The Surgical Outcomes of Spinal Fusion for Osteoporotic Vertebral Fractures in the Lower Lumbar Spine with a Neurological Deficit

Isogai, Norihiro; Hosogane, Naobumi; Funao, Haruki; Nojiri, Kenya; Suzuki, Satoshi; Okada, Eijiro; Ueda, Seiji; Hikata, Tomohiro; Shiono, Yuta; Watanabe, Kota; Watanabe, Kei; Kaito, Takashi; Yamashita, Tomoya; Fujiwara, Hiroyasu; Nagamoto, Yukitaka; Terai, Hidetomi; Tamai, Katsuto; Matsuoka, Yuji; Suzuki, Hidekazu; Nishimura, Hirosuke; Tagami, Atsushi; Yamada, Shuta; Adachi, Satoshi; Ohtori, Seiji; Orita, Sumihisa; Furuya, Takeo; Yoshii, Toshitaka; Ushio, Shuta; Inoue, Gen; Miyagi, Masayuki; Saito, Wataru; Imagama, Shiro; Ando, Kei; Sakai, Daisuke; Nukaga, Tadashi; Kiyasu, Katsuhito; Kimura, Atsushi; Inoue, Hirokazu; Nakano, Atsushi; Harimaya, Katsumi; Kawaguchi, Kohei; Yokoyama, Nobuhiko; Oishi, Hidekazu; Doi, Toshiro; Ikegami, Shota; Shimizu, Masayuki; Futatsugi, Toshimasa; Kakutani, Kenichiro; Yurube, Takashi; Oshima, Masashi; Uei, Hiroshi; Aoki, Yasuchika; Takahata, Masahiko; Iwata, Atsushi; Seki, Shoji; Murakami, Hideki; Yoshioka, Katsuhito; Endo, Hirooki; Hongo, Michio; Nakanishi, Kazuyoshi; Abe, Tetsuya; Tsukanishi, Toshinori; Ishii, Ken

doi:10.22603/ssrr.2019-0079

Cited by 9 publications

(15 citation statements)

References 29 publications

(40 reference statements)

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“…Neurological compromise following LVF is relatively rare. According to a recent multicenter cohort study, 6 ) number of the thoracolumbar junction fractures causing neurological deficits was five times that of lower lumbar fractures causing radiculopathy. Thoracolumbar junction fractures commonly cause anterior-wedge vertebral deformity, while LVF commonly develops a concave deformity.…”

Section: Discussionmentioning

confidence: 99%

“…Although radiculopathy usually lacks severe neurological deficits, it is often resistant to conservative therapies and so severe that it negatively impacts patient's daily activities. 1 - 6 )…”

Section: Discussionmentioning

confidence: 99%

“…Back pain is the most common symptom of LVF and is usually managed with conservative treatments, such analgesics and spinal orthosis. Although relatively rare, LVF occasionally causes radiculopathy due to lateral recess stenosis (LRS) or foraminal stenosis (FS) secondary to vertebral deformity, 1 - 6 ) and patients often suffer from radicular pain even after fracture healing. This is attributed to the instability or loss of intervertebral height at the affected spinal segments, including the fractured vertebrae.…”

Section: Introductionmentioning

confidence: 99%

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Lateral Lumbar Interbody Fusion Using Bone Graft Substitute for Lumbar Vertebral Fracture Associated Radiculopathy

Sasaki

Fukunaga

Ninomiya

et al. 2022

Neurol. Med. Chir.(Tokyo)

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This study aims to present our surgical technique of lateral lumbar interbody fusion (LLIF) without corpectomy for lumbar vertebral fracture (LVF) associated radiculopathy. This study includes three patients treated with LLIF (mean age of 77.3 years, Group L) and three patients treated with PLIF (mean age of 75.7 years, Group P) to compare the surgical outcomes. The cartilage on the fractured vertebrae was aggressively resected with attention to avoid injury to the ring apophysis. The central cavity of the fractured endplate was filled with a bone graft substitute made of hydroxyapatite and collagen composite, followed by interbody fusion achieved by utilizing of a cage with sufficient length spanning the bilateral edges of the fractured vertebra. PLIF was performed with a standard technique using two interbody cages, and vertebroplasty was combined in one patient. Comparing to PLIF, LLIF could be performed with less estimated blood loss in shorter surgical time. Local kyphotic angle improved in all cases of Group L immediately after the surgery, but correction loss was observed at the final examination. The lordotic angle was lost in Group P postoperatively. Arthrodesis was achieved in all the cases. The mean VAS score for leg pain was 85.3 mm in Group L and 82.0 mm in Group P at preoperation and decreased to 8.7 mm and 11.3 mm, respectively, at postoperation. LLIF is an effective surgical option that enables stabilization of the fractured vertebra and reduces radicular pain by indirect neural decompression.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lateral Lumbar Interbody Fusion Using Bone Graft Substitute for Lumbar Vertebral Fracture Associated Radiculopathy

Sasaki

Fukunaga

Ninomiya

et al. 2022

Neurol. Med. Chir.(Tokyo)

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“…Further, sarcopenia is implicated in causing spinal sagittal imbalance due to insufficient compensation [35]. An OVF often necessitates fusion surgery [36]. Meta-analysis revealed that implant failure is considerably higher in osteoporotic spines than with normal bone mineral density [37].…”

Section: Introductionmentioning

confidence: 99%

Impact of Sarcopenia and Bone Mineral Density on Implant Failure after Dorsal Instrumentation in Patients with Osteoporotic Vertebral Fractures

et al. 2022

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Background and Objectives: Age-related loss of bone and muscle mass are signs of frailty and are associated with an increased risk of falls and consecutive vertebral fractures. Management often necessitates fusion surgery. We determined the impacts of sarcopenia and bone density on implant failures (IFs) and complications in patients with spondylodesis due to osteoporotic vertebral fractures (OVFs). Materials and Methods: Patients diagnosed with an OVF according to the osteoporotic fracture classification (OF) undergoing spinal instrumentation surgery between 2011 and 2020 were included in our study. The skeletal muscle area (SMA) was measured at the third lumbar vertebra (L3) level using axial CT images. SMA z-scores were calculated for the optimal height and body mass index (BMI) adjustment (zSMAHT). The loss of muscle function was assessed via measurement of myosteatosis (skeletal muscle radiodensity, SMD) using axial CT scans. The bone mineral density (BMD) was determined at L3 in Hounsfield units (HU). Results: A total of 68 patients with OVFs underwent instrumentation in 244 segments (mean age 73.7 ± 7.9 years, 60.3% female). The median time of follow-up was 14.1 ± 15.5 months. Sarcopenia was detected in 28 patients (47.1%), myosteatosis in 45 patients (66.2%), and osteoporosis in 49 patients (72%). The presence of sarcopenia was independent of chronological age (p = 0.77) but correlated with BMI (p = 0.005). The zSMAHT was significantly lower in patients suffering from an IF (p = 0.0092). Sarcopenia (OR 4.511, 95% CI 1.459–13.04, p = 0.0092) and osteoporosis (OR 9.50, 95% CI 1.497 to 104.7, p = 0.014) increased the likelihood of an IF. Using multivariate analysis revealed that the zSMAHT (p = 0.0057) and BMD (p = 0.0041) were significantly related to IF occurrence. Conclusion: Herein, we established sarcopenic obesity as the main determinant for the occurrence of an IF after instrumentation for OVF. To a lesser degree, osteoporosis was associated with impaired implant longevity. Therefore, measuring the SMA and BMD using an axial CT of the lumbar spine might help to prevent an IF in spinal fusion surgery via early detection and treatment of sarcopenia and osteoporosis.

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“…Low lumbar OVC is also frequently found in patients with lower bone mineral density (BMD) and a higher mechanical failure rate, compared with thoracolumbar junction collapse 3 . Complications after surgery for OVC occurred in 14.1% of cases in a multicenter cohort study, with age, liver disease, and Parkinson’s disease (PD) found to be independent risk factors for postoperative complications 4 .…”

Section: Introductionmentioning

confidence: 99%

Clinical and imaging features of surgically treated low lumbar osteoporotic vertebral collapse in patients with Parkinson’s disease

Nakajima

Kubota

Watanabe

et al. 2021

Sci Rep

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Osteoporosis and Parkinson’s disease (PD) are age-related diseases, and surgery for osteoporotic vertebral collapse (OVC) in PD patients become more common. OVC commonly affects the thoracolumbar spine, but low lumbar OVC is frequent in patients with lower bone mineral density (BMD). The aim of this study was to identify differences in clinical and imaging features of low lumbar OVC with or without PD and to discuss the appropriate treatment. The subjects were 43 patients with low lumbar OVC below L3 who were treated surgically, including 11 patients with PD. The main clinical symptoms were radicular pain in non-PD cases and a cauda equina sign in PD cases. Rapid progression and destructive changes of OVC were seen in patients with PD. The morphological features of OVC were flat-type in non-PD cases with old compression fracture, and destruction-type in PD cases without old compression fracture. Progression of PD was associated with decreased lumbar lordosis, lower lumbar BMD, and severe sarcopenia. High postoperative complication rates were associated with vertebral fragility and longer fusion surgery. Progression of postural instability as a natural course of PD may lead to mechanical stress and instrumentation failure. Invasive long-fusion surgery should be avoided for single low lumbar OVC.

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The Surgical Outcomes of Spinal Fusion for Osteoporotic Vertebral Fractures in the Lower Lumbar Spine with a Neurological Deficit

Abstract: are the Editorial Board members of Spine Surgery and Related Research and on the journal's Editorial Committee. They were not involved in the editorial evaluation or decision to accept this article for publication at all.

Cited by 9 publications

References 29 publications

Lateral Lumbar Interbody Fusion Using Bone Graft Substitute for Lumbar Vertebral Fracture Associated Radiculopathy

Lateral Lumbar Interbody Fusion Using Bone Graft Substitute for Lumbar Vertebral Fracture Associated Radiculopathy

Impact of Sarcopenia and Bone Mineral Density on Implant Failure after Dorsal Instrumentation in Patients with Osteoporotic Vertebral Fractures

Clinical and imaging features of surgically treated low lumbar osteoporotic vertebral collapse in patients with Parkinson’s disease

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