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18-12-2023 | Spinal Stenosis | Original Article

Changes in spinal sagittal balance after a new osteoporotic vertebral compression fracture

Authors: Kunio Yokoyama, Naokado Ikeda, Hidekazu Tanaka, Yutaka Ito, Akira Sugie, Makoto Yamada, Masahiko Wanibuchi, Masahiro Kawanishi

Published in: Osteoporosis International | Issue 4/2024

Abstract

Summary

We conduct a longitudinal study to examine how new VCF alter spinal sagittal balance. New VCF increased SVA by an average of 2.8 cm. Sagittal balance deteriorates as a VCF develops in the lower lumbar spine. A new fracture below L1 increased the relative risk of a deterioration of sagittal balance 2.9-fold compared to one above Th12.

Purpose

Studies on the relationship between osteoporotic vertebral fractures and spinal sagittal balance have all been limited to cross-sectional studies. The aim of this study is to conduct a longitudinal study to examine how new vertebral compression fracture (VCF) alter spinal sagittal balance.

Methods

Subjects were patients undergoing periodic examinations after treatment of a vertebral fracture or lumbar spinal canal stenosis. Forty patients who developed a new VCF were included in this study. Full-spine standing radiographs were compared before and after the fracture to examine changes in spinopelvic parameters and factors determining the changes in sagittal balance.

Results

The mean age of the patients was 79.0 years. The mean interval between pre- and post-fracture radiographs was 22.7 months, and the mean time between development of a fracture and post-fracture radiographs was 4.6 months. After a fracture, sagittal vertical axis (SVA) increased an average of 2.78 cm and spino-sacral angle (SSA) decreased an average of 5.3°. Both ⊿SVA and ⊿SSA were not related to pre-fracture parameters. The wedge angle of the fractured vertebra was not related to changes in sagittal balance. ⊿SVA increased markedly in patients with a fracture of the lower lumbar vertebrae. receiver operating characteristic analysis revealed that the relative risk of a deterioration of sagittal balance was 2.9 times higher for a new fracture below L1 than for a fracture above Th12.

Conclusion

New VCF increased SVA by an average of 2.8 cm. Sagittal balance deteriorates as a new fracture develops in the lower lumbar spine. Early intervention in osteoporosis is vital for the elderly.

Birknes JK, White AP, Albert TJ et al (2008) Adult degenerative scoliosis: a review. Neurosurgery 63:94–103CrossRefPubMed

Mehta VA, Amin A, Omeis I et al (2012) Implications of spinopelvic alignment for the spine surgeon. Neurosurgery 70:707–721CrossRefPubMed

Phan K, Rao PJ, Scherman DB et al (2015) Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity. J Clin Neurosci 22:1714–1721CrossRefPubMed

Schwab F, Ungar B, Blondel B et al (2012) Scoliosis research society—schwab adult spinal deformity classification. Spine 37:1077–1082CrossRefPubMed

Zhang Y, Shao Y, Liu H et al (2019) Association between sagittal balance and adjacent segment degeneration in anterior cervical surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord 20(1):430CrossRefPubMedPubMedCentral

Chau LTC, Hu Z, Ko KSY et al (2021) Global sagittal alignment of the spine, pelvis, lower limb after vertebral compression fracture and its effect on quality of life. BMC Musculoskelet Disord 22(1):476CrossRefPubMedPubMedCentral

Dai J, Yu X, Huang S et al (2015) Relationship between sagittal spinal alignment and the incidence of vertebral fracture in menopausal women with osteoporosis: a multicenter longitudinal follow-up study. Eur Spine J 24(4):737–743CrossRefPubMed

Fechtenbaum J, Etcheto A, Kolta S et al (2016) Sagittal balance of the spine in patients with osteoporotic vertebral fractures. Osteoporos Int 27(2):559–567CrossRefPubMed

Chang HS (2018) Effect of sagittal spinal balance on the outcome of decompression surgery for lumbar canal stenosis. World Neurosurg 119:e200–e208CrossRefPubMed

10.

Dohzono S, Toyoda H, Matsumoto T et al (2015) The influence of preoperative spinal sagittal balance on clinical outcomes after microendoscopic laminotomy in patients with lumbar spinal canal stenosis. J Neurosurg Spine 23(1):49–54CrossRefPubMed

11.

Katsumi R, Mannen EM, Bajaj G et al (2022) The influence of knee osteoarthritis on spinopelvic alignment and global sagittal balance. J Knee Surg 36(9):917–924

12.

Ucurum SG, Kirmizi M, Altas EU et al (2023) Sagittal spinal alignment and mobility and their relation to physical function in women with and without mild-to-moderate knee osteoarthritis. J Biomech 146:111412CrossRefPubMed

13.

Innmann MM, Weishorn J, Beaule PE et al (2020) Pathologic spinopelvic balance in patients with hip osteoarthritis : preoperative screening and therapeutic implications. Orthopade 49(10):860–869CrossRefPubMed

14.

Ochi H, Baba T, Homma Y et al (2016) Importance of the spinopelvic factors on the pelvic inclination from standing to sitting before total hip arthroplasty. Eur Spine J 25(11):3699–3706CrossRefPubMed

15.

Genant HK, Wu CY, van Kuijk C et al (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148CrossRefPubMed

16.

Jackson RP, McManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size a prospective controlled clinical study. Spine 19:1611–1618CrossRefPubMed

17.

Yokoyama K, Tanaka H, Ito Y et al (2021) Analgesic posture and pelvic morphology in patients with lumbar disc herniation. World Neurosurg 147:e411–e415CrossRefPubMed

18.

Bae J, Lee SH, Shin SH et al (2016) Radiological analysis of upper lumbar disc herniation and spinopelvic sagittal alignment. Eur Spine J 25(5):1382–1388CrossRefPubMed

19.

Kashii M, Yamazaki R, Yamashita T et al (2013) Surgical treatment for osteoporotic vertebral collapse with neurological deficits: retrospective comparative study of three procedures–anterior surgery versus posterior spinal shorting osteotomy versus posterior spinal fusion using vertebroplasty. Eur Spine J 22(7):1633–1642CrossRefPubMedPubMedCentral

20.

Sheng X, Ren S (2016) Surgical techniques for osteoporotic vertebral collapse with delayed neurological deficits: a systematic review. Int J Surg 33 Pt A:42–48CrossRefPubMed

21.

Baek SW, Kim C, Chang H (2015) The relationship between the spinopelvic balance and the incidence of adjacent vertebral fractures following percutaneous vertebroplasty. Osteoporos Int 26(5):1507–1513CrossRefPubMed

Title: Changes in spinal sagittal balance after a new osteoporotic vertebral compression fracture
Authors: Kunio Yokoyama
Naokado Ikeda
Hidekazu Tanaka
Yutaka Ito
Akira Sugie
Makoto Yamada
Masahiko Wanibuchi
Masahiro Kawanishi
Publication date: 18-12-2023
Publisher: Springer London
Keyword: Spinal Stenosis
Published in: Osteoporosis International / Issue 4/2024
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-023-06976-4

EASD 2024

Springer Medicine

Changes in spinal sagittal balance after a new osteoporotic vertebral compression fracture

Abstract

Summary

Purpose

Methods

Results

Conclusion

EASD 2024

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

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