Clinical Features and Surgical Outcomes of Lower Lumbar Osteoporotic Vertebral Collapse with Symptomatic Stenosis: A Surgical Strategy from a Multicenter Case Series.

Abstract

STUDY DESIGN:

A retrospective multicenter case series was conducted.

PURPOSE:

This study was designed to investigate the clinical features and surgical outcomes of lower lumbar osteoporotic vertebral collapse (LL-OVC) with symptomatic stenosis based on various surgical procedures and classify them using the newly developed collapse severity criteria.

OVERVIEW OF LITERATURE:

The surgical outcomes of LL-OVC with symptomatic stenosis remain unclear.

METHODS:

We investigated patients who underwent surgical intervention for LL-OVC (L3, L4, and/or L5) with symptomatic foraminal and/or central stenosis from eight spine centers. Only patients with a minimum follow-up duration of 1 year were included. We developed new criteria to grade vertebral collapse severity (grade 1, 0%-25%; grade 2, 25%-50%; grade 3, 50%-75%; and grade 4, 75%-100%). The clinical features and outcomes were compared based on the collapse grade and surgical procedures performed (i.e., decompression alone, posterior lateral fusion [PLF], lateral interbody fusion [LIF], posterior/transforaminal interbody fusion [PLIF/TLIF], or vertebral column resection [VCR]).

RESULTS:

In this study, 59 patients (average age, 77.4 years) were included. The average follow-up period was 24.6 months. The clinical outcome score (Japanese Orthopaedic Association score) was more favorable in the LIF and PLIF/TLIF groups than in the decompression alone, PLF, and VCR groups. The use of VCR was associated with a high rate of revision surgery (57.1%). No significant difference in clinical outcomes was observed between the collapse grades; however, grade 4 collapse was associated with a high rate of revision surgery (40.0%).

CONCLUSIONS:

When treating LL-OVC, appropriate instrumented reconstruction with rigid intervertebral stability is necessary. According to our newly developed criteria, LIF may be a surgical option for any collapse grade. The use of VCR for grade 4 collapse is associated with a high rate of revision.

• Authors: Takayoshi Shimizu, Shunsuke Fujibayashi, Soichiro Masuda, Hiroaki Kimura, Tatsuya Ishibe, Masato Ota, Yasuyuki Tamaki, Eijiro Onishi, Hideo Ito, Bungo Otsuki, Koichi Murata, Shuichi Matsuda
• Journal: Asian spine journal (Asian Spine J) Vol. 16 Issue 6 Pg. 906-917 (Dec 2022) ISSN: 1976-1902 [Print] Korea (South)
• PMID: 35527535 (Publication Type: Journal Article)