2022 Volume 13 Issue 8 Pages 1030-1036
Introduction: Osteoporotic vertebral body fractures with spinal canal stenosis are often associated with osteoporosis, spinal deformity, and intervertebral instability, and are often difficult to treat. We report the clinical results of using Balloon kyphoplasty (BKP) and microendoscopic laminotomy (MEL) for lumbar vertebral body fractures with spinal canal stenosis.
Methods: The subjects were 7 patients (2 males and 5 females, average 85 years old) who underwent surgical treatment at our department and related hospitals. Fracture sites are L1: 1 case, L3: 1 case, L4: 2 cases, L5: 3 cases, and decompression sites are L1/2: 1 case, L3/4 and L4/5: 3 cases, L4/5: 2 cases, L3 lumbar foraminal: 1 case. The average postoperative follow-up period was 13±6.0 months (6 to 21 months). The examination items were operation time, blood loss, Numerical rating scale (NRS) for back pain/leg pain (preoperative, postoperative, at final follow-up), and JOA score, changes in ADL before surgery and at final follow-up. As an X-ray evaluation, the anterior/posterior height of the fractured vertebral body, wedged angle of the vertebral body, and local kyphosis angle were measured before surgery, immediately after surgery, and at the final follow-up, and the presence or absence of bone union and perioperative complications were also evaluated.
Results: The average operation time was 144±61minutes and the average blood loss was 46±53 ml. NRS for back pain and leg pain were 8.7±2.2 and 6.7±2.0 before surgery, 2.3±0.8 and 3.4±1.5 immediately after surgery, and 1.1±1.1 and 1.3±1.7 at the final follow-up. Anterior height of fractured vertebral body, posterior height of that, vertebral body wedge angle, and local kyphosis angle were 15.8±5.4 mm, 26.0±2.3 mm, 14.1±8.2 ° and −1.7±21.2 ° before surgery, 22.5±3.3 mm, 26.8±3.0 mm, 6.7±5.7 °, and −5.6±22.9° after surgery, respectively. At the final follow-up, it was 20.6±3.1 mm, 27.3±1.9 mm, 9.2±5.8 °, and −2.3±20.1 °. All patients had bone union in average 6.7 months and there were no perioperative complications.
Conclusions: The combined surgery of BKP and MEL was minimally invasive and preserved the posterior tissue of lumbar spine, and no postoperative local kyphosis progress was observed. It may be considered as one of the treatment options especially for elderly patients with medical complications.
