Asian Spine Journal (Dec 2022)

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

  • Takayoshi Shimizu,
  • Shunsuke Fujibayashi,
  • Soichiro Masuda,
  • Hiroaki Kimura,
  • Tatsuya Ishibe,
  • Masato Ota,
  • Yasuyuki Tamaki,
  • Eijiro Onishi,
  • Hideo Ito,
  • Bungo Otsuki,
  • Koichi Murata,
  • Shuichi Matsuda

DOI
https://doi.org/10.31616/asj.2021.0421
Journal volume & issue
Vol. 16, no. 6
pp. 906 – 917

Abstract

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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.

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