Characteristics of osteonecrosis in osteoporotic vertebral fractures and the efficacy of balloon kyphoplasty treatment

Abstract

Osteonecrosis in osteoporotic vertebral fractures (OVFs) may lead to a continued source of chronic pain and disability for patients. This study aims to describe the characteristics of the osteonecrosis in OVFs and the efficacy of balloon kyphoplasty (BKP) for the osteonecrosis. This was a prospective study of 61 patients with the osteonecrosis in OVFs who underwent BKP. Their mean age was 68 years (55 to 90). All the patients received radiography, MRI and CT examination before BKP, and were performed a histological analysis of biopsies obtained from OVFs. Efficacy was assessed by changes in anterior vertebral body height, a visual analogue pain scale and the Oswestry Disability Index at one day preoperative, two days postoperative and final follow-up assessments. All the patients had back pain more than six weeks before surgery. The back pain had a certain feature that was distinctly proportional to activity and position. 54% of the osteonecrosis showed intervertebral clefts in radiography, 73% of the osteonecrosis showed intervertebral clefts in CT. 98% of the osteonecrosis showed a well-defined signal intensity in the location of the osteonecrosis on T2-weighted and short tau inversion recovery (STIR) in MRI. Histological examination revealed osteonecrosis in the 61 patients. Significant improvements in all efficacy measures were observed at the postoperative versus preoperative assessments; no significant differences were observed between the postoperative and final follow-up assessments. The osteonecrosis in OVFs can be diagnosed according to the pattern of back pain and the imaging characteristics, especially MRI. BKP is one of minimally invasive, safe and effective procedures for the disease.

Keywords: osteonecrosis, osteoporotic vertebral fractures, diagnosis, kyphoplast