Spinal Surgery Review article Abstract Osteoporotic vertebral fracture OVF is a common condition in the elderly population. Vertebropl

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1 Spinal Surgery Review article Abstract Osteoporotic vertebral fracture OVF is a common condition in the elderly population. Vertebroplasty and kyphoplasty were introduced in the 1990s and since then, became standard procedures for the treatment of OVF. Balloon kyphoplasty BKP is a technique that involves percutaneous advancement of a trocar in the fractured vertebral body VB, followed by the insertion of a special balloon, which is subsequently inflated for restoring the height of the VB. The space created by the balloon is filled with polymethylmethacrylate to restore stability. BKP has been used for 5 years in Japan, and its outcome has been described in several reports. In this paper, we review previous studies and reports on the surgical results, efficacy, and limitations of BKP. Received November 27, accepted February 18, 2016 Key words osteoporotic vertebral fracture, balloon kyphoplasty, indication limitation osteoporotic vertebral fracture OVF 1, OVF OVF gastroesophageal reflux disease GERD activity of daily living ADL OVF OVF Department of Orthopaedic Surgery, Toyama University Address reprint requests to Yoshiharu Kawaguchi, M.D., Ph.D., Department of Orthopaedic Surgery, Toyama University, 2630 Sugitani, Toyama shi, Toyama , Japan 88 VOL. 30 NO

2 delayed union 3 6 pseudoarthrosis 6 MRI T OVF BKP Balloon kyphoplasty BKP polymethylmethacrylate PMMA 2011 BKP BKP BKP BKP BKP BKP 7,8 X balloon kyphoplasty CT BKP BKP 9 1 cm needle vertebroplasty VP kyphoplasty KPKP VP 2001 Garfin 10 new technologies VP VOL. 30 NO

3 Fig. 1 b a Table 1 An 80 year old woman with a complaint of low back pain that persisted for 3 months after a fall a Lateral radiograph of the lumbar spine. The vertebral height of L3 is decreased. b T2 weighted sagittal view of a magnetic resonance image showing delayed union of the L3 vertebral fracture. c Balloon kyphoplasty performed at L3, which relieved the pain after the surgery. c List of published reviews regarding vertebroplasty and/or kyphoplasty from 2001 to Author Year Garfin SR, et al Garfin SR, et al Hardouin P, et al Truumees E, et al Yuan HA, et al Ontario Hadjipavlou AG, et al Suresh SP, et al Talor RS, et al Hulme PA, et al Bouza C, et al Talor RS, et al Lewiecki EM Eck JC, et al Marcucci G, et al Ontario Boonen S, et al Han S, et al Wardlaw D, et al Ma XL, et al Itshayek E, et al Shi MM, et al Papanastassiou ID, et al Yimin Y, et al Chitale A, et al Lamy O, et al Hsieh MK, et al Bouza C, et al M Lopes JE Mung GSM, et al Journal J Joint Bone J J Disord Tech Ont Health Technol Assesser J Bone Jonit Surg Br J Br Menopause Soc Eur J Eur J Current Osteoporos Rep J Clin Cases Miner Bone Metab Ont Health Technol Assesser Osteporos Int Int Orthop Expert Rev. Med Devices Eur J J Clin Neurosci Clin Orthop Relat Res Eur J Med Sci Monit J Neurosurg Sci Osteporos Int Biomed J Eur J Orthop Tramatol Surg Res Indian J Orthop No. of cases KP を紹介する論文を掲載した 2009 年には N Engl J randomized study の結果が掲載され BKP と VP の有効 Med に骨粗鬆症性椎体骨折に対する VP の有効性を疑問 性と安全性が示された また 2013 年にも に同様 視する論文が 2 編掲載されたが 2009 年と 2010 年に の randomized trial が掲載されている16 その後も欧米 は Lancet 誌に13, 年には J Neurosurg 誌に15 BKP を中心に多くの review 論文が発刊されており 現在では と VP の randomized controlled trial および open label BKP の有効性は世界中で認められ 多くの OVF 患者に 90 11,12 脊髄外科 VOL. 30 NO 年 4 月

4 2005 BKP SF 36 general health 12 BKP 2011 BKP BKP VAS JOABPEQ 4 BKP 18 ADL BKP alignment BKP 4 X BKP Reference 18 Pain, expressed as visual analogue scale VAS score, decreased 1 day after surgery. This decrease was maintained at 1 month after surgery. Tseng BKP 18 BKP BKP case series BKP OVF OVF OVF BKP BKP BKP BKP PMMA VOL. 30 NO

5 calcium phosphate cement CPC OVF BKP BKP 文献 1 pp4 5 2 Lunt M, O Neill TW, Felsenberg D, et al Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture results from the European prospective osteoporosis study EPOS. Bone , Kado DM, Browner WS, Palermo L, et al Vertebral fractures and mortality in older womam a prospective study. Arch Intern Med , Trone DW, Krotz Silverstein D, von Muhlen DG, et al Is radiologic ver tebral fracture a risk factor for mor tality? Am J Epidemiol , Bouza C, López Cuadrado T, Cediel P, et al Balloon kyphoplasty in malignant spinal fractures a systematic review and meta analysis. BMC Palliat Care, doi X 8 12, Berenson J, Pflugmacher R, Jarzem P, et al Balloon kyphoplasty versus non surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer a multicentre, randomised controlled trial. Lancet Oncol , balloon kyphoplasty MB Orthop Garfin SR, Yuan HA, Reiley MA New technologies in spine kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures , Kallmes DF, Comstock BA, Heagerty PJ, et al A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med , Buchbinder R, Osborne RH, Ebeling PR, et al A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med , Klazen CA, Lohle PN, de Vries J, et al Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures Vertosan open label randomised trial. Lancet , Wardlaw D, Cummings SR, Van Meirhaeghe J, et al Efficacy and safety of balloon kyphoplasty compared with non surgical care for vertebral compression fracture FREEa randomised controlled trial. Lancet , Farrokhi MR, Alibai E, Maghami Z, et al Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression fractures. J Neurosurg , Van Meirhaeghe J, Bastian L, Boonen S, et al A randomized trial of balloon kyphoplasty and nonsurgical management for treating acute vertebral compression fractures vertebral body kyphosis correction and surgical parameters , Balloon KyphoplastyJ Res Balloon kyphoplasty Kanayama M, Oha F, Iwata A, et al Does balloon kyphoplasty improve the global spinal alignment in osteoporotic vertebral fracture? Int Orthop , 20 Yokoyama K, Kawanishi M, Yamada M, et al Postoperative change in sagittal balance after Kyphoplasty for the treatment of osteoporotic vertebral compression fracture. Eur J , Voggenreiter G Balloon kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fractures , Tseng YY, Su CH, Lui TN, et al Prospective comparison of the therapeutic effect of teriparatide with that of combined vertebroplasty with antiresorptive agents for the treatment of new onset adjacent vertebral compression fracture after percutaneous vertebroplasty. Osteoporos Int , 92 VOL. 30 NO

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