Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Clinical outcomes and risk factors associated with spinal kyphotic deformity following osteoporotic vertebral fracture.   Loss of lower lumbar lordosis cause spinal kyphotic deformity and affect activities of daily living after osteoporotic vertebral fracture. (#165)

Hayato H.O Oishi 1 2 , Keishi K.M Maruo 2 3 , Tomoyuki T.K Kusukawa 2 4 , Tetsto T.Y Yamaura 2 5 , Kazuma K.N Nagao 2 6 , Masaru M.H Hatano 2 7 , Masakazu M.T Toi 2 , Norichika N.Y Yoshie 2 8 , Kazuya K.K Kishima 2 , Fumihiro F.A Arizumi 2 , Toshiya T.T Tachibana 2
  1. Harima Hospital, Kakogun, Hyogo , Japan
  2. Department of Orthopedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo , Japan
  3. Goshi Hospital, Amagasaki, Hyogo, Japan
  4. Hyogo College of Medicine, Sasayama Medical Center, Tanba Sasayama, Hyogo, Japan
  5. Miyoshi Hospital, Nishinomiya, Hyogo, Japan
  6. Takarazuka City Hospital, Takarazuka, Hyogo, Japan
  7. daiwa central Hospital, osaka, Osaka, Japan
  8. Osaka bay cetral Hospital, Osaka, Japan

(Introduction)

The causes of kyphosis deformity after osteoporotic vertebral fracture (OVF) are still unknown. Multifactors such as severe kyphotic deformity, pre-existing lumbar degeneration, and sarcopenia may have a key role in spinal alignment. The aim of this study was to investigate the impact of global sagittal alignment (GSA) on clinical outcomes and to identify the factors associated with kyphosis deformity after conservative treatment for OVF.

(Methods)

This study is a prospective multicenter cohort study conducted in eight hospitals. The inclusion criteria as follow: 1) acute single OVF occurring within 3 weeks, 2) aged >60 years, 3) single OVF, and 4) follow-up period for 12-months. A total of 70 patients met the inclusion criteria. The GSA at 12-months was divided into 3 groups: SVA<40 mm (Group A), 40 mm≤ SVA≤95 mm (Group B), SVA>95 mm (Group C). Patient characteristics (age, sex, BMI, bone mineral density), fatty degeneration of paraspinal muscles (Goutallier classification), lumbar indentation value (LIV), and PMI (psoas muscle index) as an index of sarcopenia were compared among 3 groups. The location of fracture (T:T7-9, TL: T10-L2, L: L3-5)), number of prevalent fractures, SQ grade, clinical outcome (JOA Back Pain Evaluation Questionnaire [JOABPEQ], Oswestry Disability Index [ODI], and Visual analog scale [VAS] for low back pain [LBP], and radiographic parameters (TK, TLK, LL, lower LL, PI, PT, PI-LL, wedge angle) were compared among three groups. Statistical analysis was conducted using ANOVA tests, chi-squared tests, and the Turkey-Kramer test.

(Results)

There were 20 patients in Group A, 34 patients in Group B, and 16 patients in Group C. No significant difference were observed in JOABPEQ, ODI, and VAS at baseline. However, there were significant difference in gait ability of JOABPEQ (A: 74.9 vs B: 59.7 vs C: 41.2, p=0.012) and ODI (A: 19 vs B: 23.9 vs C: 41.7, p=0.006) at 12-months. Lumbar fracture site (L3-5) were tended to be more common in the group C (A: 10% vs. B: 17.6% vs. C: 43.7%, p=0.15). Severe fatty degeneration tended to be more common in the group C (A: 21% vs. B: 39% vs. C: 50%, p=0.19). On the other hand, LIV and PMI were equivalent between the two groups. Wedge angle and SQ grade were similar among three groups. There was no significant difference in TK an TLK among three group. The LLL was significantly lower in the group C (A: 33.2° vs. B: 26.9° vs. C: 23.3°, p=0.01) than the group A at 12-months.

 

(Discussion)

Post-OVF kyphotic deformity had a negative impact on gait ability and ODI. Lower lumbar OVF, loss of lower LL, and fatty degeneration may cause kyphotic deformity after OVF.