Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 8, pp 1083–1091 | Cite as

Prospective quantitative assessment of spinal range of motion before and after minimally invasive surgical treatment of vertebral body fractures

  • C. Druschel
  • K.-D. Schaser
  • A. Rohlmann
  • T. Pirvu
  • A. C. DischEmail author
Orthopaedic Surgery

Abstract

Introduction

Randomized clinical trials have generated doubts regarding the therapeutic effectiveness of spinal kyphoplasty to reduce pain and improve quality of life in patients with vertebral fractures. There is a paucity of data on the influence of kyphoplasty on spinal range of motion. To quantify early postoperative changes following kyphoplasty in spinal motion, a noninvasive, radiation-free measurement method was used and results related to clinical and radiological parameters.

Methods

The study group included 30 patients with an overall number of 54 symptomatic pathological vertebral compression fractures. All patients were treated with balloon kyphoplasty. Clinical results were recorded using the visual analog scale, SF 36, Roland Morris Score and the Oswestry Disability Index, at three time points; preoperative, 2 days postoperative, and at 12 weeks postoperative. The kyphosis angle/sagittal index were determined with biplanar X-rays. Amplitude/velocity of motion in extension/flexion was measured at each time point by use of the EpionicsSPINE© system (Epionics Medical GmbH; Potsdam, Germany) using two external sensor strips.

Results

Preoperative magnetic resonance imaging scans showed bone marrow edema in all vertebral bodies indicative of a recent, non-consolidated fracture. Pain and quality of life was significantly improved by kyphoplasty, both for the immediate postoperative period, as well as at 12 weeks postoperative. Radiological parameters also showed significant improvement following surgery. Total ROM did not significantly change 2 days after kyphoplasty, but amplitude and velocity were found to be increased 12 weeks postoperatively. Significant positive correlations were observed between increased range of motion and improved clinical/radiological scores.

Conclusion

Significant clinical and radiological improvement following kyphoplasty supports the rational for cement augmentation in patients with pathological vertebral body fractures. To the knowledge of the authors, no prior study has assessed the influence of preservation and improvement of spinal range of motion on clinical outcome following kyphoplasty.

Keywords

Vertebral body fracture Pathologic fracture Spinal range of motion Outcome measurement Range of motion measurement 

Notes

Acknowledgments

No funding has been received for research on which this article is based.

Conflict of interest

None.

References

  1. 1.
    Wang HK, Lu K, Liang CL, Weng HC, Wang KW et al (2010) Comparing clinical outcomes following percutaneous vertebroplasty with conservative therapy for acute osteoporotic vertebral compression fractures. Pain Med 11:1659–1665CrossRefPubMedGoogle Scholar
  2. 2.
    Dennison E, Cooper C (2000) Epidemiology of osteoporotic fractures. Horm Res 54(Suppl 1):58–63CrossRefPubMedGoogle Scholar
  3. 3.
    Tamayo-Orozco J, Arzac-Palumbo P, Peon-Vidales H, Mota-Bolfeta R, Fuentes F (1997) Vertebral fractures associated with osteoporosis: patient management. Am J Med 103:44S–48S (discussion 8S–50S)CrossRefPubMedGoogle Scholar
  4. 4.
    Alvarez L, Alcaraz M, Perez-Higueras A, Granizo JJ, de Miguel I et al (2006) Percutaneous vertebroplasty: functional improvement in patients with osteoporotic compression fractures. Spine 31:1113–1118CrossRefPubMedGoogle Scholar
  5. 5.
    Fourney DR, Schomer DF, Nader R, Chlan-Fourney J, Suki D et al (2003) Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg 98:21–30CrossRefPubMedGoogle Scholar
  6. 6.
    Garfin SR, Buckley RA, Ledlie J, Balloon KOG (2006) Balloon kyphoplasty for symptomatic vertebral body compression fractures results in rapid, significant, and sustained improvements in back pain, function, and quality of life for elderly patients. Spine 31:2213–2220CrossRefPubMedGoogle Scholar
  7. 7.
    Heini PF (2005) The current treatment–a survey of osteoporotic fracture treatment. Osteoporotic spine fractures: the spine surgeon’s perspective. Osteoporos Int: J Establ Result Cooper Eur Found Osteoporos Natl Osteoporos Found USA 16 Suppl 2:S85–S92CrossRefGoogle Scholar
  8. 8.
    Klazen CA, Venmans A, de Vries J, van Rooij WJ, Jansen FH et al (2010) Percutaneous vertebroplasty is not a risk factor for new osteoporotic compression fractures: results from VERTOS II. AJNR Am J Neuroradiol 31:1447–1450CrossRefPubMedGoogle Scholar
  9. 9.
    Voormolen MH, Mali WP, Lohle PN, Fransen H, Lampmann LE et al (2007) Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol 28:555–560PubMedGoogle Scholar
  10. 10.
    Diamond TH, Champion B, Clark WA (2003) Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 114:257–265CrossRefPubMedGoogle Scholar
  11. 11.
    Ledlie JT, Renfro MB (2006) Kyphoplasty treatment of vertebral fractures: 2-year outcomes show sustained benefits. Spine 31:57–64CrossRefPubMedGoogle Scholar
  12. 12.
    Lieberman IH, Dudeney S, Reinhardt MK, Bell G (2001) Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine 26:1631–1638CrossRefPubMedGoogle Scholar
  13. 13.
    Zampini JM, White AP, McGuire KJ (2010) Comparison of 5766 vertebral compression fractures treated with or without kyphoplasty. Clin Orthop Relat Res 468:1773–1780CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Kasperk C, Hillmeier J, Noldge G, Grafe IA, Dafonseca K et al (2005) Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study. J Bone Miner Res: Off J Am Soc Bone Miner Res 20:604–612CrossRefGoogle Scholar
  15. 15.
    Edidin AA, Ong KL, Lau E, Kurtz SM (2011) Mortality risk for operated and nonoperated vertebral fracture patients in the medicare population. J Bone Miner Res: Off J Am Soc Bone Miner Res 26:1617–1626CrossRefGoogle Scholar
  16. 16.
    Julka A, Tolhurst SR, Srinivasan RC, Graziano GP (2012) Functional outcomes and height restoration for patients with multiple myeloma-related osteolytic vertebral compression fractures treated with kyphoplasty. J Spinal Disord Tech [Epub ahead of print]Google Scholar
  17. 17.
    Taylor WR, Consmuller T, Rohlmann A (2010) A novel system for the dynamic assessment of back shape. Med Eng Phys 32:1080–1083CrossRefPubMedGoogle Scholar
  18. 18.
    Consmuller T, Rohlmann A, Weinland D, Druschel C, Duda GN, Taylor WR (2012) Velocity of lordosis angle during spinal flexion and extension. PLoS One 7:e50135CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Consmuller T, Rohlmann A, Weinland D, Druschel C, Duda GN, Taylor WR (2012) Comparative evaluation of a novel measurement tool to assess lumbar spine posture and range of motion. Eur Spine J: Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Sect Cerv Spine Res Soc 21:2170–2180CrossRefGoogle Scholar
  20. 20.
    Colon-Emeric CS, Saag KG (2006) Osteoporotic fractures in older adults. Best practice and research. Clin Rheumatol 20:695–706Google Scholar
  21. 21.
    Li X, Yang H, Tang T, Qian Z, Chen L, Zhang Z (2012) Comparison of kyphoplasty and vertebroplasty for treatment of painful osteoporotic vertebral compression fractures: twelve-month follow-up in a prospective nonrandomized comparative study. J Spinal Disord Tech 25:142–149CrossRefPubMedGoogle Scholar
  22. 22.
    Voggenreiter G, Brocker K, Rohrl B, Sadick M, Obertacke U (2008) Results of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures. Der Unfallchirurg 111:403–412CrossRefPubMedGoogle Scholar
  23. 23.
    Ledlie JT, Renfro M (2003) Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg 98:36–42PubMedGoogle Scholar
  24. 24.
    Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P et al (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361:557–568CrossRefPubMedGoogle Scholar
  25. 25.
    Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ et al (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361:569–579CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Taylor RS, Fritzell P, Taylor RJ (2007) Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J: Off Publ Eur Spine Soc, Eur Spinal Deformity Soc, Eur Sect Cerv Spine Res Soc 16:1085–1100CrossRefGoogle Scholar
  27. 27.
    Rohlmann A, Zander T, Bergmann G (2006) Spinal loads after osteoporotic vertebral fractures treated by vertebroplasty or kyphoplasty. Eur Spine J: Off Publ Eur Spine Soc, Eur Spinal Deformity Soc, Eur Sect Cerv Spine Res Soc 15:1255–1264CrossRefGoogle Scholar
  28. 28.
    Kumar K, Nguyen R, Bishop S (2010) A comparative analysis of the results of vertebroplasty and kyphoplasty in osteoporotic vertebral compression fractures. Neurosurgery 67:ons171–ons188 (discussion ons88)CrossRefPubMedGoogle Scholar
  29. 29.
    Liu JT, Liao WJ, Tan WC, Lee JK, Liu CH et al (2010) Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int: J Establ Result Cooper Eur Found Osteoporos Natl Osteoporos Found USA 21:359–364CrossRefGoogle Scholar
  30. 30.
    Pradhan BB, Bae HW, Kropf MA, Patel VV, Delamarter RB (2006) Kyphoplasty reduction of osteoporotic vertebral compression fractures: correction of local kyphosis versus overall sagittal alignment. Spine 31:435–441CrossRefPubMedGoogle Scholar
  31. 31.
    Stoffel M, Wolf I, Ringel F, Stuer C, Urbach H, Meyer B (2007) Treatment of painful osteoporotic compression and burst fractures using kyphoplasty: a prospective observational design. J Neurosurg Spine 6:313–319CrossRefPubMedGoogle Scholar
  32. 32.
    Holt CA, Evans SL, Dillon D, Ahuja S (2005) Three-dimensional measurement of intervertebral kinematics in vitro using optical motion analysis. Proc Inst Mech Eng Part H J Eng Med 219:393–399CrossRefGoogle Scholar
  33. 33.
    Lee BW, Lee JE, Lee SH, Kwon HK (2011) Kinematic analysis of the lumbar spine by digital videofluoroscopy in 18 asymptomatic subjects and 9 patients with herniated nucleus pulposus. J Manip Physiol Ther 34:221–230CrossRefGoogle Scholar
  34. 34.
    Schulze M, Trautwein F, Vordemvenne T, Raschke M, Heuer F (2011) A method to perform spinal motion analysis from functional X-ray images. J Biomech 44:1740–1746CrossRefPubMedGoogle Scholar
  35. 35.
    Williams JM, Haq I, Lee RY (2010) Dynamic measurement of lumbar curvature using fibre-optic sensors. Med Eng Phys 32:1043–1049CrossRefPubMedGoogle Scholar
  36. 36.
    Dlugosz MM, Panek D, Maciejasz P, Chwala W, Alda W (2012) An improved kinematic model of the spine for three-dimensional motion analysis in the Vicon system. Stud Health Technol Inf 176:227–231Google Scholar
  37. 37.
    Phillips FM, Ho E, Campbell-Hupp M, McNally T, Todd Wetzel F, Gupta P (2003) Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine 28:2260–2265 (discussion 5–7)CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • C. Druschel
    • 1
  • K.-D. Schaser
    • 1
  • A. Rohlmann
    • 2
  • T. Pirvu
    • 1
  • A. C. Disch
    • 1
    Email author
  1. 1.Center for Musculoskeletal Surgery, Spine UnitCharité - University Medicine BerlinBerlinGermany
  2. 2.Julius Wolff InstituteCharité - University Medicine BerlinBerlinGermany

Personalised recommendations