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Published in: Osteoporosis International 11/2015

01-11-2015 | Original Article

Improvement of spinal alignment and quality of life after corrective surgery for spinal kyphosis in patients with osteoporosis: a comparative study with non-operated patients

Authors: N. Miyakoshi, M. Hongo, T. Kobayashi, T. Abe, E. Abe, Y. Shimada

Published in: Osteoporosis International | Issue 11/2015

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Abstract

Summary

This study evaluated changes in spinal alignment and quality of life (QOL) after corrective spinal surgery for patients with postmenopausal osteoporosis and spinal kyphosis. Spinal global alignment and QOL were significantly improved after corrective spinal surgery but did not reach the level of non-operated controls.

Introduction

With the increased aging of society, the demand for corrective spinal instrumentation for spinal kyphosis in osteoporotic patients is increasing. However, previous studies have not focused on the improvement of quality of life (QOL) after corrective spinal surgery in patients with osteoporosis, compared to non-operated control patients. The purposes of this study were thus to evaluate changes in spinal alignment and QOL after corrective spinal instrumentation for patients with osteoporosis and spinal kyphosis and to compare these results with non-operated patients.

Methods

Participants comprised 39 patients with postmenopausal osteoporosis ≥50 years old who underwent corrective spinal surgery using multilevel posterior lumbar interbody fusion (PLIF) for symptomatic thoracolumbar or lumbar kyphosis, and 82 age-matched patients with postmenopausal osteoporosis without prevalent vertebral fractures. Spinopelvic parameters were evaluated with standing lateral spine radiography, and QOL was evaluated with the Japanese Osteoporosis QOL Questionnaire (JOQOL), SF-36, and Roland-Morris Disability Questionnaire (RDQ).

Results

Lumbar kyphosis angle, sagittal vertical axis, and pelvic tilt were significantly improved postoperatively. QOL evaluated with all three questionnaires also significantly improved after 6 months postoperatively, particularly in domain and subscale scores for pain and general/mental health. However, these radiographic parameters, total JOQOL score, SF-36 physical component summary score, and RDQ score were significantly inferior compared with non-operated controls.

Conclusions

The results indicate that spinal global alignment and QOL were significantly improved after corrective spinal surgery using multilevel PLIF for patients with osteoporosis and spinal kyphosis but did not reach the level of non-operated controls.
Literature
1.
go back to reference Sinaki M, Itoi E, Rogers JW, Bergstralh EJ, Wahner HW (1996) Correlation of back extensor strength with thoracic kyphosis and lumbar lordosis in estrogen-deficient women. Am J Phys Med Rehabil 75:370–374CrossRefPubMed Sinaki M, Itoi E, Rogers JW, Bergstralh EJ, Wahner HW (1996) Correlation of back extensor strength with thoracic kyphosis and lumbar lordosis in estrogen-deficient women. Am J Phys Med Rehabil 75:370–374CrossRefPubMed
2.
go back to reference Mika A, Unnithan VB, Mika P (2005) Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis. Spine (Phila Pa 1976) 30:241–246CrossRef Mika A, Unnithan VB, Mika P (2005) Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis. Spine (Phila Pa 1976) 30:241–246CrossRef
3.
go back to reference Ryan SD, Fried LP (1997) The impact of kyphosis on daily functioning. J Am Geriatr Soc 45:1479–1486CrossRefPubMed Ryan SD, Fried LP (1997) The impact of kyphosis on daily functioning. J Am Geriatr Soc 45:1479–1486CrossRefPubMed
4.
go back to reference Martin AR, Sornay-Rendu E, Chandler JM, Duboeuf F, Girman CJ, Delmas PD (2002) The impact of osteoporosis on quality-of-life: the OFELY cohort. Bone 31:32–36CrossRefPubMed Martin AR, Sornay-Rendu E, Chandler JM, Duboeuf F, Girman CJ, Delmas PD (2002) The impact of osteoporosis on quality-of-life: the OFELY cohort. Bone 31:32–36CrossRefPubMed
5.
go back to reference Miyakoshi N, Itoi E, Kobayashi M, Kodama H (2003) Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis. Osteoporos Int 14:1007–1012CrossRefPubMed Miyakoshi N, Itoi E, Kobayashi M, Kodama H (2003) Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis. Osteoporos Int 14:1007–1012CrossRefPubMed
6.
go back to reference Miyakoshi N, Hongo M, Maekawa S, Ishikawa Y, Shimada Y, Itoi E (2007) Back extensor strength and lumbar spinal mobility are predictors of quality of life in patients with postmenopausal osteoporosis. Osteoporos Int 18:1397–1403CrossRefPubMed Miyakoshi N, Hongo M, Maekawa S, Ishikawa Y, Shimada Y, Itoi E (2007) Back extensor strength and lumbar spinal mobility are predictors of quality of life in patients with postmenopausal osteoporosis. Osteoporos Int 18:1397–1403CrossRefPubMed
7.
go back to reference Roux C, Fechtenbaum J, Kolta S, Said-Nahal R, Briot K, Benhamou CL (2010) Prospective assessment of thoracic kyphosis in postmenopausal women with osteoporosis. J Bone Miner Res 25:362–368. doi:10.1359/jbmr.090727 CrossRefPubMed Roux C, Fechtenbaum J, Kolta S, Said-Nahal R, Briot K, Benhamou CL (2010) Prospective assessment of thoracic kyphosis in postmenopausal women with osteoporosis. J Bone Miner Res 25:362–368. doi:10.​1359/​jbmr.​090727 CrossRefPubMed
8.
go back to reference Hongo M, Miyakoshi N, Shimada Y, Sinaki M (2012) Association of spinal curve deformity and back extensor strength in elderly women with osteoporosis in Japan and the United States. Osteoporos Int 23:1029–1034. doi:10.1007/s00198-011-1624-z CrossRefPubMed Hongo M, Miyakoshi N, Shimada Y, Sinaki M (2012) Association of spinal curve deformity and back extensor strength in elderly women with osteoporosis in Japan and the United States. Osteoporos Int 23:1029–1034. doi:10.​1007/​s00198-011-1624-z CrossRefPubMed
9.
go back to reference Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine (Phila Pa 1976) 27:387–392CrossRef Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine (Phila Pa 1976) 27:387–392CrossRef
10.
go back to reference Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 30:2024–2029CrossRef Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 30:2024–2029CrossRef
11.
go back to reference Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 34:E599–E606. doi:10.1097/BRS.0b013e3181aad219 CrossRef Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 34:E599–E606. doi:10.​1097/​BRS.​0b013e3181aad219​ CrossRef
12.
go back to reference Schwab F, Patel A, Ungar B, Farcy JP, Lafage V (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 35:2224–2231. doi:10.1097/BRS.0b013e3181ee6bd4 CrossRef Schwab F, Patel A, Ungar B, Farcy JP, Lafage V (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 35:2224–2231. doi:10.​1097/​BRS.​0b013e3181ee6bd4​ CrossRef
13.
go back to reference Orimo H, Nakamura T, Hosoi T, Iki M, Uenishi K, Endo N, Ohta H, Shiraki M, Sugimoto T, Suzuki T, Soen S, Nishizawa Y, Hagino H, Fukunaga M, Fujiwara S (2012) Japanese 2011 guidelines for prevention and treatment of osteoporosis—executive summary. Arch Osteoporos 7:3–20PubMedCentralCrossRefPubMed Orimo H, Nakamura T, Hosoi T, Iki M, Uenishi K, Endo N, Ohta H, Shiraki M, Sugimoto T, Suzuki T, Soen S, Nishizawa Y, Hagino H, Fukunaga M, Fujiwara S (2012) Japanese 2011 guidelines for prevention and treatment of osteoporosis—executive summary. Arch Osteoporos 7:3–20PubMedCentralCrossRefPubMed
14.
go back to reference Miyakoshi N, Abe E, Kobayashi T, Abe T, Shimada Y (2012) Spinal corrective fusion using multilevel PLIF technique for lumbar spinal deformities: comparison of the surgical outcomes between the elderly and the non-elderly patients. J East Jpn Orthop Traumatology 24:62–65 (in Japanese) Miyakoshi N, Abe E, Kobayashi T, Abe T, Shimada Y (2012) Spinal corrective fusion using multilevel PLIF technique for lumbar spinal deformities: comparison of the surgical outcomes between the elderly and the non-elderly patients. J East Jpn Orthop Traumatology 24:62–65 (in Japanese)
15.
go back to reference Suzuki T, Abe E, Miyakoshi N, Murai H, Kobayashi T, Abe T, Kikuchi K, Shimada Y (2013) Posterior-approach vertebral replacement with rectangular parallelepiped cages (PAVREC) for the treatment of osteoporotic vertebral collapse with neurological deficits. J Spinal Disord Tech 26:E170–E176. doi:10.1097/BSD.0b013e318286fc18 CrossRefPubMed Suzuki T, Abe E, Miyakoshi N, Murai H, Kobayashi T, Abe T, Kikuchi K, Shimada Y (2013) Posterior-approach vertebral replacement with rectangular parallelepiped cages (PAVREC) for the treatment of osteoporotic vertebral collapse with neurological deficits. J Spinal Disord Tech 26:E170–E176. doi:10.​1097/​BSD.​0b013e318286fc18​ CrossRefPubMed
16.
go back to reference Miyakoshi N, Abe E, Kobayashi T, Suzuki T, Abe T, Hongo M, Kasukawa Y, Murai H, Shimada Y (2011) Perioperative complications of instrumented corrective surgery for spinal deformity in the healthy elderly. J Spine Res 2:337–340 Miyakoshi N, Abe E, Kobayashi T, Suzuki T, Abe T, Hongo M, Kasukawa Y, Murai H, Shimada Y (2011) Perioperative complications of instrumented corrective surgery for spinal deformity in the healthy elderly. J Spine Res 2:337–340
17.
go back to reference Takahashi H, Iwaya C, Iba K, Gorai I, Suzuki T, Hayashi Y, Fujinawa T, Yamazaki K, Endo N (2001) The Japanese osteoporosis QOL questionnaire (JOQOL): 2000 edition. J Jpn Soc Bone Miner Res 18:85–101 (in Japanese) Takahashi H, Iwaya C, Iba K, Gorai I, Suzuki T, Hayashi Y, Fujinawa T, Yamazaki K, Endo N (2001) The Japanese osteoporosis QOL questionnaire (JOQOL): 2000 edition. J Jpn Soc Bone Miner Res 18:85–101 (in Japanese)
18.
go back to reference Kumamoto K, Nakamura T, Suzuki T, Gorai I, Fujinawa O, Ohta H, Shiraki M, Yoh K, Fujiwara S, Endo N, Matsumoto T (2010) Validation of the Japanese osteoporosis quality of life questionnaire. J Bone Miner Metab 28:1–7. doi:10.1007/s00774-009-0125-z CrossRefPubMed Kumamoto K, Nakamura T, Suzuki T, Gorai I, Fujinawa O, Ohta H, Shiraki M, Yoh K, Fujiwara S, Endo N, Matsumoto T (2010) Validation of the Japanese osteoporosis quality of life questionnaire. J Bone Miner Metab 28:1–7. doi:10.​1007/​s00774-009-0125-z CrossRefPubMed
19.
go back to reference Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483CrossRefPubMed Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483CrossRefPubMed
20.
go back to reference Patel AA, Donegan D, Albert T (2007) The 36-item short form. J Am Acad Orthop Surg 15:126–134PubMed Patel AA, Donegan D, Albert T (2007) The 36-item short form. J Am Acad Orthop Surg 15:126–134PubMed
21.
go back to reference Roland M, Morris R (1983) A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 8:141–144CrossRef Roland M, Morris R (1983) A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 8:141–144CrossRef
22.
go back to reference Roland M, Morris R (1983) A study of the natural history of low-back pain. Part II: development of guidelines for trials of treatment in primary care. Spine (Phila Pa 1976) 8:145–150CrossRef Roland M, Morris R (1983) A study of the natural history of low-back pain. Part II: development of guidelines for trials of treatment in primary care. Spine (Phila Pa 1976) 8:145–150CrossRef
23.
go back to reference Randell AG, Bhalerao N, Nguyen TV, Sambrook PN, Eisman JA, Silverman SL (1998) Quality of life in osteoporosis: reliability, consistency, and validity of the osteoporosis assessment questionnaire. J Rheumatol 25:1171–1179PubMed Randell AG, Bhalerao N, Nguyen TV, Sambrook PN, Eisman JA, Silverman SL (1998) Quality of life in osteoporosis: reliability, consistency, and validity of the osteoporosis assessment questionnaire. J Rheumatol 25:1171–1179PubMed
24.
go back to reference Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O, Kanis JA, Liberman U, Minne H, Reeve J, Reginster JY, de Vernejoul MC, Wiklund I (1997) Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European foundation for osteoporosis. Osteoporos Int 7:36–38CrossRefPubMed Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O, Kanis JA, Liberman U, Minne H, Reeve J, Reginster JY, de Vernejoul MC, Wiklund I (1997) Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European foundation for osteoporosis. Osteoporos Int 7:36–38CrossRefPubMed
25.
go back to reference Cockerill W, Ismail AA, Cooper C, Matthis C, Raspe H, Silman AJ, O’Neill TW (2000) Does location of vertebral deformity within the spine influence back pain and disability? European Vertebral Osteoporosis Study (EVOS) Group. Ann Rheum Dis 59:368–371PubMedCentralCrossRefPubMed Cockerill W, Ismail AA, Cooper C, Matthis C, Raspe H, Silman AJ, O’Neill TW (2000) Does location of vertebral deformity within the spine influence back pain and disability? European Vertebral Osteoporosis Study (EVOS) Group. Ann Rheum Dis 59:368–371PubMedCentralCrossRefPubMed
26.
go back to reference Jacobs JM, Hammerman-Rozenberg R, Cohen A, Stessman J (2006) Chronic back pain among the elderly: prevalence, associations, and predictors. Spine (Phila Pa 1976) 31:E203–E207CrossRef Jacobs JM, Hammerman-Rozenberg R, Cohen A, Stessman J (2006) Chronic back pain among the elderly: prevalence, associations, and predictors. Spine (Phila Pa 1976) 31:E203–E207CrossRef
27.
28.
go back to reference Miyakoshi N, Hongo M, Shimada Y (2012) Prevalence of back pain in postmenopausal osteoporosis and associations with multiple spinal factors. In: Dionyssiotis Y (ed) Osteoporosis. InTech, Rijeka, pp 103–114 Miyakoshi N, Hongo M, Shimada Y (2012) Prevalence of back pain in postmenopausal osteoporosis and associations with multiple spinal factors. In: Dionyssiotis Y (ed) Osteoporosis. InTech, Rijeka, pp 103–114
29.
go back to reference Satoh K, Kasama F, Itoi E, Tanuma S, Wakamatsu E (1988) Clinical features of spinal osteoporosis: spinal deformity and pertinent back pain. Contemp Orthop 16:23–30 Satoh K, Kasama F, Itoi E, Tanuma S, Wakamatsu E (1988) Clinical features of spinal osteoporosis: spinal deformity and pertinent back pain. Contemp Orthop 16:23–30
31.
go back to reference Baron EM, Albert TJ (2006) Medical complications of surgical treatment of adult spinal deformity and how to avoid them. Spine (Phila Pa 1976) 31(19 Suppl):S106–S118CrossRef Baron EM, Albert TJ (2006) Medical complications of surgical treatment of adult spinal deformity and how to avoid them. Spine (Phila Pa 1976) 31(19 Suppl):S106–S118CrossRef
32.
go back to reference DeWald CJ, Stanley T (2006) Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality. Spine (Phila Pa 1976) 31(19 Suppl):S144–S151CrossRef DeWald CJ, Stanley T (2006) Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality. Spine (Phila Pa 1976) 31(19 Suppl):S144–S151CrossRef
34.
go back to reference Miyakoshi N, Kasukawa Y, Ishikawa Y, Nozaka K, Shimada Y (2010) Spinal alignment and mobility in subjects with chronic low back pain with walking disturbance: a community-dwelling study. Tohoku J Exp Med 221:53–59CrossRefPubMed Miyakoshi N, Kasukawa Y, Ishikawa Y, Nozaka K, Shimada Y (2010) Spinal alignment and mobility in subjects with chronic low back pain with walking disturbance: a community-dwelling study. Tohoku J Exp Med 221:53–59CrossRefPubMed
35.
go back to reference Joseph SA Jr, Moreno AP, Brandoff J, Casden AC, Kuflik P, Neuwirth MG (2009) Sagittal plane deformity in the adult patient. J Am Acad Orthop Surg 17:378–388PubMed Joseph SA Jr, Moreno AP, Brandoff J, Casden AC, Kuflik P, Neuwirth MG (2009) Sagittal plane deformity in the adult patient. J Am Acad Orthop Surg 17:378–388PubMed
37.
go back to reference Lau D, Clark AJ, Scheer JK, Daubs MD, Coe JD, Paonessa KJ, LaGrone MO, Kasten MD, Amaral RA, Trobisch PD, Lee JH, Fabris-Monterumici D, Anand N, Cree AK, Hart RA, Hey LA, Ames CP (2014) Proximal junctional kyphosis and failure after spinal deformity surgery: a systematic review of the literature as a background to classification development. Spine (Phila Pa 1976) 39:2093–2102. doi:10.1097/BRS.0000000000000627 CrossRef Lau D, Clark AJ, Scheer JK, Daubs MD, Coe JD, Paonessa KJ, LaGrone MO, Kasten MD, Amaral RA, Trobisch PD, Lee JH, Fabris-Monterumici D, Anand N, Cree AK, Hart RA, Hey LA, Ames CP (2014) Proximal junctional kyphosis and failure after spinal deformity surgery: a systematic review of the literature as a background to classification development. Spine (Phila Pa 1976) 39:2093–2102. doi:10.​1097/​BRS.​0000000000000627​ CrossRef
Metadata
Title
Improvement of spinal alignment and quality of life after corrective surgery for spinal kyphosis in patients with osteoporosis: a comparative study with non-operated patients
Authors
N. Miyakoshi
M. Hongo
T. Kobayashi
T. Abe
E. Abe
Y. Shimada
Publication date
01-11-2015
Publisher
Springer London
Published in
Osteoporosis International / Issue 11/2015
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-015-3163-5

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