Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Low lumbar osteoporotic vertebral collapse (OVC) has not been well documented compared with OVC of the thoracolumbar spine. The differences between low lumbar and thoracolumbar lesions should be studied to provide better treatment. The aim of this study was to clarify the clinical and imaging features as well as outcomes of low lumbar OVC and to discuss the appropriate surgical treatment.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Thirty patients (10 men; 20 women; mean age 79.3 ± 4.7 years [range 70–88 years]) with low lumbar OVC affecting levels below L-3 underwent surgical treatment. The clinical symptoms, morphological features of affected vertebra, sagittal spinopelvic alignment, neurological status before and after surgery, and surgical procedures were reviewed at a mean follow-up period of 2.4 years.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The main clinical symptom was radicular leg pain. Most patients had old compression fractures at the thoracolumbar level. The affected vertebra was flat-type and concave or H-shaped type, not wedge type as often found in thoracolumbar OVC. There were mismatches between pelvic incidence and lumbar lordosis on plain radiographs. On CT and MR images, foraminal stenosis was seen in 18 patients (60%) and canal stenosis in 24 patients (80%). Decompression with short fusion using a posterior approach was performed. Augmentations of vertebroplasty, posterolateral fusion, and posterior lumbar interbody fusion were performed based on the presence/absence of local kyphosis of lumbar spine, cleft formation, and/or intervertebral instability. Although the neurological and visual analog scale scores improved postoperatively, 8 patients (26.7%) developed postoperative complications mainly related to instrumentation failure. In patients with postoperative complications, lumbar spine bone mineral density was significantly low, but the spinopelvic alignment showed no correlation when compared with those without complications.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The main types of low lumbar OVC were flat-type and concave type, which resulted in neurological symptoms by retropulsed bony fragments generating foraminal stenosis and/or canal stenosis. For patients with low lumbar OVC, decompression of the foraminal and canal stenosis with short fusion surgery via posterior approach can improve neurological symptoms. Since these patients are elderly with poor bone quality and other complications, treatments for both OVC and osteoporosis should be provided to achieve good clinical outcome.</jats:p></jats:sec>

Surgical Treatment of Osteoporotic Vertebral Fracture Associated with Diffuse Idiopathic Skeletal Hyperostosis along with Comparative Assessment of the Levels of Affected Vertebra or Anterior Column Reconstruction

“…Research on spinopelvic parameters has advanced, and it is now possible to evaluate the ideal lumbar lordosis. Meanwhile, according to Nakajima et al, mismatch of parameters did not necessarily increase the rate of complications postoperatively with surgeries involving the ML lesion 10) . In addition, cases exist in which obtaining full-length radiography of the spinal column prior to surgery proved impracticable and avoiding highly invasive surgical procedures is deemed necessary.…”

“…Yeoh et al reported observing fewer complications as a result of percutaneous spinal fusion surgery in the course of treatment to address vertebral fractures associated with ankylosing spondylitis 19) . In addition, Nakajima et al described the importance of osteoporosis treatment as an approach to prevent implant-related postoperative complications arising after OVF surgery 10) . Among our cases, 54% had perioperative complications and 23% had instances of revision surgery that are considered to be frequent; the causes are presumed to be the presence of comorbidities and osteoporosis, age of around 80 years, and the impact of invasive surgery.…”

“…The average number of DISH vertebrae was 7.8 (range [4][5][6][7][8][9][10][11][12][13][14], and spatial relationships between the DISH sites and OVFs were 16 cases at the bottom end, five inside the ossified site, and five at the distal bottom end. Prior vertebral fractures were observed in 12 cases, and three-column injuries were observed in 15 cases.…”

Differences in clinical and imaging features of low lumbar osteoporotic vertebral collapse in patients with or without Parkinson’s disease: Rapid destructive progression and appearance of a cauda equina sign in Parkinson’s disease patients

“…In a multicenter cohort of 403 patients in Japan who underwent fusion surgery for OVC with neurological de cits, a thoracolumbar junction lesion at T12 and L1 was most frequent, but 18.9% of cases had low lumbar OVC below L3 [1]. Clinical and imaging features in low lumbar OVC may differ from those in thoracolumbar OVC, based on our previous ndings [2].…”

“…Each OVC was classi ed as one of four types based on its appearance on a lateral projection in a neutral position (Fig. 1) [2]: type 1 is a wedge-type collapse de ned as a ratio of the anterior to posterior height of the vertebral body of <60%; type 2 is a at or vertebra plana-like fracture with uniform compression; type 3 is a concave or H-shaped fracture with anterior spur formation or sclerotic change; and type 4 is a burst fracture with severe destruction of the anterior vertebral body. Type 2 collapse often appears as intervertebral cleft formation on radiographs or MRI.…”