Surgical Treatment of Osteoporotic Vertebral Fracture with Neurological Deficit―A Nationwide Multicenter Study in Japan―

• Main Authors: Naobumi Hosogane, Kenya Nojiri, Satoshi Suzuki, Haruki Funao, Eijiro Okada, Norihiro Isogai, Seiji Ueda, Tomohiro Hikata, Yuta Shiono, Kota Watanabe, Kei Watanabe, Takashi Kaito, Tomoya Yamashita, Hiroyasu Fujiwara, Yukitaka Nagamoto, Hidetomi Terai, Koji Tamai, Yuji Matsuoka, Hidekazu Suzuki, Hirosuke Nishimura, Atsushi Tagami, Syuta Yamada, Shinji Adachi, Seiji Ohtori, Sumihisa Orita, Takeo Furuya, Toshitaka Yoshii, Shuta Ushio, Gen Inoue, Masayuki Miyagi, Wataru Saito, Shiro Imagama, Kei Ando, Daisuke Sakai, Tadashi Nukaga, Katsuhito Kiyasu, Atsushi Kimura, Hirokazu Inoue, Atsushi Nakano, Katsumi Harimaya, Kenichi Kawaguchi, Nobuhiko Yokoyama, Hidekazu Oishi, Toshio Doi, Shota Ikegami, Masayuki Shimizu, Toshimasa Futatsugi, Kenichiro Kakutani, Takashi Yurube, Masashi Oshima, Hiroshi Uei, Yasuchika Aoki, Masahiko Takahata, Akira Iwata, Shoji Seki, Hideki Murakami, Katsuhito Yoshioka, Hirooki Endo, Michio Hongo, Kazuyoshi Nakanishi, Tetsuya Abe, Toshinori Tsukanishi, Ken Ishii
• Format: Article
• Language: English
• Published: The Japanese Society for Spine Surgery and Related Research 2019-10-01
• Series: Spine Surgery and Related Research
• Subjects: vertebral compression fracture; osteoporosis; multicenter study
• Online Access: https://www.jstage.jst.go.jp/article/ssrr/3/4/3_2019-0004/_pdf/-char/en

Introduction: The prevalence of patients with osteoporosis continues to increase in aging societies, including Japan. The first choice for managing osteoporotic vertebral compression fracture (OVF) is conservative treatment. Failure in conservative treatment for OVF may lead to non-union or vertebral collapse, resulting in neurological deficit and subsequently requiring surgical intervention. This multicenter nationwide study in Japan was conducted to comprehensively understand the outcomes of surgical treatments for OVF non-union. Methods: This multicenter, retrospective study included 403 patients (89 males, 314 females, mean age 73.8 ± 7.8 years, mean follow-up 3.9 ± 1.7 years) with neurological deficit due to vertebral collapse or non-union after OVF at T10-L5 who underwent fusion surgery with a minimum 1-year follow-up. Radiological and clinical outcomes at baseline and at the final follow-up (FU) were evaluated. Results: OVF was present at a thoracolumbar junction such as T12 (124 patients) and L1 (117 patients). A majority of OVF occurred after a minor trauma, such as falling down (55.3%) or lifting objects (8.4%). Short segment fusion, including affected vertebra, was conducted (mean 4.0 ± 2.0 vertebrae) with 256.8 minutes of surgery and 676.1 g of blood loss. A posterior approach was employed in 86.6% of the patients, followed by a combined anterior and posterior (8.7%), and an anterior (4.7%) approach. Perioperative complications and implant failures were observed in 18.1% and 41.2%, respectively. VAS scores of low back pain (74.7 to 30.8 mm) and leg pain (56.8 to 20.7 mm) improved significantly at FU. Preoperatively, 52.6% of the patients were unable to walk and the rate of non-ambulatory patients decreased to 7.5% at FU. Conclusions: This study demonstrated that substantial improvement in activity of daily living (ADL) was achieved by fusion surgery. Although there was a considerable rate of complications, fusion surgery is beneficial for elderly OVF patients with non-union.