1
|
Funayama T, Tatsumura M, Fujii K, Shibao Y, Okuwaki S, Sakashita K, Sunami T, Inomata K, Gamada H, Miura K, Noguchi H, Takahashi H, Koda M, Yamazaki M. Exploring factors affecting activities of daily living in patients with osteoporotic vertebral fractures managed conservatively: a post-hoc analysis of a prospective cohort study. Asian Spine J 2024; 18:570-578. [PMID: 39117356 PMCID: PMC11366561 DOI: 10.31616/asj.2024.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/30/2024] [Accepted: 04/24/2024] [Indexed: 08/10/2024] Open
Abstract
STUDY DESIGN A post-hoc analysis of a prospective cohort study. PURPOSE This study aimed to identify factors at the time of injury associated with declining activities of daily living (ADLs) in the chronic phase of osteoporotic vertebral fractures (OVFs) managed conservatively. OVERVIEW OF LITERATURE Although a conservative approach is the treatment of choice for OVFs, ADLs do not improve or eventually decrease in some cases. However, the risk factors for ADL decline after the occurrence of OVFs, particularly the difference between those with or without initial bed rest, are unknown. METHODS A total of 224 consecutive patients with OVFs aged ≥65 years who received treatment within 2 weeks after the occurrence of injury were enrolled. The patients were followed up for 6 months thereafter. The criteria for evaluating the degree of independence were applied to evaluate ADLs. Multivariable analysis with a logistic regression model was performed to evaluate the risk factors for ADL decline. RESULTS In total, 49/224 patients (21.9%) showed a decline in ADLs. Of these, 23/116 patients (19.8%) in the rest group and 26/108 patients (24.1%) in the no-rest group experienced a decline in ADLs. In the logistic regression analyses, a diffuse low signal on T2- weighted magnetic resonance imaging (MRI) (odds ratio, 5.78; 95% confidence interval, 2.09-16.0; p=0.0007) and vertebral instability (odds ratio, 3.89; 95% confidence interval, 1.32-11.4; p=0.0135) were identified as independent factors in the rest and no-rest groups, respectively. CONCLUSIONS In patients with acute OVFs, a diffuse low signal on T2-weighted MRI and severe vertebral instability were independently associated with ADL decline in patients treated with and without initial bed rest, respectively.
Collapse
Affiliation(s)
- Toru Funayama
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba,
Japan
| | - Masaki Tatsumura
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, Mito,
Japan
| | - Kengo Fujii
- Department of Orthopaedic Surgery, Showa General Hospital, Kodaira,
Japan
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Takahagi,
Japan
| | - Yosuke Shibao
- Department of Orthopaedic Surgery, University of Tsukuba Hospital/Jichi Medical University Joint Ibaraki Western Regional Clinical Education Center/Ibaraki Western Medical Center, Chikusei,
Japan
| | - Shun Okuwaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba,
Japan
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Takahagi,
Japan
| | - Kotaro Sakashita
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba,
Japan
| | - Takahiro Sunami
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba,
Japan
| | - Kento Inomata
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba,
Japan
| | - Hisanori Gamada
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba,
Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba,
Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba,
Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba,
Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba,
Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba,
Japan
| |
Collapse
|
2
|
Viswanathan VK, Shetty AP, Sindhiya N, Kanna RM, Rajasekaran S. Prospective Study to Identify the Clinical and Radiologic Factors Predictive of Pseudarthrosis Development in Patients with Osteoporotic Vertebral Fractures. World Neurosurg 2022; 167:e350-e359. [PMID: 35961591 DOI: 10.1016/j.wneu.2022.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although most osteoporotic vertebral fractures (OVFs) heal conservatively, the most crucial undesirable outcome of conservative treatment is the failure to unite. There is paucity of literature on prevalence and risk factors of pseudarthrosis. METHODS A prospective study involving patients (aged ≥50 years) undergoing conservative treatment of osteoporotic thoracic/lumbar fractures without neurodeficits was performed. Patients were followed for a minimum of 6 months and classified into 3 groups based on fracture healing: group 1, healing without collapse; group 2, healing with collapse; and group 3, pseudarthrosis. An assessment of all clinicoradiologic parameters at the time of injury and at each follow-up was performed and compared among patients belonging to the groups. RESULTS A total of 77 patients (90 fractures) were studied. Sixty-six (73.3%), 16 (17.8%), and 28 (8.9%) fractures were classified under groups 1, 2, and 3, respectively. Mean ages in groups 1, 2, and 3 were 67.9 ± 9.1, 70.4 ± 7.6 and 72.3 ± 7.9 years (P = 0.08). Sex distribution was 62:15 (female/male). Seventy-three fractures (81.1%) occurred at the thoracolumbar junction. Stiff spine, ambulatory status, comorbidities, bone mineral density, and injury level were not associated with pseudarthrosis/collapse (P > 0.05). Male sex was associated with pseudarthrosis (P = 0.03). Based on regression analysis, initial vertebral height loss (radiography; P = 0.028), segmental Cobb (radiography; P = 0.019), vertebral comminution (computed tomography; P = 0.032), posterior ligamentous complex injury (magnetic resonance imaging; P = 0.048), and marrow change pattern (T2-weighted magnetic resonance imaging, Kanchiku classification; P = 0.037) were correlated with poorer outcome. Patients with pseudarthrosis had higher visual analog scale score (P = 0.04; final follow-up). CONCLUSIONS Of OVFs, 8.9% developed pseudarthrosis. Male sex, severity of postinjury vertebral deformation (vertebral loss, kyphosis, comminution, and marrow changes) and presence of posterior ligamentous complex injury are risk factors for pseudarthrosis.
Collapse
Affiliation(s)
| | | | - Nancy Sindhiya
- Department of Orthopedics, Ganga Hospital, Coimbatore, India
| | | | | |
Collapse
|
3
|
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."
Collapse
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
| | | |
Collapse
|
4
|
Okuwaki S, Funayama T, Ikumi A, Shibao Y, Miura K, Noguchi H, Takahashi H, Koda M, Tatsumura M, Kawamura H, Yamazaki M. Risk factors affecting vertebral collapse and kyphotic progression in postmenopausal osteoporotic vertebral fractures. J Bone Miner Metab 2022; 40:301-307. [PMID: 34773152 DOI: 10.1007/s00774-021-01283-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We aimed to investigate the risk factors that affect vertebral deformity 6 months after osteoporotic vertebral fractures (OVFs) at the time of injury. MATERIALS AND METHODS From May 2017 to May 2020, 70 postmenopausal women with OVFs were evaluated for age; body mass index; number of previous OVFs; total 25-hydroxy vitamin D [25(OH)D] levels; posterior wall injury on computed tomography; cross-sectional area (CSA) of the psoas major, erector spinae, and multifidus; fat infiltration; vertebral instability (VI) upon admission; collapse rate (CR); and kyphotic angle (KA) at 6 months after injury. A multiple regression analysis was conducted to identify the risk factors for the CR and KA. RESULTS The CR was correlated with posterior wall injury (r = 0.295, p = 0.022), 25(OH)D levels (r = - 0.367, p = 0.002), and VI (r = 0.307, p = 0.010). In the multiple regression analysis, the 25(OH)D levels (p = 0.032) and VI (p = 0.035) were significant risk factors for the CR at the 6-month follow-up. The KA was correlated with the 25(OH)D levels (r = - 0.262, p = 0.031) and VI (r = 0.298, p = 0.012). In the multiple regression analysis, the CSA of the psoas major (p = 0.011) and VI (p < 0.001) were significant risk factors for the KA at the 6-month follow-up. CONCLUSION In cases with large VI at the time of injury, the CR and KA were significantly higher at 6 months after injury. Moreover, the CR was affected by the 25(OH)D level, while the KA was affected by the CSA of the psoas major upon admission.
Collapse
Affiliation(s)
- Shun Okuwaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Toru Funayama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akira Ikumi
- Department of Orthopedic Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Yosuke Shibao
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kousei Miura
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroshi Noguchi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masaki Tatsumura
- Department of Orthopedic Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Haruo Kawamura
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Takahagi, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| |
Collapse
|
5
|
Okuwaki S, Funayama T, Ikumi A, Matsuura S, Kawamura H, Yamazaki M. Relationship between Vertebral Instability and the Cross-Sectional Area of Lumbar Muscles in Postmenopausal Acute Osteoporotic Vertebral Fractures. Spine Surg Relat Res 2022; 6:51-57. [PMID: 35224247 PMCID: PMC8842355 DOI: 10.22603/ssrr.2021-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/15/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Methods Results Conclusions
Collapse
Affiliation(s)
- Shun Okuwaki
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital
| | - Toru Funayama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba
| | - Akira Ikumi
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital
| | - Satoshi Matsuura
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital
| | - Haruo Kawamura
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba
| |
Collapse
|