Prone position in balloon kyphoplasty leads to no secondary vertebral compression fractures in osteoporotic spine - a MRI study.
OBJECTIVE
Vertebral compression fractures are the most common fractures in the elderly. Long lasting pain and deformity is responsible for consecutive impairment with markedly reduced life quality, increased morbidity and mortality. The beneficial effects of balloon kyphoplasty are verified in many studies. Subsequent fracture risk is not finally clarified, cement related risks and deformity related risks are discussed. There is less knowledge about the risk of bone marrow edema and new fractures during balloon kyphoplasty procedure. The goal of this study is to examine, if prone position during kyphoplasty is an independent risk factor for new fractures in the osteoporotic spine.


METHODS
Consecutive MRI study of 20 patients with fresh, non-traumatic thoracolumbar vertebral compression fractures and balloon kyphoplasty treatment. MRI Scans of the thoracolumbar spine were obtained after surgery, before patients have been mobilized. Specific MRI changes like new bone marrow edema, signal intensity changes in adjacent and remote segments and new fractures were assessed by specialized neuro-radiologist.


RESULTS
20 MR images were examined within 48 hours after balloon kyphoplasty procedure. 85% did not show bone marrow edema extent changes after kyphoplasty. We found minor increase of bone marrow edema within the augmented vertebral body in 3 cases. We did not find any new bone marrow edema and no new fractures in adjacent and remote segments after balloon kyphoplasty treatment.


CONCLUSIONS
Prone position leads to no new bone marrow edema and no new fractures in the osteoporotic spine. Accordingly, prone position has no risk for adjacent level fractures in osteoporotic spines.
Klinik für Unfallchirurgie, Orthopädie und spezialisierte septische Chirurgie, Klinikum St. Georg Leipzig, Germany.
Matthias
M
Spalteholz
Klinik für Unfallchirurgie, Orthopädie und spezialisierte septische Chirurgie, Klinikum St. Georg Leipzig, Germany.
Evald
E
Strasser
Klinik für Diagnostische und Interventionelle Radiologie, FB Neuroradiologie, Klinikum St. Georg Leipzig, Germany.
Torsten
T
Hantel
Klinik für Unfallchirurgie, Orthopädie und spezialisierte septische Chirurgie, Klinikum St. Georg Leipzig, Germany.
Ralf Herbert
RH
Gahr
adjacent level fractures; balloon kyphoplasty; osteoporotic vertebral compression fractures; prone positioning; subsequent vertebral compression fractures