Correlation between lumbar vertebral compression fractures and lumbar spinal stenosis and the influence of surgical methods on prognosis

doi:10.21203/rs.3.rs-2840861/v1

Download PDF

Research Article

Correlation between lumbar vertebral compression fractures and lumbar spinal stenosis and the influence of surgical methods on prognosis

https://doi.org/10.21203/rs.3.rs-2840861/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Study Design:

Retrospective Cohort Study

OBJECTIVE

We conducted a retrospective study to evaluate the correlation of lumbar compression fractures (LCF) and lumbar spinal stenosis (LSS) ,and to explore the clinical outcomes of different surgical methods.

METHODS

A total of 134 eligible patients were divided into minor/moderate stenosis and severe/extreme stenosis groups .We counted the patients' age, sex, BMI, BMD, history of hypertension, diabetes, rheumatism and hormone used, symptom duration and history of trauma. The LLA, PI, lumbar spondylolisthesis, LSI(lumbar stenosis indexes) and fracture grades were calculated. The preoperative VAS, ODI and JOA scores of the patients were surveyed, and the clinical outcomes were followed up by telephone.

RESULTS

There is a clear correlation between the degree of LSS and the degree of fracture(r = 0.532,P < 0.0001). Severe/extreme stenosis groups was higher in BMI, proportion of trauma and lower extremity symptoms(P = 0.038, P = 0.023, P = 0.005) and lower PI(P < 0.001).There was no statistical difference in the improvement of VAS, ODI and JOA between different surgical methods (P = 0.093, P = 0.545, P = 0.576).Furthermore, for patients with preoperative lower extremity symptoms, the prognosis of decompression surgery is better than that of non-decompression surgery(improvement of VAS ,ODI ,JOA :P = 0.042, 0.032, 0.597,respective).

CONCLUSIONS

There is a clear correlation between LCF and LSS. For patients with severe LCF, it is necessary to perform relevant imaging examinations and pay attention to whether LSS is combined, especially for patients with trauma, obesity or low PI. If the patient has lower extremity symptoms, decompression surgery can be considered if the patient's general condition permits.

lumbar compression fracture

lumbar spinal stenosis

clinical outcomes

With the aging population, lumbar compression fracture (LCF) has been receiving more and more attention due to its increasing prevalence ¹. Although only about one-third of LCF are symptomatic, they still seriously affect the patient's life. Pain is the most hallmark clinical manifestation of patients, usually suddenly occurs between T8 and L4, and is aggravated by Valsalva maneuver or changing position². So far, LCF has become a considerable burden to public health services and have fairly high morbidity^{3, 4}. And its complications are also more and more concerned by clinicians, especially with regard to neurological symptoms^{5, 6}.Such as lumbar spinal stenosis (LSS), a degenerative disease that is also prevalent in the elderly population, is defined as the narrowing of any vertebral canal, foramina or lateral recess. Symptoms often manifest as low back pain, radiating to the lower extremities and buttocks, with a clear precipitating and relieving cause associated with compression of neurovascular structures within the lumbar spinal canal. Degenerative disease due to degenerative discopathy and facet arthrosis are the most common causes⁷. Although the incidence of LSS is not completely known, some studies suggested that 11–14% of patients may have varying degrees of stenosis, with still increasing frequency in older age groups ^{8, 9}.

When both LCF and LSS occur in a patient at the same time, whether there is a correlation between these two diseases is an interesting question. Many current studies have shown that changes in spinal balance in patients with osteoporosis¹⁰, loss of vertebral height¹¹, and direct posterior displacement of the vertebral body after compression fractures¹² can lead to spinal stenosis. On the other hand, one previous study of older women found that 79.2% of LSS patients had osteoporosis or osteopenia¹³. One of the possible reasons is patients with LSS often reduce activities due to lower extremity symptoms, and then lead to develop disuse osteoporosis¹⁴. One of the most critical features of LSS is the changing of gait ⁷ ,and meanwhile the existence of TSS (tandem spinal stenosis) suggests that patients with LSS are often prone to have cervical spinal stenosis ,which also causes the patient to walk unsteadily¹⁵. Both of the above symptoms could lead to traumatic events ,such as falling. Some reasons may lead to the appearance of both LCF and LSS, such as obesity¹⁶ or vitamin D deficiency¹⁷. Then, there has been less previous evidence for how to choose the surgical method for these patients. First of all, the lower BMD has an impact on the stress of the internal fixation system, increasing the risk of failure¹⁸.But, if only performed PKP at the first operation ,once the postoperative symptoms of LSS aggravate, the bone cement will have an impact on the second operation¹⁹. Some studies have demonstrated that the incidence of frailty in elderly patients with LSS is much higher than that of the general population²⁰, therefore, their surgical tolerance is often poor and likely not able to tolerate major surgery. Therefore, the purpose of this study was to explore whether there is correlation of LCF) with the occurrence of lumbar spinal stenosis (LSS) and to compare the clinical outcomes of different surgical methods.

Patient Selection

The present study included 134 patients diagnosed as LCF with concomitant LSS by using MRI after our exclusion metrics from June 2018 to June 2021. All of them were hospitalized with the main complaint of low back pain, with or without lower extremity symptoms. Among them, patients with multiple injuries, tumors, two or more lumbar spine surgeries’ history, and patients with other serious comorbidities were excluded, and patients who missing or incomplete imaging data or medical records were also excluded. We collected their demographic data ,including age, sex, BMI, BMD, and a history of hypertension, diabetes, rheumatism, or hormonal used, and history of trauma such as falls. The surgical methods performed by the patients were also documented. The ethics committee and internal review board of the First Affiliated Hospital of Nanjing Medical University approved the study, and all included patients provided written informed consent for participation and the report of their case details.

Spinal Radiography

Radiographic evaluation included lumbar fractures and stenotic segments, lumbar lordosis angle (LLA), pelvic incidence (PI), and spondylolisthesis. The LLA was defined by the Cobb angle formed between the superior endplate of L1 and the superior endplate of S1. The PI was defined as the angle between the vertical line of the sacral upper endplate midpoint and the line from the midpoint of the upper sacral endplate to the center of the hip axis.

Luner Stenosis Indexes and Grading of fracture

The LCF and LSS were also graded, and the LSI(lumbar stenosis indexes) were determined by the state of the nerve roots in cross-sectional MRI scans using the method described by Schizas et al.²¹ Table 1. LCF uses the semi-quantitative grading proposed by GENANT et al.²² Table 2. According to previous studies ^{21, 23}, the complete absence of CSF on MR cross-sections is considered a marker of severe spinal stenosis (corresponding to LSI grades 4 and 5). We accordingly divided patients with grade ≤ 3 into mild/moderate stenosis group and those with ≥ 4 into severe/extreme stenosis group.

Table 1

Lumbar Stenosis Indexes
score	Description
1	The rootlets lie dorsally and occupy less than half of the dural sac area
2	The rootlets occupy more than half of the dural sac area
3	The rootlets occupy the whole of the dural sac, but they can still be individualized. Some CSF is still present giving a grainy appearance to the sac
4	No rootlets can be recognized, the dural sac demonstrating a homogeneous gray signal with no CSF signal visible. There is epidural fat present posteriorly
5	In addition to no rootlets being recognizable ,there is no epidural fat posteriorly

Table 2

Grading of fracture
Grade	Description
1	Approximately 20–25% reduction in anterior, middle, and/or posterior height and a reduction of area 10–20%
2	Approximately 25–40% reduction in any height and a reduction in area 20–40%
3	Approximately 40% reduction in any height and area

Clinical outcomes

The patients' on admission VAS (visual analogue scale), ODI (The Oswestry Disability Index) and JOA (Japanese Orthopaedic Association Scores) of the patients were surveyed, and the postoperative VAS, ODI and JOA scores of the patients were followed up by telephone (10 patients were lost to follow-up, and 5 patients had secondary fractures and underwent surgery again were excluded). We calculated the improvement in VAS(presurgery VAS - postsurgery VAS ), improvement in ODI (postsurgery ODI- presurgery ODI)and the improvement index in JOA([JOA (post)-JOA (pre)] / [29-JOA (pre)]).

Statistical Analysis

Statistical evaluation was performed using SPSS 20.0 software (IBM Corp, Armonk, New York, USA). The results are presented as the mean ± standard deviation. For comparison of sex, disease duration, hypertension, diabetes, rheumatism, history of hormonal used, trauma, lower extremity symptoms, spondylolisthesis, chi-squared test was used. Independent sample t-test was used to compare the mean age, BMI, BMD, lumbar stenosis and fractured segments, and grading of fracture. The correlation between grading of fracture and LSI was analyzed by Pearson correlation analysis. We used multivariate analysis of variance to compare the therapeutic effects of different surgical methods for patients in severe/extreme stenosis group. Postoperative improvement in VAS/ODI/JOA of different surgical approaches in patients with preoperative lower extremity symptoms were compared by independent samples t-test. P value of < 0.05 was considered to indicate statistical significance.

Demographics and Radiological Outcomes

Among the 951 patients with LCF who underwent surgery in our hospital from June 2018 to June 2021, according to our exclusion criteria described above, there are 738 people left. Through MR examination, 134 of the remaining 738 patients had varying degrees of LSS. Of these 134 patients, 65 were male and 69 were female, with a mean age of 61.4 years (range, 42–95 years).Then, patients were divided into mild/moderate stenosis group (77 patients; 57.5%) and severe/extreme stenosis group (57 patients, 42.5%) according to the degree of stenosis as criteria as mentioned above. In this study ,98 patients (73%) had LSS caused by posterior displacement of the vertebral body at the fractured segment. 26 patients were due to herniation of the adjacent disc above the fractured vertebral body, and 17 cases were caused by the adjacent disc below (7 patients had both vertebral body and intervertebral disc compression). Twenty patients had coexisting old lumbar fractures (none were surgically treated). These patients subsequently underwent PKP, lumbar fixation, decompression and pedicle screw system internal fixation with or without PKP surgery in our hospital. Surgical options for patients with different LSI are shown in Fig. 1. LSI in patients with different grading of fracture are shown in Table 3. The statistics show that there is a clear correlation between LSI and grading of fracture(r = 0.532,P＜0.0001; Cramer’s V = 0.433,P＜0.0001).

Table 3

Chi - square test of LSI and Grading of fracture
		LSI					Total
		1	2	3	4	5	Total
Grading	1	3	12	13	1	0	29
	2	2	9	25	23	3	62
	3	1	2	10	15	15	43
Total		6	23	48	39	18	134

There were no statistical differences in age, sex, BMD, hypertension, diabetes, rheumatism, history of hormone used, and disease duration between the two groups (P > 0.05). There were also no statistical differences in lumbar spondylolisthesis (P = 0.625), and the number of fractured segments (P = 0.262) between the two groups, but the number of segments with lumbar spinal stenosis was significantly higher in the severe/extreme stenosis group(P = 0.011). As shown above, fracture grades were significantly higher in severe/extreme stenosis group (P < 0.0001). There was no significant difference in LLA between the two groups (P = 0.486), but the PI of the severe/extreme stenosis group (46.6 ± 13.0°) was significantly lower than that of the mild/moderate stenosis group (50.1 ± 12.1°) (P = 0.001). In addition, severe/extreme stenosis group was higher in BMI, proportion of trauma and lower extremity symptoms upon admission (P = 0.038, P = 0.023, P = 0.005, respectively) Table 4.

Table 4

Comparison of the minor/moderate stenosis and severe/extreme stenosis groups
Factor	Minor/moderate stenosis	Severe/extreme stenosis	P value
Age (years)	67.6 ± 16.2	61.0 ± 19.1	0.088
Sex			0.055
Male	32	32
Female	45	24
BMI (kg/m2)	23.4 ± 4.0	25.4 ± 3.8	0.038
BMD	-2.4 ± 1.4	-2.7 ± 1.5	0.355
Duration			0.844
＜1 week	57	40
＞1 week	20	16
Hypertension	22	20	0.690
Diabetes	7	4	0.385
History of hormonal medications/ rheumatism	1	2	0.867
History of injury	49	47	0.023
Lower limb pain/paresthesia	9	18	0.005
Grading of fracture Lumbar stenosis level	1.81 ± 0.71	2.52 ± 0.54	＜0.0001 0.011
Single	72	45
Multiple	4	11
Lumbar fracture level			0.262
Single	58	42
Multiple	18	14
LLA (°)	39.8 ± 12.3	38.2 ± 13.0	0.486
PI(°)	50.1 ± 12.1	46.6 ± 13.0	0.001
Spondylolisthesis	10	9	0.625
BMI: Body Mass Index; BMD: Bone Mass Measurement; LLA: lumbar lordosis angle; PI, pelvic incidence

Surgical options and prognosis

The clinical symptoms of the two groups of patients were both significantly relieved Table 5. We noticed that the improvement in ODI and JOA was significantly better in the mild/moderate stenosis group than in the severe/extreme stenosis group(P = 0.041, P = 0.002). However, there was no statistical difference in VAS improvement (P = 0.432)Table 6. From Fig. 1, we know that the main surgical options for patients in group mild/moderate group are PKP or lumbar fixation surgeries, and in most cases the treatment is equivalent to simple lumbar fracture surgeries. So, we mainly focus on the severe/extreme stenosis group of patients in the follow-up analysis. For these patients, the choice of surgery is a question worthy of consideration. The treatment effect is shown in Table 6. We performed a one-way ANOVA for the different surgical methods, and surprisingly the results showed no significant difference in the VAS (pre)-VAS (post), ODI (post)-ODI (pre) and Improvement index, respectively (P = 0.093, P = 0.545, P = 0.576, respectively) Table 7.

Table 5

Clinical outcomes before and after surgery
Groups	VAS	ODI	JOA
Minor/moderate stenosis
Presurgery	5.90 ± 1.28	0.48 ± 0.06	15.99 ± 5.35
Postsurgery	1.76 ± 1.81	0.09 ± 0.20	27.37 ± 4.09
Severe/extreme stenosis
Presurgery	6.59 ± 1.37	0.51 ± 0.07	16.25 ± 5.61
Postsurgery	2.65 ± 1.98	0.20 ± 0.23	25.09 ± 4.60
VAS: visual analogue scale; ODI: the Oswestry Disability Index; JOA, Japanese Orthopaedic Association Score

Table 6

Treatment effects of two groups
Groups	VAS (pre)-VAS (post)	ODI (post)-ODI (pre)	Improvement index
Minor/moderate stenosis	4.49 ± 1.31	0.39 ± 0.18	0.63 ± 0.07
Severe/extreme stenosis	4.26 ± 1.56	0.30 ± 0.21	0.31 ± 0.04
P value between two groups	0.432	0.041	0.002
Pre: Presurgery Post: Postsurgery VAS: visual analogue scale; ODI: the Oswestry Disability Index; JOA, Japanese Orthopaedic Association Score; Improvement index= [JOA (post)-JOA (pre)] / [29-JOA (pre)]

Table 7

Influence of different surgical methods on the treatment effect in severe/extreme stenosis group
Groups	VAS (pre)-VAS (post)	ODI (post)-ODI (pre)	Improvement index
PKP	3.82 ± 1.46	0.31 ± 0.18	0.64 ± 0.43
Lumbar fixation	3.92 ± 1.32	0.26 ± 0.23	0.53 ± 0.54
Decompression and pedicle screw system internal fixation	4.75 ± 1.75	0.28 ± 0.27	0.58 ± 0.36
Decompression and pedicle screw system internal fixation with PKP	5.8 ± 1.30	0.44 ± 0.07	0.86 ± 0.20
PKP: percutanouskyphoplasty Pre: Presurgery Post: Postsurgery VAS: visual analogue scale; ODI: the Oswestry Disability Index; JOA, Japanese Orthopaedic Association Score; Improvement index= [JOA (post)-JOA (pre)] / [29-JOA (pre)]

Both imaging and clinical symptoms are important indications that affect the choice of surgery, so, we then selected patients with preoperative lower extremity symptoms (n = 27) for analysis. Their mean LSI (3.6 ± 1.2) was higher than that of asymptomatic patients (3.1 ± 1.0), but it was not statistically significant (= 0.295). Considering that the presence of lower extremity neurological symptoms is one of the indications for lumbar decompression surgery, we compared the decompression group with the non-decompression group (There was no statistical difference in demographics between decompression group and non-decompression group, P value > 0.05). We found that, with the exception of no statistical difference in improvement index scores (P = 0.597), the improvement of VAS and ODI in the decompression surgery group was better than that in the non-decompression surgery group (P = 0.042, P = 0.032)Table 8. This may suggest that in addition to imaging, the patient's physical examination should also be one of the important indications for choosing surgery for LCF patients. When the patient has lower extremity symptoms, if the patient's conditions permit, choosing decompression surgery may be a better choice.

Table 8

Influence of different surgical methods on the treatment effect in severe/extreme stenosis group
	PKP/ Lumbar fixation	Decompression (with or without PKP)	P value
VAS (pre)-VAS (post)	4.64 ± 1.33	5.88 ± 1.36	0.042
ODI (post)-ODI (pre)	0.2914 ± 0.22	0.50 ± 0.20	0.032
Improvement index	0.69 ± 0.34	0.76 ± 0.32	0.597
PKP: percutanouskyphoplasty Pre: Presurgery Post: Postsurgery VAS: visual analogue scale; ODI: the Oswestry Disability Index; JOA, Japanese Orthopaedic Association Score; Improvement index= [JOA (post)-JOA (pre)] / [29-JOA (pre)]

Due to the aging tendency of population, LCF’s incidence is increasing rapidly. Approximately 1.5 million adults are affected by LCF each year in the United States²⁴. BMD gradually decreases with age, and almost half of normal axial bone mass is lost by age 80(24). For those older than 80, approximately 16% of men and 33% of women suffer from osteoporotic vertebral fractures²⁵. In addition to the classic low back pain, it can also cause complications such as progressive spinal deformity, pulmonary dysfunction, severe back pain, deep vein thrombosis, muscle atrophy, pressure ulcers, sleep disturbance, depression, intestinal obstruction and, sometimes is easily overlooked, LSS. Many studies thus far were concerned with the relationship between lumbar burst fractures and LSS^{12, 26, 27}, but few studies have investigated LSS in patients with the LCF, although it has a higher morbidity²⁸. We speculate that lumbar VCF and burst fractures may have some similarities in the pathogenesis of LSS, such as the deformation of the vertebral body directly compressing the spinal canal²⁹ or the loss of vertebral body height and the intervertebral foramen leading to lower extremity symptoms³⁰. And now we can say our results are broadly consistent with this view.

For LCF with LSS, the first challenge of clinicians is to diagnose it. This is sometimes easily overlooked because these patients often have severe low back pain, which may mask some lower extremity symptoms. This requires clinicians to not only pay attention to X-rays, but also CT and MR examinations². Through more detailed imaging examinations, clinicians can more accurately diagnose LSS and access its severity. Ishimoto et al. found that the most severe central spinal stenosis is closely associated with typical LSS symptoms, while mild radiographic spinal stenosis is likely to be atypical. The author also emphasizes that the lumbar vertebral osteoporotic compression fractures can cause nerve root radiating pain and claudication even if there is no obvious spinal canal compression³¹. It is notable that in our study, some patients with no obvious stenosis on MR but still have lower extremity symptoms that seriously limited their life confirmed this view. So, a complete clinical examination is also always necessary.

In this study, we found that patients with severe/extreme LSS had a higher BMI, a higher proportion of history of trauma and lower extremity symptoms. Radiographically, the patient had a higher grading of fracture and a lower PI. First, an increase in BMI increases the load on the vertebral body and intervertebral disc simultaneously, so body weight itself is an important risk factor for both LCF and LSS⁷. A study of spinal balance in patients with lumbar fractures by Fechtenbaum et al showed that there was no statistically significant difference in PI between fracture patients and controls³².Meanwhile ,Farrokhi et al. found that patients with lower PI had greater degenerative changes in the lumbar spine³³. This suggests that PI may be independent of lumbar fractures, but accelerate the occurrence of LSS in fractured patients. Trauma as a common cause of LCF, is not surprising that it occurred more frequently in the more severe stenosis group. On one hand ,patient has LSS due to degeneration and other reasons, the typical gait changes will greatly increase the probability ³⁴. On the other hand, the force can cause the vertebral body to be displaced dorsally, similar to burst fractures³⁵. Among all 134 patients in this study, 98 (73%) had LSS caused by the posterior displacement of the vertebral body of the fractured segment, which suggests that the most important factor affecting LSS in patients with fractures is the degree of the fracture itself such as retropulsion of the superior portion of the posterior wall. Our results demonstrated that that when we face severe lumbar vertebral compression fractures, it is necessary to determine whether there is LSS at the vertebral body or adjacent disc level.

After confirming that the patient has LCF with LSS, the next step is to choose the best surgical approach for the patient. We recognized that most of the patients have achieved satisfactory postoperative outcomes evaluated by VAS, ODI, and JOA compared with those at preoperative admission regardless of which surgical method was chose Table 5 .According to our statistics in Fig. 1, when the preoperative imaging indicates that the LSS is more severe, clinicians are more inclined to perform decompression surgery. However, the results in our study don’t seem to support this tendency Table 7 .This is in line with the North American Spine Society (NASS) Guideline of LSS and some other studies that there is insufficient evidence for a correlation between clinical symptoms or function and anatomic stenosis of the spinal canal on imaging^36–38. Sangbong et al. compared ODI and VAS before and 3 years after surgery in patients with different degrees of sttly enosis(without fracture), and they also did not find a statistically significant difference in the prognosis of these patients³⁹. But meanwhile ,we found that the prognosis of patients with preoperative lower extremity symptoms who choose decompression surgery is better than non-decompression surgery. In contrast, there are some studies that suggest that PKP is a sufficiently safe and effective option for patients with LCF combined with radiculopathy^{29, 30}. Their theory is PKP can increase in segmental stability provided by the cement augmentation and decrease in retropulsion and foraminal narrowing secondary to some degree of fracture reduction and height restoration ⁴⁰.But the patients selected in those two studies were all undergoing PKP, and there was no comparison with other surgeries. The study by Masaaki et al also showed that decompression surgery has a satisfactory effect on the relief of lower extremity symptoms in patients with LSS-OVF, but the problem that cannot be ignored is that the authors pointed out that these patients developed many complications such as wound infection, delirium, respiratory complications, pedicle screw loosening and adjacent vertebral fracture⁴¹. Furthermore, some other surgical methods such as spinal endoscopy or interspinous spacer^{40, 42} have also been reported to have good therapeutic effects, but the number of cases is still small and needs further study. Overall, the choice of surgery is a comprehensive issue, except for LSS ,the patient's surgical tolerance, life expectancy, and economic situation must be taken into account, which requires the clinician to exercise their own judgment.

This study has several limitations. First, we reviewed the postoperative images of the patients, but most of the patients only had X-rays after surgery, lacking MR examination results, and it was impossible to evaluate and compare the degree of spinal stenosis before and after surgery. Second, the follow-up time of this study is only 2–3 years. Considering that LSS is a chronic degenerative disease, some long-term changes could not be included in our study. Furthermore, this was a retrospective study lacking strict randomized control. Thus, further large-scale, randomized controlled study with longer follow-up time is recommended.

The results of this retrospective study indicated that there is a clear correlation between LCF and LSS. MR and monitoring for lower extremity symptoms may allow at-risk patients’ access to better management and intervention. In particular, more attention should be paid to patients with severe fractures, history of trauma, obesity, and low PI. When a patient has been diagnosed as LCF with LSS, in addition to radiology, lower extremity signs are also important indicators. If the patient has preoperative lower extremity symptoms, decompression surgery may be a better chose if the patient's general condition permits.

Ethics approval

Approved by the ethics committee and internal review board of the First Affiliated Hospital of Nanjing Medical University.

All methods were carried out in accordance with relevant institutional guidelines and regulations.

Consent to participate

Informed consent was obtained from all individual participants included in the study

Availability of data and materials

The datasets used or analysed during the current study are available from the corresponding author on reasonable request.

Conflicts of interest

The authors declare no conflicts of interest.

Consent for publication

Not applicable.

Acknowledgements

Not applicable.

Authors' contributions

Weihua Cai: Conceptualization, Methodology. Yufeng Zhu: Data curation, Investigation ,Writing- Original draft preparation. Yu Gao: Data curation. Haofan Wang: Writing- Original draft preparation, Visualization. Zhuanghui Wang: Software. Xuhui Ge:Writing - Review & Editing. Wu ye: Investigation. Jiaxing Wang:Validation. Chengyue Ji: Software, Validation. Wei liu: Supervision. Pengyu Tang: Project administration.

Credit Author Statement

Lin T, Lu J, Zhang Y, et al. Does spinal sagittal imbalance lead to future vertebral compression fractures in osteoporosis patients? Spine J. 2021;21(8): 1362-1375. https://doi.org/10.1016/j.spinee.2021.03.014.
McCarthy J, Davis A. Diagnosis and Management of Vertebral Compression Fractures. Am Fam Physician. 2016;94(1): 44-50.
Hippisley-Cox J, Coupland C. Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores. BMJ. 2009;339: b4229. https://doi.org/10.1136/bmj.b4229.
Harvey N, Dennison E, Cooper C. Osteoporosis: impact on health and economics. Nat Rev Rheumatol. 2010;6(2): 99-105. https://doi.org/10.1038/nrrheum.2009.260.
Barrada Y, Guinena Y, Hassan AH, El-Naby SA, Taher Y. Neurological complications of compression fracture of the first lumbar vertebra. J Egypt Med Assoc. 1951;34(3): 177-201.
Hershey K. Fracture complications. Crit Care Nurs Clin North Am. 2013;25(2): 321-331. https://doi.org/10.1016/j.ccell.2013.02.004.
Hennemann S, de Abreu MR. Degenerative Lumbar Spinal Stenosis. Rev Bras Ortop (Sao Paulo). 2021;56(1): 9-17. https://doi.org/10.1055/s-0040-1712490.
Jensen RK, Jensen TS, Koes B, Hartvigsen J. Prevalence of lumbar spinal stenosis in general and clinical populations: a systematic review and meta-analysis. Eur Spine J. 2020;29(9): 2143-2163. https://doi.org/10.1007/s00586-020-06339-1.
Watters WC, 3rd, Baisden J, Gilbert TJ, et al. Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J. 2008;8(2): 305-310. https://doi.org/10.1016/j.spinee.2007.10.033.
Abbas J, Peled N, Hershkovitz I, Hamoud K. Facet Tropism and Orientation: Risk Factors for Degenerative Lumbar Spinal Stenosis. Biomed Res Int. 2020;2020: 2453503. https://doi.org/10.1155/2020/2453503.
Lai MKL, Cheung PWH, Samartzis D, Cheung JPY. Prevalence and Definition of Multilevel Lumbar Developmental Spinal Stenosis. Global Spine J. 2022;12(6): 1084-1090. https://doi.org/10.1177/2192568220975384.
Saruta W, Takahashi T, Kumabe T, et al. Transdural reduction of a bone fragment protruding into the spinal canal during surgical treatment of lumbar burst fracture: A case report. Surg Neurol Int. 2021;12: 406. https://doi.org/10.25259/SNI_611_2021.
Lee BH, Moon SH, Kim HJ, Lee HM, Kim TH. Osteoporotic profiles in elderly patients with symptomatic lumbar spinal canal stenosis. Indian J Orthop. 2012;46(3): 279-284. https://doi.org/10.4103/0019-5413.96379.
Fahrleitner-Pammer A, Obernosterer A, Pilger E, et al. Hypovitaminosis D, impaired bone turnover and low bone mass are common in patients with peripheral arterial disease. Osteoporos Int. 2005;16(3): 319-324. https://doi.org/10.1007/s00198-004-1693-3.
Wang Z, Rong Y, Tang P, et al. Prevalence and Predictive Factors of Asymptomatic Spondylotic Cervical Spinal Stenosis in Patients with Symptomatic Lumbar Spinal Stenosis. World Neurosurg. 2021;151: e1051-e1058. https://doi.org/10.1016/j.wneu.2021.05.054.
Margulies JY, Payzer A, Nyska M, Neuwirth MG, Floman Y, Robin GC. The relationship between degenerative changes and osteoporosis in the lumbar spine. Clin Orthop Relat Res. 1996(324): 145-152. https://doi.org/10.1097/00003086-199603000-00017.
Kim TH, Lee BH, Lee HM, et al. Prevalence of vitamin D deficiency in patients with lumbar spinal stenosis and its relationship with pain. Pain Physician. 2013;16(2): 165-176.
Wang T, Zhao Y, Cai Z, et al. Effect of osteoporosis on internal fixation after spinal osteotomy: A finite element analysis. Clin Biomech (Bristol, Avon). 2019;69: 178-183. https://doi.org/10.1016/j.clinbiomech.2019.07.032.
Park JH, Ju CI, Kim SW. Posterior Screw Fixation in Previously Augmented Vertebrae with Bone Cement: Is It Inapplicable? J Korean Neurosurg Soc. 2018;61(1): 114-119. https://doi.org/10.3340/jkns.2017.0202.004.
Kim HJ, Park S, Park SH, et al. The prevalence and impact of frailty in patients with symptomatic lumbar spinal stenosis. Eur Spine J. 2019;28(1): 46-54. https://doi.org/10.1007/s00586-018-5710-1.
Schizas C, Theumann N, Burn A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976). 2010;35(21): 1919-1924. https://doi.org/10.1097/BRS.0b013e3181d359bd.
Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9): 1137-1148. https://doi.org/10.1002/jbmr.5650080915.
Lee CK, Rauschning W, Glenn W. Lateral lumbar spinal canal stenosis: classification, pathologic anatomy and surgical decompression. Spine (Phila Pa 1976). 1988;13(3): 313-320. https://doi.org/10.1097/00007632-198803000-00015.
Madassery S. Vertebral Compression Fractures: Evaluation and Management. Semin Intervent Radiol. 2020;37(2): 214-219. https://doi.org/10.1055/s-0040-1709208.
Lau EM, Chan HH, Woo J, Sham A, Leung PC. Body composition and bone mineral density of Chinese women with vertebral fracture. Bone. 1996;19(6): 657-662. https://doi.org/10.1016/s8756-3282(96)00279-7.
Shuman WP, Rogers JV, Sickler ME, et al. Thoracolumbar burst fractures: CT dimensions of the spinal canal relative to postsurgical improvement. AJR Am J Roentgenol. 1985;145(2): 337-341. https://doi.org/10.2214/ajr.145.2.337.
Tanriverdi B, Aydingoz O, Unlu MC, Bilsel N, Hanci M. The relationship between the ratio of interpedicular distance increase and the ratio of spinal canal compromise in thoracolumbar burst fractures. Ulus Travma Acil Cerrahi Derg. 2022;28(6): 857-862. https://doi.org/10.14744/tjtes.2021.99560.
McAfee PC, Yuan HA, Lasda NA. The unstable burst fracture. Spine (Phila Pa 1976). 1982;7(4): 365-373. https://doi.org/10.1097/00007632-198207000-00007.
Kim DE, Kim HS, Kim SW, Kim HS. Clinical analysis of acute radiculopathy after osteoporotic lumbar compression fracture. J Korean Neurosurg Soc. 2015;57(1): 32-35. https://doi.org/10.3340/jkns.2015.57.1.32.
Chung SK, Lee SH, Kim DY, Lee HY. Treatment of lower lumbar radiculopathy caused by osteoporotic compression fracture: the role of vertebroplasty. J Spinal Disord Tech. 2002;15(6): 461-468. https://doi.org/10.1097/00024720-200212000-00005.
Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med. 2008;358(8): 818-825. https://doi.org/10.1056/NEJMcp0708097.
Fechtenbaum J, Etcheto A, Kolta S, Feydy A, Roux C, Briot K. Sagittal balance of the spine in patients with osteoporotic vertebral fractures. Osteoporos Int. 2016;27(2): 559-567. https://doi.org/10.1007/s00198-015-3283-y.
Farrokhi MR, Haghnegahdar A, Rezaee H, Sharifi Rad MR. Spinal sagittal balance and spinopelvic parameters in patients with degenerative lumbar spinal stenosis; a comparative study. Clin Neurol Neurosurg. 2016;151: 136-141. https://doi.org/10.1016/j.clineuro.2016.10.020.
Hou X, Sun C, Liu X, et al. Clinical Features of Thoracic Spinal Stenosis-associated Myelopathy: A Retrospective Analysis of 427 Cases. Clin Spine Surg. 2016;29(2): 86-89. https://doi.org/10.1097/BSD.0000000000000081.
Kaplan PA, Orton DF, Asleson RJ. Osteoporosis with vertebral compression fractures, retropulsed fragments, and neurologic compromise. Radiology. 1987;165(2): 533-535. https://doi.org/10.1148/radiology.165.2.3659378.
Farrokhi MR, Alibai E, Maghami Z. Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression fractures. J Neurosurg Spine. 2011;14(5): 561-569. https://doi.org/10.3171/2010.12.SPINE10286.
Sirvanci M, Bhatia M, Ganiyusufoglu KA, et al. Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging. Eur Spine J. 2008;17(5): 679-685. https://doi.org/10.1007/s00586-008-0646-5.
Ko S. Correlations between sedimentation sign, dural sac cross-sectional area, and clinical symptoms of degenerative lumbar spinal stenosis. Eur Spine J. 2018;27(7): 1623-1628. https://doi.org/10.1007/s00586-017-5374-2.
Ko S, Lee H, Chae S, Choi W, Lee S. Direction and Severity of Root Compression Affects the Clinical Outcome After Decompression?: Correlation Between Radiologic Grading and Postoperative Prognosis in Lumbar Foraminal Stenosis. Clin Spine Surg. 2020;33(8): E415-E419. https://doi.org/10.1097/BSD.0000000000000987.
Bonaldi G, Cianfoni A. Percutaneous treatment of lumbar compression fracture with canal stenosis and neurogenic intermittent claudication: combining kyphoplasty and interspinous spacer. J Vasc Interv Radiol. 2012;23(11): 1437-1441. https://doi.org/10.1016/j.jvir.2012.06.023.
Machino M, Ando K, Kobayashi K, et al. A comparative study of two reconstruction procedures for osteoporotic vertebral fracture with lumbar spinal stenosis: Posterior lumbar interbody fusion versus posterior and anterior and combined surgery. J Orthop Sci. 2020;25(1): 52-57. https://doi.org/10.1016/j.jos.2019.02.013.
Ishimoto Y, Yamada H, Curtis E, et al. Spinal Endoscopy for Delayed-Onset Lumbar Radiculopathy Resulting from Foraminal Stenosis after Osteoporotic Vertebral Fracture: A Case Report of a New Surgical Strategy. Case Rep Orthop. 2018;2018: 1593021. https://doi.org/10.1155/2018/1593021.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Correlation between lumbar vertebral compression fractures and lumbar spinal stenosis and the influence of surgical methods on prognosis

Status:

Version 1

Abstract

Figures

INTRODUCTION

METHODS

Patient Selection

Spinal Radiography

Luner Stenosis Indexes and Grading of fracture

Clinical outcomes

Statistical Analysis

Result

Demographics and Radiological Outcomes

Surgical options and prognosis

DISCUSSION

CONCLUSIONS

Declarations

References

Additional Declarations

Status:

Version 1