Purpose

To clarify the relationship between operative timing and the early post-operative radiological and clinical outcome after kyphoplasty.

Methods

We conducted a retrospective cohort study including patients who underwent kyphoplasty of a single vertebra. Patients were divided into three groups (acute [< 2 weeks], subacute [2–6 weeks] or chronic [6–51 weeks]) based on the interval between fracture and surgery. The relative vertebral body height (VBH) and local kyphotic angle (LKA) of the fractured vertebra (measured on plain radiographs) as well as pain and use of analgesics were compared pre- and post-operatively (day 2) and between the groups.

Results

A total of 230 patients (100 with acute, 91 with subacute and 39 with chronic fractures) with fractures from T4 to L5 were included. In all groups, there was a significant post-operative improvement in the anterior (8.9–12.9%) and middle (10.7–13.4%) VBH (all groups: p < 0.001), LKA (acute: 3.8°, p < 0.001; subacute: 4.3°, p < 0.001; chronic: 1.7°, p = 0.046) and pain. The use of analgesics significantly decreased post-operatively in the acute and subacute groups, but did not significantly change in the chronic group. Patients from acute (p = 0.042) and subacute (p = 0.027) groups showed significantly better post-operative correction of the LKA than the chronic group.

Conclusion

Kyphoplasty is effective for vertebral height restoration as well as pain relief for both acute, subacute and chronic fractures. However, the achievable correction of the fracture-related local kyphosis decreases significantly after 6 weeks. Therefore, we recommend making a final decision about conservative vs. operative treatment within 6 weeks to ensure better height restoration in surgically treated patients.

中文翻译：

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手术时机对后凸成形术后早期放射学和临床结局的影响。

目的

为了明确后凸手术后手术时机与术后早期影像学和临床结局之间的关系。

方法

我们进行了一项回顾性队列研究，包括接受单个椎骨后凸成形术的患者。根据骨折和手术之间的间隔，将患者分为三组（急性[<2周]，亚急性[2-6周]或慢性[6-51周]）。比较两组患者术前和术后（第2天）的相对椎体高度（VBH）和局部椎体后凸角（LKA）（在X线平片上测量）以及疼痛和使用止痛药的情况。

结果

总共包括230例T4至L5骨折的患者（100例急性，91例亚急性和39例慢性骨折）。在所有组中，前VBH（所有组：p  <0.001），LKA（急性：3.8°，p  <0.001；前者（8.9-12.9％）和中部（10.7-13.4％）都有明显的术后改善。亚急性：4.3°，p  <0.001;慢性：1.7°，p  = 0.046）和疼痛。急性和亚急性组术后镇痛药的使用明显减少，而慢性组没有明显改变。急性（p  = 0.042）和亚急性（p  = 0.027）组的患者术后LKA的矫正效果明显好于慢性组。

结论

后凸成形术可有效恢复椎体高度，并能缓解急性，亚急性和慢性骨折的疼痛。但是，与骨折相关的局部后凸畸形的可实现矫正在6周后显着降低。因此，我们建议在6周内就保守治疗与手术治疗做出最终决定，以确保手术治疗患者的身高得到更好的恢复。