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. 2022 Jul 29:9:962723.
doi: 10.3389/fsurg.2022.962723. eCollection 2022.

Kyphoplasty for thoracic and lumbar fractures with an intravertebral vacuum phenomenon in ankylosing spondylitis patients

Hao Liu  1 , Quan Zhou  1 , Junxin Zhang  1 , Lei Deng  1 , Xiayu Hu  1 , Wei He  1 , Tao Liu  1 , Huilin Yang  1
Affiliations

Kyphoplasty for thoracic and lumbar fractures with an intravertebral vacuum phenomenon in ankylosing spondylitis patients

Hao Liu et al. Front Surg. .

Abstract

Background: Intravertebral vacuum phenomenon (IVP) is a special sign after vertebral fractures, which is common in patients with ankylosing spondylitis (AS) and may indicate pseudarthrosis and bone nonunion that lead to spinal instability. The objective of this study is to evaluate the efficacy and safety of kyphoplasty (KP) in treating such types of vertebral fractures with AS.

Methods: Sixteen patients with AS suffering from thoracic or lumbar fractures with IVP received KP from 2015 to 2020 and were monitored for more than 1 year. The visual analog scale (VAS) score was used to evaluate back pain relief. The Oswestry Disability Index (ODI) questionnaire was used to assess the improvement of the patients' living quality. The anterior and middle vertebral height restoration ratio (AVH, MVH) and the kyphotic angle (KA) were used to evaluate the radiographic results.

Results: The mean follow-up period was 20.8 months (12-28 months). The VAS and ODI significantly reduced at 3 days, 3 months after surgery, and at the last follow-up compared with the preoperative outcomes (p < 0.05). The AVH and MVH were significantly increased compared with the preoperative outcomes (p < 0.05). There was a significant correction in the KA between pre- and postoperative assessments (p < 0.05). Asymptomatic intradiscal polymethylmethacrylate (PMMA) cement leakage was found in two patients.

Conclusions: For thoracic or lumbar fractures with IVP in AS patients, KP may be safe and effective, which achieves pain relief and satisfying functional improvement, restores the anterior and middle height, and corrects the kyphotic angle of the fractured vertebra.

Keywords: PMMA; ankylosing spondylitis; intravertebral vacuum phenomenon; kyphoplasty; vertebral fracture.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Intravertebral vacuum phenomenon (IVP) with vertebral fractures and ankylosing spondylitis. Lateral x-ray (A) and sagittal CT (B) showed low-intensity cleft throughout T12 and L1, characterized by well-defined hypointensity on T1 (C), hyperintensity on T2 (D), and hyperintensity on short time inversion recovery (E).
Figure 2
Figure 2
A 66-year-old male patient with T11 and T12 fractures (A,B). Coronal (C) and sagittal (D) CT showed intravertebral vacuum phenomenon (IVP). MRI showed well-defined hypointensity on T1 (E), hyperintensity on T2 (F), and hyperintensity on short time inversion recovery (G), verifying the diagnosis of IVP.
Figure 3
Figure 3
This patient received kyphoplasty. Three days later, anteroposterior (A) and lateral (B) x-ray showed the vertebral height and the Cobb's angle was restored. Traverse (C), coronal (D), and sagittal (E) CT showed intravertebral filling of the cavity without cement leakage.
Figure 4
Figure 4
Twelve months later, bone union was observed (A,B). Traverse CT (C) showed union within the vertebra. Coronal CT showed the formation of a bone bridge (D). Sagittal CT showed intraspinous fusion (E). These ossification phenomena suggested that KP contributed to spinal stability.
Figure 5
Figure 5
Asymptomatic intradiscal polymethylmethacrylate cement leakage was found in two patients by postoperative x-ray. The cement respectively leaked into the lower (A) and upper (B) discs of the fractured vertebrae.
See this image and copyright information in PMC

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