Balloon Kyphoplasty for osteoporotic thoracolumbar vertebral fracture with diffuse idiopathic skeletal hyperostosis

<p>Introduction: Since thoracolumbar vertebral fracture with diffuse idiopathic skeletal hyperostosis (DISH) is common in the elderly, it may occur with low-energy trauma based on osteoporosis. Conservative treatment such as bed rest and brace may cause nonunion and delayed paralysis due to the long lever arms of the fractured segments that make the fracture extremely unstable, long fusion surgery using instrumentation is often performed. On the other hand, Balloon kyphoplasty (BKP) is indicated for primary osteoporotic vertebral fracture that cannot be treated with conservative treatment. The purpose of this study was to investigate the effectiveness of treatment with BKP for the osteoporotic thoracolumbar vertebral fracture with DISH. </p><p>Methods: 16 patients (7 males and 9 females, average 84.1 years old, range 71-94) with thoracolumbar fracture with DISH were treated with BKP. The periods from injury to first visit were average 20.1±26.7 days (range 0-80). Follow-up periods was 17±9.5months (range 3-36). The numbers of DISH affected vertebral body were average 9.0 (5-17). Outcome measurements were Numerical Rating Scale (NRS) for back pain, and use period of teriparatide and brace. Radiographic measurements were fracture type, existence of bone union, existence of postoperative subsequent fracture, local kyphosis angle and wedged angle of the vertebral body. </p><p>Results: All patients had bone union at average 6.4 months after BKP. All patients were wearing hard braces for average 4.1months with using teriparatide for average 8.6 months after BKP. Fracture types were wedged compression type (14 patients) and insufficient fracture (2 patients), there was no dislocation, the posterior ligament injury and facet joint injury in all patients. NRS was 8.6±1.2 before BKP, 0.8±1.1 after BKP and 1.7±2.1 at final follow-up. Local kyphosis angle was 20.1±9.1° before BKP, 10.2±5.4° after BKP and 18.1±9.6°at final follow-up. Wedged angle of the vertebral body was 15.5±5.3° before BKP, 6.4±4.6° after BKP and 10.9±4.2°at final follow-up. Postoperative subsequent fractures occurred in 4 patients, but they were healed with conservative treatment. </p><p>Conclusions: 1. BKP for thoracolumbar vertebral fracture with DISH is indicated to fracture of the anterior column without dislocation, the posterior ligaments injury and facet joints injury. 2. BKP for thoracolumbar vertebral fracture with DISH is minimum invasive surgery and more effective method by adding teriparatide and rigid hard brace. </p>