Is Balloon kyphoplasty applicable to osteoporotic vertebral fractures related to diffuse idiopathic skeletal hyperostosis? — The International Society for the Study of the Lumbar Spine
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  3. Is Balloon kyphoplasty applicable to osteoporotic vertebral fractures related to diffuse idiopathic skeletal hyperostosis?

Is Balloon kyphoplasty applicable to osteoporotic vertebral fractures related to diffuse idiopathic skeletal hyperostosis? (#1139)

Shinji Takahashi 1 , Yusuke Hori 1 , Masatoshi Hoshino 2 , Hiroyuki Yasuda 3 , Hidetomi Terai 1 , Kazunori Hayashi 1 4 , Tadao Tsujio 5 , Hiroshi Kono 6 , Akinobu Suzuki 1 , Koji Tamai 1 , Shoichiro Ohyama 7 , Hiromitsu Toyoda 1 , Sho Dohzono 8 , Fumiaki Kanematsu 9 , Ryuichi Sasaoka 8 , Hiroaki Nakamura 1
  1. Orthopaedic Surgery, Osaka City University, Osaka, Japan
  2. Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
  3. Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
  4. Shimada Hospital, Habikino, Osaka, Japan
  5. Orthopaedic Surgery, Shiraniwa Hospital, Ikoma, Nara, Japan
  6. Ishikiriseiki Hospital, HIgashi-osaka, Osaka, Japan
  7. Nishinomiya Watanabe Hospital, Nishinomiya, Hyogo, Japan
  8. Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
  9. Saiseikai Nakatsu Hospital, Osaka, Japan

 

Introduction. 

Treatment of diffuse idiopathic skeletal hyperostosis (DISH)-related osteoporotic vertebral fractures (OVFs) is challenging due to the vertebral instability and weakness of cancellous bone. Therefore, spinal fixation with instrumentation has been deemed a common option for such fractures. However, elderly patients with multiple comorbidities may not be eligible for aggressive surgery. It remains unclear whether these fractures can apply to Balloon Kyphoplasty (BKP) without instrumentation, which has been seldom reported. The purpose of this study is to elucidate the effectiveness and limitations of BKP for OVFs related to DISH.

Methods.

Consecutive patients older than 65 with acute OVFs underwent BKP in ten different institutions between 2015 and 2017. Clinical and radiographic data were collected pre-and six months post-operatively. Patients with OVFs at the lower end or one caudal to the DISH were assigned to the DISH group, and the others were to the non-DISH group. Two groups were compared for the following outcomes and complications: activity of daily life (ADL), a visual analog scale (VAS) for back pain, the short form (SF)-36, reoperation, adjacent vertebral fracture (AVF), and cement dislodgement. Multivariate analysis was performed to investigate whether DISH is an independent risk factor for poor clinical outcomes and complications.

Results.

Of the 116 patients included, 14 patients were classified as the DISH group. Demographic data showed severer vertebral angular motion in the DISH group. There was no significant difference between the two groups in terms of ADL and SF-36. In addition, the reoperation rate (7%) and AVF rate (29%) of the DISH group were similar to those of the non-DISH group. The VAS of back pain improved in the non-DISH group (72.8 to 28.9), while the improvement in the DISH group (74.4  to 44.1) was significantly poor (p = 0.04). In addition, cement dislodgement at 6 months postoperatively was significantly more common in the DISH group (21%) than in the non-DISH group (4%) (p = 0.04). However, multivariate analysis showed that the significant risk factor for those was preoperative vertebral instability rather than the DISH itself.

Discussion.

Patients with DISH had similar improvement of ADL and SF-36, reoperation rate, and AVF rate at 6 months postoperatively compared to those without DISH. Although the DISH group achieved poor improvement in back pain and experienced more cement dislodgement, multivariate analysis identified preoperative vertebral instability, rather than DISH, as a significant risk factor for these poor outcomes. BKP can be applied to the OVF at or adjacent to the lower end of the DISH, though careful attention should be paid in cases with severe preoperative vertebral instability.

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