty: complementary techniques for the treatment of painful osteoporotic vertebral compression fractures. A prospective non-randomised study on 154 patients. Eur Spine J 2009; 18: 95-101
• 19 Petersen A, Hartwig E, Koch EM. et al. Clinical comparison of postoperative results of balloon kyphoplasty (BKP) versus radiofrequency-targeted vertebral augmentation (RF-TVA): a prospective clinical study. Eur J Orthop Surg Traumatol 2016; 26: 67-75
• 20 Bornemann R, Jansen TR, Kabir K. et al. Comparison of radiofrequency-targeted vertebral augmentation with balloon kyphoplasty for the treatment of vertebral compression fractures: 2-year results. Clin Spine Surg 2017; 30: E247-E251
• 21 Pflugmacher R, Bornemann R, Koch EM. et al. [Comparison of clinical and radiological data in the treatment of patients with osteoporotic vertebral compression fractures using radiofrequency kyphoplasty or balloon kyphoplasty]. Z Orthop Unfall 2012; 150: 56-61
• 22 Kaul R, Chhabra HS, Vaccaro AR. et al. Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study. Eur Spine J 2016; 26: 1470-1476
• 23 Reinhold M, Audigé L, Schnake KJ. et al. AO spine injury classification system: a revision proposal for the thoracic and lumbar spine. Eur Spine J 2013; 22: 2184-2201
• 24 Schroeder GD, Vaccaro AR, Kepler CK. et al. Establishing the injury severity of thoracolumbar trauma: confirmation of the hierarchical structure of the AOSpine Thoracolumbar Spine Injury Classification System. Spine (Phila Pa 1976) 2015; 40: E498-503