Impact of Instrumented Spinal Fusion on the Development of Vertebral Compression Fracture

Chiu, Yen-Chun; Tsai, Tsung‐Ting; Yang, Shih-Chieh; Chen, Hung-Shu; Kao, Yu-Hsien; Tu, Yuan‐Kun

doi:10.1097/md.0000000000003455

Cited by 13 publications

(14 citation statements)

References 31 publications

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“…The influence of the dosage forms of alendronate sodium hydrate used here on the serum level of Ca may have been small despite its high efficacy in improving bone metabolism. In general, osteoporosis is frequently observed in females [30] . Therefore, we evaluated the changes of bone metabolism-related factors according to gender between the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Intravenous Injection Form and Oral Jelly Form of Alendronate Sodium Hydrate for Bone Mineral Disorder after Gastrectomy

Kunisaki

Tanaka²,

Kubo³

et al. 2017

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Background/Aims: Osteoporosis is found to have high prevalence after gastrectomy and therefore, it is important to prevent this condition by means of effective medication, such as alendronate sodium hydrate. Methods: A total number of 48 gastric cancer patients diagnosed with osteoporosis after R0 gastrectomy was registered in this study between December 2013 and August 2014. Twenty-three patients received intravenous (i.v.) alendronate sodium hydrate and 25 patients received the drug in an oral jelly form. Serological and urinary examinations related to bone metabolism and bone mineral density (BMD) were performed periodically and the results obtained from the 2 groups were compared. Results: BMD increased, serum levels of bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase-5b, and the urine level of urine N-terminal telopeptide decreased with time in both groups. However, the serum Ca level did not change. Two-way analysis of variance revealed no significant differences in these factors between the 2 groups. Conclusion: It is essential to prevent both forms of osteoporosis by using alendronate sodium hydrate after gastrectomy for gastric cancer. A prospective, randomized, controlled trial in many patients following long duration should be conducted to clarify the benefits of i.v. alendronate sodium hydrate.

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Section: Discussionmentioning

confidence: 99%

A Comparative Study of Intravenous Injection Form and Oral Jelly Form of Alendronate Sodium Hydrate for Bone Mineral Disorder after Gastrectomy

Kunisaki

Tanaka²,

Kubo³

et al. 2017

Digestion

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“…They reported that subsequent vertebral compression fractures occurred in 224 patients (11.6%). They also investigated subsequent vertebral compression fractures after instrumented spinal fusion surgery ( n = 6949) or non-fusion spinal surgery ( n = 69,490) from the National Health Insurance Research Database of Taiwan [13]. They reported that the incidences of developing subsequent vertebral compression fractures were 130 patients (1.87%) for instrumented spinal fusion surgery and 175 patients (0.25%) for non-fusion spinal surgery, respectively.…”

Section: Discussionmentioning

confidence: 99%

Vertebral fracture in elderly female patients after posterior fusion with pedicle screw fixation for degenerative lumbar pathology: a retrospective cohort study

Nakahashi

Uei

Tokuhashi

et al. 2019

BMC Musculoskelet Disord

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Background There have been only a few reports of subsequent postoperative vertebral fracture following posterior spinal instrumentation fusion, especially in elderly female patients. This study attempted to evaluate the long-term prevalence of subsequent postoperative vertebral fracture in female patients aged 70 years and older who underwent spine decompression and fusion surgery with pedicle screw fixation. Methods We retrospectively reviewed prospectively collected data from 125 patients who met our inclusion and exclusion criteria. Patients were divided into 2 groups according to age: patients aged 70 years and older (Group A) and patients aged under 70 years of age (Group B). We evaluated incidence of subsequent postoperative vertebral fractures, type and timing of vertebral fractures, preoperative bone mineral density (BMD), preoperative diagnosis, surgical procedure, number of levels fused, extension of fusion to the lumbosacral junction, and presence of a transverse fixator. Results Baseline characteristics excluding patients’ age were not statistically different between the two groups. Preoperative BMD of Group A was an average 81.7% of the young adult mean (YAM) value and that of Group B was an average 85.1% YAM value. Subsequent postoperative vertebral fractures occurred in 22 (41.5%) of 53 in Group A. On the other hand, fracture occurred in 17 (23.6%) of 72 in Group B. There were significant differences between the groups ( p = 0.02). The odds ratio for subsequent vertebral fracture was 2.4 (95% confidence interval: 1.1–5.2) in favor of Group A. Survival analysis showed that the rate of subsequent vertebral fracture was significantly higher in Group A (log-rank test, P = 0.007). Conclusions The incidence of subsequent vertebral fracture in patients aged 70 years and older was significantly higher than in patients aged under 70 years of age. In the case of pedicle screw fixation in elderly female patients, it is necessary to note the high risk of subsequent vertebral fracture despite short or non-rigid fusion. Vertebral fracture after posterior fusion surgery even for degenerative lumbar pathology could occur in more than one-third of female patients aged 70 years and older.

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“…Osteoporosis can directly affect the hold of the screws placed during surgery, especially when superimposed on pre-existing osteopenia and osteoporosis. This can lead to loosening of the screws, localized pain, screw pullout, and fractures at the interface between instrumented and non-instrumented levels [ 19 ]. The relative inactivity of the patients post spinal instrumentation has been documented to lead to increased loss of bone density.…”

Section: Discussionmentioning

confidence: 99%

“…The immobility of the fused stenotic spinal segment, with or without instrumentation, leads to restriction of lower lumbar motion, and a higher incidence of falls that can lead to VCF [ 8 ]. This appears to have a greater impact on the upper level of the fusion, and when combined with later development of osteoporosis, can lead to fractures close to the spinal fusion [ 19 - 20 ] (Figure 2 ).…”

Section: Discussionmentioning

confidence: 99%

Vertebral Compression Fractures after Lumbar Instrumentation

Granville

Berti

Jacobson

2017

Cureus

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Lumbar spinal stenosis (LSS) is primarily found in an older population. This is a similar demographic group that develops both osteoporosis and vertebral compression fractures (VCF). This report reviewed a series of patients treated for VCF that had previous lumbar surgery for symptomatic spinal stenosis. Patients that only underwent laminectomy or fusion without instrumentation had a similar distribution of VCF as the non-surgical population in the mid-thoracic, or lower thoracic and upper lumbar spine. However, in the patients that had previous short-segment spinal instrumentation, fractures were found to be located more commonly in the mid-lumbar spine or sacrum adjacent to or within one or two spinal segments of the spinal instrumentation. Adjacent-level fractures that occur due to vertebral osteoporosis after long spinal segment instrumentation has been discussed in the literature. The purpose of this report is to highlight the previously unreported finding of frequent lumbar and sacral osteoporotic fractures in post-lumbar instrumentation surgery patients. Important additional factors found were lack of preventative medical treatment for osteoporosis, and secondary effects related to inactivity, especially during the first year after surgery.

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Impact of Instrumented Spinal Fusion on the Development of Vertebral Compression Fracture

Cited by 13 publications

References 31 publications

A Comparative Study of Intravenous Injection Form and Oral Jelly Form of Alendronate Sodium Hydrate for Bone Mineral Disorder after Gastrectomy

A Comparative Study of Intravenous Injection Form and Oral Jelly Form of Alendronate Sodium Hydrate for Bone Mineral Disorder after Gastrectomy

Vertebral fracture in elderly female patients after posterior fusion with pedicle screw fixation for degenerative lumbar pathology: a retrospective cohort study

Vertebral Compression Fractures after Lumbar Instrumentation

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