Risk Factor Analysis of the Incidence of Subsequent Adjacent Vertebral Fracture After Lumbar Spinal Fusion Surgery with Instrumentation

Luo, Ping; Tang, Yong‐chao; Zhou, Teng-peng; Guo, Haipeng; Guo, Dan‐qing; Mo, Guo‐ye; Ma, Yuwei; Liu, Panjie; Zhang, Shun-cong; Liang, De

doi:10.1016/j.wneu.2019.11.010

Cited by 11 publications

(8 citation statements)

References 25 publications

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“…PI reflects the compensatory ability in maintaining overall spinal balance and reducing the forward tilt of the trunk. To obtain the balance between the spine and the pelvis, humans will use various compensatory mechanisms to pull the trunk backward, such as reducing thoracic kyphosis (decreasing TK), pelvic tilting (increasing PT), etc., thereby pulling back the center of gravity [ 28 – 30 ]. The smaller the LL, the larger the PI-LL, and the greater the degree of mismatch between the spine and pelvis.…”

Section: Discussionmentioning

confidence: 99%

Impact of sarcopenia and sagittal parameters on the residual back pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture

Zhao

Hua

et al. 2022

J Orthop Surg Res

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Objective The objective of this study was to explore the impact of sarcopenia and sagittal parameters on the residual back pain (RBP) after percutaneous vertebroplasty (PVP) for treatment of osteoporotic vertebral compression fracture (OVCF). Methods This retrospective study included elderly patients (age range 60–90 years) with OVCF treated with PVP from January 2015 and December 2020 in our hospital. The skeletal muscle mass index (SMI) was calculated by dividing the T12 pedicle level muscle cross-sectional area by the square of body height from chest CT to diagnose sarcopenia. The radiological parameters for measuring the sagittal alignment were included: C7-sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI). Result According to whether the VAS score > 4, patients were divided into RBP group (56 patients) and Control group (100 patients). There was no difference in age, gender, body mass index, BMD, surgical segment, bone cement usage between the groups (P > 0.05). The SMI in RBP group (27.3 ± 5.1) was significantly lower compared to that in Control group (36.8 ± 3.2) (P < 0.05). Sarcopenia was present in 19 patients (20.3%) in RBP group, which was significantly more than that in Control group (P < 0.05). C7-SVA and TPA was significantly larger in the RBP group than in the Control group (P < 0.05). PI and LL was significantly smaller in the RBP group compared to the Control group (P < 0.05). However, no significant differences between the two groups with respect to TK, SS and PT (P > 0.05). Conclusion Poor sagittal parameters and sarcopenia in OVCF patients after PVP were more prone to residual back pain. Larger C7-SVA, TPA and PI-LL mismatch could increase the incidence of RBP in elderly patients with single-segment osteoporotic compression fractures.

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Section: Discussionmentioning

confidence: 99%

Impact of sarcopenia and sagittal parameters on the residual back pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture

Zhao

Hua

et al. 2022

J Orthop Surg Res

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“…The rate of osteoporosis among patients undergoing spine surgery is substantial: 85% of operative patients have been reported to be either osteoporotic or osteopenic based on DEXA and CT scans. 28 This is especially alarming since osteoporosis correlates with poor surgical outcomes, including adjacent vertebral compression fractures 7,8 and implant subsidence, 2,9,29 and must be appropriately addressed when designing an operative plan. Despite this, only a minority of patients with risk factors for osteoporosis have preoperative DEXA information available or undergo any workup for osteoporosis prior to or following their surgery.…”

Section: Discussionmentioning

confidence: 99%

“…1 Biomechanical studies have demonstrated that pedicle screw pullout strength, maximum insertion torque, and fixation strength significantly correlate with BMD. [2][3][4] Consequentially, in surgical patients, poor bone quality increases the risk for revision surgery, 5 acute surgical site infection, 6 hardware failure, 2 adjacent vertebral compression fractures, 7,8 cage migration and cage retropulsion, 9 and proximal junctional kyphosis. 10 Surgeons must, therefore, consider multidisciplinary strategies to enhance clinical outcomes in patients with low BMD, which include utilizing antiresorptive and anabolic agents, proper choice of instrumentations, and bone marrow aspiration.…”

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confidence: 99%

MRI-based Score for Assessment of Bone Mineral Density in Operative Spine Patients

Kim

Lyons

Sarmiento

et al. 2022

Spine

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Study Design. Retrospective comparison. Objective. The aim was to determine whether a previously developed magnetic resonance imaging (MRI)-derived bone mineral density (BMD) scoring system can differentiate between healthy and osteoporotic vertebrae and to validate this scoring system against quantitative computed tomography measurements. Summary of Background Data. BMD is an important preoperative consideration in spine surgery. Techniques to measure BMD are subject to falsely elevated values in the setting of spondylosis (dual-energy X-ray absorptiometry) or require significant exposure to radiation [quantitative computed tomography (QCT)]. Previous studies have shown that MRI may be utilized to measure bone quality using changes in the bone marrow signal observed on T1-weighted MRIs. Materials and Methods. Retrospective study of patients who underwent operative lumbar procedures at a single tertiary institution between 2016 and 2021 (n=61). Vertebral bone quality (VBQ) scores were measured by dividing the median signal intensities of L1–L4 by the signal intensity of cerebrospinal fluid on noncontrast T1W MRI. Demographic data, comorbidities, VBQ scores, and QCT-derived T scores and BMD of the lumbar spine were compared between healthy (T score ≥−1; n=21), osteopenic (−2.5

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“…In addition, the spinal fusion rate of 89.47% was comparable to the fusion rate of 89.7% in elderly patients with osteoporosis reported in the literature [ 12 ]. Regardless of bone mineral density, a general rate of 4% of adjacent vertebral compression fractures is reported in conventional open spinal surgery, and osteoporosis is regarded as a risk factor for adjacent vertebral compression fracture after spinal fixation and fusion surgery [ 4 ]. In our study, there were no significant differences in decreased vertebral body heights in fixation and adjacent segments between preoperative and postoperative evaluations, and there were no new-onset in situ or adjacent vertebral compression fractures in spinal fixation and fusion observed after minimally invasive surgery with the assistance of the robotic system for osteoporosis patients after a long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…In spinal fixation and fusion surgery, screw-loosening events continue to remain a major complication [ 2 ], and cage subsidence is relevant to the severity of osteoporosis [ 3 ]. Recently, adjacent vertebral compression fractures have attracted attention after spinal fixation and fusion in osteoporosis patients [ 4 ]. Less fatty degeneration in the paraspinal muscle has been noted in patients undergoing minimally invasive surgery than in those undergoing conventional open surgery [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Prevention of Compression Fracture in Osteoporosis Patients under Minimally Invasive Trans-Foraminal Lumbar Interbody Fusion with Assistance of Bone-Mounted Robotic System in Two-Level Degenerative Lumbar Disease

et al. 2022

Medicina

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Background and Objectives: Minimally invasive spine surgery reduces destruction of the paraspinal musculature and improves spinal stability. Nevertheless, screw loosening remains a challenging issue in osteoporosis patients receiving spinal fixation and fusion surgery. Moreover, adjacent vertebral compression fracture is a major complication, particularly in patients with osteoporosis. We assessed long-term imaging results to investigate the outcomes of osteoporosis patients with two-level degenerative spine disease receiving minimally invasive surgery with the assistance of a robotic system. Materials and Methods: We retrospectively analyzed consecutive osteoporosis patients who underwent minimally invasive surgery with the assistance of a robotic system at our institution during 2013–2016. All patients were diagnosed with osteoporosis according to the World Health Organization criteria. All patients were diagnosed with two levels of spinal degenerative disease, including L34, L45, or L5S1. The study endpoints included screw-loosening condition, cage fusion, and vertebral body heights of the adjacent, first fixation segment, and second fixation segments before and after surgery, including the anterior, middle, and posterior third parts of the vertebral body. Differences in vertebral body heights before and after surgery were evaluated using the F-test. Results: Nineteen consecutive osteoporosis patients were analyzed. A lower rate of screw loosening was observed in osteoporosis patients in our study. There were no significant differences between the preoperative and postoperative vertebral body heights, including adjacent and fixation segments. Conclusions: According to our retrospective study, we report that minimally invasive surgery with the assistance of a robotic system provided better screw fixation, a lower rate of screw loosening, and a lesser extent of vertebral compression fracture after spinal fixation and fusion surgery in osteoporosis patients.

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Risk Factor Analysis of the Incidence of Subsequent Adjacent Vertebral Fracture After Lumbar Spinal Fusion Surgery with Instrumentation

Cited by 11 publications

References 25 publications

Impact of sarcopenia and sagittal parameters on the residual back pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture

Impact of sarcopenia and sagittal parameters on the residual back pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture

MRI-based Score for Assessment of Bone Mineral Density in Operative Spine Patients

Prevention of Compression Fracture in Osteoporosis Patients under Minimally Invasive Trans-Foraminal Lumbar Interbody Fusion with Assistance of Bone-Mounted Robotic System in Two-Level Degenerative Lumbar Disease

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