Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture

Abstract

The purpose of this study was to examine factors affecting the severity of neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture (OVF). Reports of insufficient union following OVF have recently increased. Patients with this lesion have various degrees of neurological deficits and back pain. However, the factors contributing to the severity of these are still unknown. A total of 45 patients with insufficient union following OVF were included in this study. Insufficient union was diagnosed based on the findings of vertebral cleft on plain radiography or CT, as well as fluid collection indicating high-intensity change on T2-weighted MRI. Multivariate logistic regression analysis was performed to determine the factors contributing to the severity of neurological deficits and back pain in the patients. Age, sex, level of fracture, duration after onset of symptoms, degree of local kyphosis, degree of angular instability, ratio of occupation by bony fragments, presence or absence of protrusion of flavum, and presence or absence of ossification of the anterior longitudinal ligament (OALL) in the adjacent level were used as explanatory variables, while severity of neurological deficits and back pain were response variables. On multivariate analysis, factors significantly affecting the severity of neurological deficits were angular instability of more than 15°[adjusted odds ratio (OR), 9.24 (95% confidence interval, CI 1.49-57.2); P \ 0.05] and ratio of occupation by bony fragments in the spinal canal of more than 42% [adjusted OR 9.23 (95%CI 1.15-74.1); P \ 0.05]. The factor significantly affecting the severity of back pain was angular instability of more than 15°[ adjusted OR 14.9 (95%CI 2.11-105); P \ 0.01]. On the other hand, presence of OALL in the adjacent level reduced degree of back pain [adjusted OR 0.14 (95%CI 0.03-0.76); P \ 0.05]. In this study, pronounced angular instability and marked posterior protrusion of bony fragments in the canal were factors affecting neurological deficits. In addition, marked angular instability was a factor affecting back pain. These findings are useful in determining treatment options for patients with insufficient union following OVF.

Effect of teriparatide (rh-PTH 1–34) versus bisphosphonate on the healing of osteoporotic vertebral compression fracture: A retrospective comparative study

“…Osteoporotic fractures and related problems impact the quality of life in the older adult population. Failure of fracture healing in OVCF leads to intractable back pain associated with non-union [8, 9]. Patients with symptomatic vertebral non-union frequently require surgical interventions, including balloon kyphoplasty or spinal reconstruction.…”

“…Patients with symptomatic vertebral non-union frequently require surgical interventions, including balloon kyphoplasty or spinal reconstruction. Furthermore, once non-union advances to osteonecrosis, the collapsed vertebrae cause a progressive kyphotic deformity and severe neural tissue compression with neurological deficits [8, 9, 23]. These pathologies can be managed only through major spinal reconstruction using instrumentation [24, 25].…”

“…Failure of fracture healing in osteoporotic vertebral compression fracture (OVCF) leads to intractable back pain associated with non-union [8, 9] and delayed vertebral collapse, resulting in neurological deficits [10]. Percutaneous vertebral augmentation is a widely accepted treatment option for OVCF.…”

Comparison of the Amounts of Canal Encroachment Between Semisitting and Supine Position of Computed Tomography-Myelography for Vertebral Fractures of the Elderly Involving the Posterior Vertebral Wall

“…3 , 8 -10 Angular instability was calculated as the change in kyphotic angle between 2 positions on midsagittal dynamic computed tomographic scan. 5 The rate of dural compression was calculated using the following equation:…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the “medical” articles in the European Spine Journal, 2009

“…The paper by Hoshino et al [10] in the September issue deals with a particular subgroup of OVF with insufficient bone union following the fracture. Forty-five patients were retrospectively studied.…”