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Zhang S, Chen H, Bao L, Jia P, Sun H, Wang K, Chen M, Tang H. Association Between Spinopelvic Parameters and Intravertebral Cleft in Osteoporosis Vertebral Compression Fractures. World Neurosurg 2024; 183:e813-e817. [PMID: 38218435 DOI: 10.1016/j.wneu.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The high incidence of nonunion in osteoporosis vertebral compression fractures (OVCFs) among the elderly population is a significant concern. But the hypothesis about etiopathogenesis of the intravertebral cleft (IVC) is not convincing. This study aims to investigate the association between spinopelvic parameters and IVC. METHODS Patients with single segment IVC or healed vertebral compression fracture (HVCF) were retrospectively recruited for the study. Patients with IVC were assigned to the IVC group, the others were assigned to the HVCF group. We estimated whether IVC or HVCF locates the vertebra inflection point on lumbar lateral radiography. Distance between the sagittal line passing through the anterosuperior corner of S1and the center of the vertebra of healed fracture or with IVC (DSVA) and sacral slope (SS) were measured on lumbar lateral plain films. Intergroup spinopelvic parameters were analyzed. analysis to identify independent variables associated with IVC incidence. The receiver operating characteristics (ROC) curve was generated to identify the optimal cut-off point for statistically significant variables. RESULTS Sixty-five patients were included in the study. Thirty patients (mean age: 74 ± 7.16 years) had single-level IVC, and 35 patients (mean age: 67.71 ± 7.30 years) had single-level HVCF. Age, body mass index (BMI), and DSVA were statistically different between the groups (all P < 0.05). The occurrence of IVC was related to the DSVA in the multivariate logistic regression analysis (OR = 0.73, P < 0.05). CONCLUSIONS According to the results of this study, large DSVA was a risk factor for IVC formation in patients with OVCFs. Patients with global spinal malalignment should be actively observed during conservative treatment.
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Affiliation(s)
- Shuangjiang Zhang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hao Chen
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Li Bao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Pu Jia
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Haibo Sun
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Kaiyu Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Mengmeng Chen
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hai Tang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
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Al Taha K, Lauper N, Bauer DE, Tsoupras A, Tessitore E, Biver E, Dominguez DE. Multidisciplinary and Coordinated Management of Osteoporotic Vertebral Compression Fractures: Current State of the Art. J Clin Med 2024; 13:930. [PMID: 38398244 PMCID: PMC10889683 DOI: 10.3390/jcm13040930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
Osteoporotic vertebral compression fractures (OVCFs) present a significant health concern, affecting a substantial portion of the older adult population worldwide. This narrative review explores the prevalence, diagnostic challenges and management strategies for OVCFs. Despite the increasing incidence and impact on morbidity and mortality, existing clinical guidelines lack consistency and clear diagnostic and therapeutic recommendations. The review addresses key questions faced by physicians dealing with older adult patients experiencing acute back pain, offering insights into triage, radiological assessments and classification systems. We propose a comprehensive algorithm for clearing OVCF, considering clinical presentation, radiological findings and morphological aspects. Emphasis is placed on the importance of medically treating osteoporosis alongside OVCF management. The review encompasses relevant literature from 1993 to 2023, provides a detailed discussion on triage issues and incorporates a clinically oriented classification system developed by the German Society for Orthopaedics and Trauma. The Material and Methods section outlines the extensive literature search carried out in PUBMED, encompassing clinical and experimental studies, systematic reviews and meta-analyses. The articles retained focused mainly on answering critical questions regarding radiological assessments, imaging modalities and the presence of a specific classification system for OVCFs. The review emphasises that the evaluation and management of OVCFs necessitates a multidisciplinary approach involving spine specialists and bone disease experts. It also addresses the role of conservative versus surgical treatments, with a focus on percutaneous vertebral augmentation. The conclusion summarises the algorithm derived for use in emergency departments and general practice, aiming to streamline OVCF management, reduce unnecessary examinations and ensure optimal patient care. The algorithm recommends primary diagnosis using computed tomography, with magnetic resonance imaging reserved for specific cases. The review advocates a holistic approach, integrating medical and surgical interventions to address the complex challenges posed by OVCFs in ageing populations.
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Affiliation(s)
- Khalid Al Taha
- Spine Team, Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland; (K.A.T.); (N.L.); (D.E.B.); (A.T.)
| | - Nicolas Lauper
- Spine Team, Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland; (K.A.T.); (N.L.); (D.E.B.); (A.T.)
| | - David E. Bauer
- Spine Team, Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland; (K.A.T.); (N.L.); (D.E.B.); (A.T.)
| | - Andreas Tsoupras
- Spine Team, Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland; (K.A.T.); (N.L.); (D.E.B.); (A.T.)
| | - Enrico Tessitore
- Division of Neurosurgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland;
| | - Emmanuel Biver
- Division of Bone Diseases, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland;
| | - Dennis E. Dominguez
- Spine Team, Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland; (K.A.T.); (N.L.); (D.E.B.); (A.T.)
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Sung HS, Kim SI, Park HY, Ko MS, Lee JH, Kim YH. Predictive factors for conversion from conservatively to surgically treatment osteoporotic thoracolumbar compression fractures based on sagittal parameters and magnetic resonance imaging features. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3933-3940. [PMID: 37493855 DOI: 10.1007/s00586-023-07864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/21/2023] [Accepted: 07/08/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE To investigate the relationship between sagittal plane characteristics of the spinal column and conservative treatment failure in acute osteoporotic spinal fractures (OSFs). METHODS As a retrospective study of single-institute data, thoracolumbar OSF patients with similar propensities in terms of location of fractures and results of bone mineral density were analyzed. Among them, 43 patients (group I) who needed reconstructive surgical interventions and 39 patients (group II) who obtained successful treatment through conservative care were included. General demographic data, radiographic features of fractures, and magnetic resonance imaging (MRI) features of fractures were analyzed. To investigate the relationship between global sagittal alignment of the spine and occurrence of delayed complication following OSFs, radiological sagittal parameters were analyzed. RESULTS The number of cases requiring reconstructive surgery was significantly higher when the index vertebra showed diffuse or mid-portion bone marrow changes in MRI. In terms of sagittal parameters, pelvic incidence (group I 59.1° ± 11.9°, group II 54.6° ± 9.8°) and thoracolumbar angle (group I 26.5° ± 14.1°, group II 17.4° ± 11.2°) were significantly higher in group I. Logistic regression analysis showed that higher pelvic incidence (OR 1.09, 95% CI 1.01-1.18, p value < 0.05) and higher thoracolumbar angle (OR 1.09, 95% CI 1.02-1.17, p value < 0.05) were significant risk factors for delayed complications requiring reconstructive surgery following OSFs. CONCLUSION Delayed complications requiring reconstructive surgery following OSFs are related to sagittal plane parameters of the spine such as high pelvic incidences, in addition to previously known radiographic characteristics of fractures.
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Affiliation(s)
- Hoon-Seok Sung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Sang-Il Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Hyung-Youl Park
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, 1021, Tong-il-ro, Eunpyeong-gu, Seoul, 03312, Korea
| | - Myung-Sup Ko
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Jeong-Han Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Young-Hoon Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Korea.
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Takahashi S, Terai H, Hoshino M, Tsujio T, Kato M, Toyoda H, Suzuki A, Tamai K, Yabu A, Nakamura H. Machine-learning-based approach for nonunion prediction following osteoporotic vertebral fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3788-3796. [PMID: 36269421 DOI: 10.1007/s00586-022-07431-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/02/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE An osteoporotic vertebral fracture (OVF) is a common disease that causes disabilities in elderly patients. In particular, patients with nonunion following an OVF often experience severe back pain and require surgical intervention. However, nonunion diagnosis generally takes more than six months. Although several studies have advocated the use of magnetic resonance imaging (MRI) observations as predictive factors, they exhibit insufficient accuracy. The purpose of this study was to create a predictive model for OVF nonunion using machine learning (ML). METHODS We used datasets from two prospective cohort studies for OVF nonunion prediction based on conservative treatment. Among 573 patients with acute OVFs exceeding 65 years in age enrolled in this study, 505 were analyzed. The demographic data, fracture type, and MRI observations of both studies were analyzed using ML. The ML architecture utilized in this study included a logistic regression model, decision tree, extreme gradient boosting (XGBoost), and random forest (RF). The datasets were processed using Python. RESULTS The two ML algorithms, XGBoost and RF, exhibited higher area under the receiver operating characteristic curves (AUCs) than the logistic regression and decision tree models (AUC = 0.860 and 0.845 for RF and XGBoost, respectively). The present study found that MRI findings, anterior height ratio, kyphotic angle, BMI, VAS, age, posterior wall injury, fracture level, and smoking habit ranked as important features in the ML algorithms. CONCLUSION ML-based algorithms might be more effective than conventional methods for nonunion prediction following OVFs.
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Affiliation(s)
- Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan.
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City General Hospital, 2-15-16, Miyakojima Hon-Dori, Miyakojima-Ku, Osaka, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City General Hospital, 2-15-16, Miyakojima Hon-Dori, Miyakojima-Ku, Osaka, Japan
| | - Tadao Tsujio
- Department of Orthopaedic Surgery, Shiraniwa Hospital, 6-10-1. Shiraniwadai, Ikoma City, Nara, Japan
| | - Minori Kato
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Akito Yabu
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
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Funayama T, Tatsumura M, Fujii K, Ikumi A, Okuwaki S, Shibao Y, Koda M, Yamazaki M. Therapeutic Effects of Conservative Treatment with 2-Week Bed Rest for Osteoporotic Vertebral Fractures: A Prospective Cohort Study. J Bone Joint Surg Am 2022; 104:1785-1795. [PMID: 36005391 DOI: 10.2106/jbjs.22.00116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UPDATE This article was updated on October 19, 2022, because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 1787, in the legend for Figure 2, the sentence that had read "The vertebral collapse rate (in %) was defined as 1 - (A/P) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images." now reads "The vertebral collapse rate (in %) was defined as (1 - [A/P]) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images." On page 1788, in the section entitled "Data Collection," the sentence that had read "The vertebral collapse rate (in %) was defined as 1 - (anterior vertebral wall height/posterior vertebral wall height) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images 9 ." now reads "The vertebral collapse rate (in %) was defined as (1 - [anterior vertebral wall height/posterior vertebral wall height]) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images 9 ." Finally, on page 1791, in Table IV, the footnote for the "Primary outcome" row that had read "N = 113 in the rest group and 99 in the no-rest group." now reads "N = 116 in the rest group and 108 in the no-rest group."
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Affiliation(s)
- Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masaki Tatsumura
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Kengo Fujii
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Takahagi, Ibaraki, Japan.,Department of Orthopaedic Surgery, Showa General Hospital, Kodaira, Tokyo, Japan
| | - Akira Ikumi
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Ibaraki, Japan.,Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Takahagi, Ibaraki, Japan
| | - Shun Okuwaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Takahagi, Ibaraki, Japan
| | - Yosuke Shibao
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Zhao C, Liu X, Wang Y, Guo J, Han S, Zhang H, Chen M, Zhou C, Ma X. The effects of biomechanical factors on adjacent vertebral compression fractures after percutaneous kyphoplasty: a propensity score matching analysis. Osteoporos Int 2022; 33:1795-1806. [PMID: 35585277 DOI: 10.1007/s00198-022-06428-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
Abstract
UNLABELLED Adjacent vertebral compression fracture (AVCF) is the primary factor affecting satisfaction after PKP surgery. In addition to osteoporosis, certain structural characteristics of the vertebral body itself also increase their risk. The purpose of this study was to explore the impact of biomechanical changes on AVCF after balancing other factors. INTRODUCTION As a routine treatment of OVCF, the postoperative refracture of PKP is a serious problem. The aim of our study was to explore the impact of lumbar biomechanical changes on the risk of AVCF. A propensity score matching was performed to balance the interference of osteoporosis, which is the primary risk factor of AVCF. METHODS A retrospective, single-center case-control study was performed. From September 2013 to March 2020, 1752 patients were enrolled, and AVCF was assessed in 80 of these patients. A propensity score matching (PSM) analysis was performed, and 5 potential confounding factors were matched (age, BMI, number of fractured vertebral bodies, fracture region, and HDL). The preoperative and postoperative radiological factors were measured in the matched cohort of 48 pairs. A conditional logistic regression analysis to adjust the comparative risks. RESULTS The preoperative wedge angle and its postoperative recovery of the AVCF group were significantly higher than that of the non-AVCF group. The local kyphosis of the fractured vertebral body between the two groups was similar, but the recovery in the AVCF group was slightly higher than that in the non-AVCF group. The preoperative and postoperative relative anterior height (RAH) of the fractured vertebral body was familiar in two groups, so was the recovery of RAH. The preoperative spino-sacral angle (SSA) was significantly higher in the AVCF group than in the non-AVCF group. The preoperative wedge angle was identified as the only significant risk factor for AVCF in the multivariate analysis. CONCLUSION In conclusion, a larger preoperative fracture vertebral wedge angle is a risk factor for AVCF. For such high-risk patients, surgeons should be cautious about surgical decisions. The postoperative active measures and tailored surveillance should be attached to great importance as well.
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Affiliation(s)
- Chong Zhao
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Xiaojie Liu
- Department of Orthopedics Surgery, Weihai Branch of 970 Hospital of the PLA Joint Logistic Support Force, Weihai, Shandong, China
| | - Yan Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Jianwei Guo
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Shuo Han
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Hao Zhang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Mingrui Chen
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Chuanli Zhou
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China.
| | - Xuexiao Ma
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China.
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Sih IM, Shimokawa N, Zileli M, Fornari M, Parthiban J. Osteoporotic vertebral fractures: radiologic diagnosis, clinical and radiologic factors affecting surgical decision making: WFNS Spine Committee Recommendations. J Neurosurg Sci 2022; 66:291-299. [PMID: 35301843 DOI: 10.23736/s0390-5616.22.05636-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With the varied literature on osteoporotic vertebral fracture that may predispose to diagnostic and management dilemma, it is timely to evaluate and streamline the evidence. The aim of this review is to create recommendations on osteoporotic vertebral fractures regarding radiologic diagnosis, and clinical and radiological factors affecting surgical decision making. A computerized literature search was done using PubMed, Google scholar and Cochrane Database of Systematic Reviews from 2010 to 2020. For radiologic diagnosis, the keywords "osteoporotic vertebral fractures" and "radiologic diagnosis" were used yielding 394 articles (19 relevant articles). For clinical and radiological factors affecting surgical decision making, the keywords "osteoporotic vertebral fractures", "radiologic diagnosis", and "surgery" were used yielding 568 articles (25 relevant articles). All pertinent data were reviewed, and consensus statements were obtained in two virtual separate consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine committee. The statements were voted and yielded positive or negative consensus using the Delphi method. This review summarizes the WFNS Spine Committee recommendations on the radiologic diagnosis, and clinical and radiological factors affecting surgical decision making of osteoporotic vertebral fractures.
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Affiliation(s)
- Ibet M Sih
- Section of Neurosurgery, Institute for the Neurosciences, St. Luke's Medical Center, Bonifacio, Philippines -
| | | | - Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
| | - Maurizio Fornari
- Neurosurgery Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Jutty Parthiban
- Department of Neurosurgery and Spine Unit, Kovai Medical Center and Hospital, Coimbatore, India
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8
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Scheyerer MJ, Spiegl UJA, Grueninger S, Hartmann F, Katscher S, Osterhoff G, Perl M, Pumberger M, Schmeiser G, Ullrich BW, Schnake KJ. Risk Factors for Failure in Conservatively Treated Osteoporotic Vertebral Fractures: A Systematic Review. Global Spine J 2022; 12:289-297. [PMID: 33541142 PMCID: PMC8907647 DOI: 10.1177/2192568220982279] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Osteoporosis is one of the most common diseases of the elderly, whereby vertebral body fractures are in many cases the first manifestation. Even today, the consequences for patients are underestimated. Therefore, early identification of therapy failures is essential. In this context, the aim of the present systematic review was to evaluate the current literature with respect to clinical and radiographic findings that might predict treatment failure. METHODS We conducted a comprehensive, systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist and algorithm. RESULTS After the literature search, 724 potentially eligible investigations were identified. In total, 24 studies with 3044 participants and a mean follow-up of 11 months (range 6-27.5 months) were included. Patient-specific risk factors were age >73 years, bone mineral density with a t-score <-2.95, BMI >23 and a modified frailty index >2.5. The following radiological and fracture-specific risk factors could be identified: involvement of the posterior wall, initial height loss, midportion type fracture, development of an intravertebral cleft, fracture at the thoracolumbar junction, fracture involvement of both endplates, different morphological types of fractures, and specific MRI findings. Further, a correlation between sagittal spinal imbalance and treatment failure could be demonstrated. CONCLUSION In conclusion, this systematic review identified various factors that predict treatment failure in conservatively treated osteoporotic fractures. In these cases, additional treatment options and surgical treatment strategies should be considered in addition to follow-up examinations.
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Affiliation(s)
- Max J. Scheyerer
- Department of Orthopedic and Trauma
Surgery, Medical Faculty, University of Cologne, Cologne, Germany,Max J. Scheyerer, PD Dr., Department of
Orthopedic and Trauma Surgery, Medical Faculty, University of Cologne, Kerpener
Straße 62, 50937 Cologne, Germany.
| | - Ulrich J. A. Spiegl
- Department of Orthopaedics, Trauma
Surgery and Plastic Surgery, University Hospital Leipzig, Sachsen Germany
| | - Sebastian Grueninger
- Department of Orthopaedics and
Trauma Surgery, University Hospital, Paracelsus University, Hospital Nürnberg,
Nuernberg, Germany
| | - Frank Hartmann
- Department of Orthopaedics and
Trauma Surgery, Ev.Stift St. Martin, Hospital Mittelrhein, Koblenz,
Germany
| | | | - Georg Osterhoff
- Department of Orthopaedics, Trauma
Surgery and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Mario Perl
- Department of Trauma Surgery,
University Hospital Erlangen, Erlangen, Germany
| | - Matthias Pumberger
- Spine Department, Center for
Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin,
Germany
| | - Gregor Schmeiser
- Center for Spine Therapy, Schön
Klinik Hamburg Eilbeck, Hamburg, Germany
| | - Bernhard W. Ullrich
- Department of Trauma and Plastic
Surgery, University Hospital Jena, Jena, Germany
| | - Klaus J. Schnake
- Center for Spine and Scoliosis
Therapy, Malteser Waldkrankenhaus St. Marien, Erlangen, Bayern, Germany,Department of Orthopedics and
Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg,
Germany
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9
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Roux C, Cortet B, Bousson V, Thomas T. Vertebroplasty for osteoporotic vertebral fracture. RMD Open 2021; 7:rmdopen-2021-001655. [PMID: 34193518 PMCID: PMC8246346 DOI: 10.1136/rmdopen-2021-001655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022] Open
Abstract
Appropriate care of patients with a recent painful osteoporotic vertebral fracture (VF) requires immobilisation, analgesics and spinal orthoses. Some VFs are however responsible for disabling pain and prolonged bed rest. In this context, vertebroplasty techniques have been proposed with a large benefit in case series and open-label randomised studies, but lack efficacy in three among four double-blind randomised studies. The objectives of the treatment of a recent painful VF are to relieve pain and to preserve mechanical conditions. With this in mind, we report an experts’ opinion paper on the indications for vertebroplasty and research agenda for clinical studies.
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Affiliation(s)
- Christian Roux
- INSERM U1153, APHP.Centre-Université de Paris, Service de Rhumatologie, Hôpital Cochin, Paris, France
| | - Bernard Cortet
- Department of Rheumatology, ULR 4490, Université de Lille, Lille University Hospital, Lille, France
| | - Valérie Bousson
- Service de Radiologie Ostéo-Articulaire, APHP.Nord-Université de Paris, Hôpital Lariboisière, Paris, France
| | - Thierry Thomas
- Service de Rhumatologie, and INSERM U 1059, Université de Lyon-Université Jean Monnet, CHU de St-Etienne, Saint-Etienne, France
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Umehara T, Inukai A, Kuwahara D, Kaneyashiki R, Kaneguchi A, Tsunematsu M, Kakehashi M. Physical Functions and Comorbidity Affecting Collapse at 4 or More Weeks after Admission in Patients with Osteoporotic Vertebral Fractures: A Prospective Cohort Study. Asian Spine J 2021; 16:419-431. [PMID: 33940771 PMCID: PMC9260407 DOI: 10.31616/asj.2020.0285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design A prospective cohort study. Purpose This study aimed to reveal physical functions and comorbidity affecting collapse at ≥4 weeks after hospital admission of patients with osteoporotic vertebral fracture. Overview of Literature Only a few studies have investigated the influence of physical function and activity on collapse in patients with osteoporotic vertebral fractures. Methods This prospective cohort study analyzed patients with osteoporotic vertebral fractures admitted to the hospital between March 2018 and October 2019. Logistic regression analysis was performed to explore the predictors of vertebral collapse at >4 weeks after admission. Model 1 used basic medical information and physical functions at admission; model 2 used basic medical information and physical function and activity at >4 weeks after admission. Results In the model 1 results of logistic regression analysis, cardiovascular disease (odds ratio [OR], 12.27; 95% confidence interval [CI], 1.28–117.91) was extracted as a factor affecting vertebral collapse at ≥4 weeks after admission. In the model 2 results of logistic regression analysis, cardiovascular disease (OR, 34.57; 95% CI, 2.53–471.74), movement control during one leg standing at 4 weeks (OR, 7.25; 95% CI, 1.36–38.71), and Pain Catastrophizing Scale score at 4 weeks (OR, 1.11; 95% CI, 1.01–1.21) were extracted as factors affecting vertebral collapse at ≥4 weeks after admission. Conclusions Our results indicate that physical functions and comorbidity affect collapse at ≥4 weeks after admission in patients with osteoporotic vertebral fractures.
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Affiliation(s)
- Takuya Umehara
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Japan.,Department of Rehabilitation, Saiseikai Kure Hospital, Kure, Japan
| | - Ayaka Inukai
- Department of Rehabilitation, Saiseikai Kure Hospital, Kure, Japan
| | - Daisuke Kuwahara
- Department of Rehabilitation, Saiseikai Kure Hospital, Kure, Japan
| | - Ryo Kaneyashiki
- Department of Rehabilitation, Saiseikai Kure Hospital, Kure, Japan
| | - Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Japan
| | - Miwako Tsunematsu
- Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masayuki Kakehashi
- Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Warm needling moxibustion plus PKP for vertebral compression fracture due to kidney deficiency and blood stasis: a randomized controlled trial. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2021. [DOI: 10.1007/s11726-021-1237-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Is Bone Nonunion, Vertebral Deformity, or Spinopelvic Malalignment the Best Therapeutic Target for Amelioration of Low Back Pain After Osteoporotic Vertebral Fracture? Spine (Phila Pa 1976) 2020; 45:E760-E767. [PMID: 32049935 DOI: 10.1097/brs.0000000000003422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cohort study (level 3). OBJECTIVE The aim of this study was to identify independent risk factors for residual low back pain (LBP) following osteoporotic vertebral fracture (OVF). SUMMARY OF BACKGROUND DATA Nonunion has been proposed as the primary cause of residual LBP following OVF. However, LBP can occur even when union is maintained. Other reported causes of LBP after OVF include vertebral deformities and spinopelvic malalignment. METHODS Sixty-seven patients with single-level thoracolumbar OVF who had not received previous osteoporotic treatment were enrolled. Conservative treatment was conducted using a soft lumbosacral orthosis plus osteoporosis drugs, either weekly alendronate (bisphosphonate) or daily teriparatide. Pain scores, kyphosis angle of fractured vertebra (VKA), and spinopelvic alignment, including pelvic incidence minus lumbar lordosis (PI-LL), were assessed periodically during treatment. Radiographic union was evaluated independently by three specialists at 24 weeks post-admission. Patients were divided by pain scores >40% at 24 weeks into the LBP (n = 36) and non-LBP (n = 31) groups. Temporal changes and statistical associations were examined to identify risk factors for LBP at 24 weeks. RESULTS At 24 weeks, 25% of OVFs failed to achieve union. The LBP group consisted of 71% of nonunion and 48% of union cases. Stepwise multinomial regression analysis showed VKA at 24 weeks >25° was significant risk factor for the LBP group (odds ratio: 6.24, 95% confidence interval: 1.77-22.02, P = 0.004). Significant differences in VKA emerged during treatment in the LBP group, but PI-LL showed the tendency not to change throughout the treatment period. Non-union was correlated with VKA (area under the curve: 0.864). CONCLUSION Although spinopelvic malalignment is considered as a preexisting factor for LBP, VKA exacerbated by nonunion predominantly led to LBP after a new OVF. Each incidence of OVF should be treated to limit further morphological changes to the fractured vertebra. LEVEL OF EVIDENCE 3.
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Sankey EW, Park C, Howell EP, Pennington Z, Abd-El-Barr M, Karikari IO, Shaffrey CI, Gokaslan ZL, Sciubba D, Goodwin CR. Importance of Spinal Alignment in Primary and Metastatic Spine Tumors. World Neurosurg 2019; 132:118-128. [PMID: 31476476 DOI: 10.1016/j.wneu.2019.08.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 12/12/2022]
Abstract
Spinal alignment, particularly with respect to spinopelvic parameters, is highly correlated with morbidity and health-related quality-of-life outcomes. Although the importance of spinal alignment has been emphasized in the deformity literature, spinopelvic parameters have not been considered in the context of spine oncology. Because the aim of oncologic spine surgery is mostly palliative, consideration of spinopelvic parameters could improve postoperative outcomes in both the primary and metastatic tumor population by taking overall vertebral stability into account. This review highlights the relevance of focal and global spinal alignment, particularly related to spinopelvic parameters, in the treatment of spine tumors.
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Affiliation(s)
- Eric W Sankey
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Christine Park
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth P Howell
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Muhammad Abd-El-Barr
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Isaac O Karikari
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA
| | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA.
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Kao FC, Huang YJ, Chiu PY, Hsieh MK, Tsai TT. Factors Predicting the Surgical Risk of Osteoporotic Vertebral Compression Fractures. J Clin Med 2019; 8:E501. [PMID: 31013728 PMCID: PMC6517994 DOI: 10.3390/jcm8040501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 12/30/2022] Open
Abstract
The aim of our study was to investigate the association between global spinal alignment, spinopelvic parameters, and outcomes of osteoporotic vertebral compression fractures (OVCF). Patients with vertebral compression fractures seen at our hospital between October 2017 and November of 2018 with a bone mineral density (BMD) T-score < -2.5 were recruited for the study. Surgical intervention was performed after eight weeks of conservative treatment depending on clinical symptoms and the willingness of patients. Spinopelvic and sagittal alignment parameters were compared between patients who had surgery and those that did not. Seventy-nine patients were included in the study. Twenty-five patients (31.6%, mean age: 73.28 ± 9.78 years) received surgery, and 54 (68.3%, mean age: 73 ± 8.58 years) conservative treatment only. Pelvic tilt, pelvic incidence, and local kyphotic angle were statistically different between the groups (all p < 0.05). A sagittal vertical axis ≥ 50 mm, distance between the C7 plumb line and the center of the fractured vertebra (DSVA) ≥ 60 mm, pelvic incidence outside of the range of 44 to 62°), and pelvic tilt ≥ 27° were associted with the need for surgical intervention. Measurement of spinopelvic parameters can predict the need for surgery in patients with OVCF.
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Affiliation(s)
- Fu-Cheng Kao
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Yu-Jui Huang
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Ping-Yeh Chiu
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
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