Meng-Ling Lu

Percutaneous balloon kyphoplasty for the treatment of vertebral compression fractures

BackgroundVertebral compression fractures (VCFs) constitute a major health care problem, not only because of their high incidence but also because of their direct and indirect negative impacts on both patients’ health-related quality of life and costs to the health care system. Two minimally invasive surgical approaches were developed for the management of symptomatic VCFs: balloon kyphoplasty and vertebroplasty. The purpose of this study was to evaluate the effectiveness and safety of balloon kyphoplasty in the treatment of symptomatic VCFs.MethodsBetween July 2011 and June 2012, one hundred and eighty-seven patients with two hundred and fifty-one vertebras received balloon kyphoplasty in our hospital. There were sixty-five male and one hundred and twenty-two female patients with an average age of 74.5 (range, 61 to 95 years). The pain symptoms and quality of life, were measured before operation and at one day, three months, six months and one year following kyphoplasty. Radiographic data including restoration of kyphotic angle, anterior vertebral height, and any leakage of cement were defined.ResultsThe mean visual analog pain scale decreased from a preoperative value of 7.7 to 2.2 at one day (p < .05) following operation and the Oswestry Disability Index improved from 56.8 to 18.3 (p < .05). The kyphotic angle improved from a mean of 14.4° before surgery to 6.7° at one day after surgery (p < .05). The mean anterior vertebral height increased significantly from 52% before surgery to 74.5% at one day after surgery (p < .05) and 70.2% at one year follow-up. Minor cement extravasations were observed in twenty-nine out of two hundred and fifty-one procedures, including six leakage via basivertebral vein, three leakage via segmental vein and twenty leakage through a cortical defect. None of the leakages were associated with any clinical consequences.ConclusionsBalloon kyphoplasty not only rapidly reduced pain and disability but also restored sagittal alignment in our patients at one-year follow-up. The treatment of osteoporotic vertebral compression fractures with balloon kyphoplasty is a safe, effective, and minimally invasive procedure that provides satisfactory clinical results.

Costotransversectomy Approach for Treatment of Thoracic Spine Infection

Introduction: Traditionally, surgery for infective spondylodiscitis involving the anterior and posterior columns is staged or sequential and is performed during the same anesthesia session. It is well suited for direct debridement, reconstruction of the anterior column, correcting the kyphotic deformity, and posterior decompression of the spinal cord. The spine, however, may be unstable between stages. Sequentially staged operations require a long overall operating time and chest tube placement because of thoracotomy for the thoracic spine, thereby increasing the risk of complications. Purposes: To evaluate the clinical outcome and infection control of spondylodiscitis after debridement of the thoracic spine by the modified costotransversectomy Methods: Between November 2009 and October 2012, a total of 11 patients (7 male, 4 female) with pyogenic and mycobacterial thoracic spondylodiscitis underwent one-stage modified costotransversectomy for disc and endplate debridement, disc space reconstruction, and posterior instrumentation. Results: Each patient displayed clinical and laboratory improvement after the surgical intervention. The average preoperative C-reactive protein (CRP) level and peripheral white blood cell count (WBC) were compared with the levels 7 days postoperatively: CRP (166.2 ± 31.4 vs. 77.5 ± 13.9; p = 0.002) and WBC (13.7 ± 1.1 vs. 10.7 ± 0.5; p = 0.009). Clinical functional results measured by the Oswestry Disability Index preoperatively and at discharge were 69% and 53%, respectively, indicating more than 10% improvement (p ＜ 0.001). The average kyphosis angle postoperatively was 14.7° ± 2.1° vs. 23.1° ± 2.6° preoperatively (p ＜ 0.001). Conclusions: The modified costotransversectomy approach for treating thoracic spine infection is a safe, effect alternative treatment with fewer complications than with traditional surgery and encouraging clinical outcomes.