Treatment method and clinical outcomes of vertebral compression fractures of adjacent segments after lumbar fusion surgery

English Keywords:Osteoporosis  Degenerative lumbar disease  Vertebral fracture  Spinal instrumentation  Adjacent segment disease

English Abstract:

  【Abstract】 Objectives: To analyze the characteristics of adjacent vertebral compression fracture(AVCF) after lumbar spinal fusion, and to investigate its treatment modality and clinical efficacy. Methods: 353 patients treated with lumbar fixation and fusion for lumbar degenerative diseases at our center from January 2013 to January 2019 were retrospectively analyzed, and a total of 11 patients had AVCF after fusion, all were female, aged 70±7.2 years(61-83 years) old, including 1 case of T12 vertebral fracture, 1 case of T12 combined with L1 vertebral fracture, 4 cases of L1 vertebral fracture, 2 cases of L2 vertebral fracture, 1 case of L1 combined with L2 vertebral fracture, 1 case of L3 vertebral fracture, and 1 case of L3 combined with T11 vertebral fracture. The fractures were treated accordingly based on the AVCF characteristics, three cases underwent conservative treatments such as anti-osteoporosis due to healed fractures or other underlying diseases that were not suitable for surgery; Three cases of simple fractures without severe neurological damage symptoms were treated with percutaneous kyphoplasty（PKP） under local anesthesia; Five cases of fractures combined with lower limb nerve compression symptoms were treated with posterior revision surgery, spinal canal decompression, and upward extension and pedicle screws fixation. The mean follow-up time was 24.5±6.4 months(24-31 months). The visual analogue scale(VAS) score for low back pain and lower extremity pain and Japanese Orthopaedic Association(JOA) score for lumbar spine were performed preoperatively, 1 week postoperatively, and at the final follow-up, and the occurrence of complications during the perioperative period and the follow-up were recorded. Results: The incidence of AVCF after lumbar fusion was 3.1%(11/353). The VAS score for low back pain was 5.2±2.3 preoperatively, 3.5±1.8 at 1 week postoperatively(P<0.05), and 3.9±2.0 at the final follow-up(P<0.05); the VAS score for lower extremity pain was 7.1±2.2 preoperatively, 3.0±1.6 at 1 week postoperatively(P<0.05), and 3.7±1.9 at the final follow-up(P<0.05); The JOA score of lumbar spine was 14.8±5.6 before operation, 21.5±4.2 at one week after operation(P<0.05) and 18.7±3.9 at the final follow-up(P<0.05). According to the recovery rate(RR) of JOA at the final follow-up, 5 cases were excellent, 3 cases were good, 2 cases were fair and 1 case was poor, and the satisfaction rate of clinical efficacy was 72%. A total of 4 patients (36%) had 5 complications. One patient developed a deep infection of staphylococcus aureus in the wound was treated with incision, debridement, irrigation, drainage, and sensitive antibiotics, and was cured afterward; One patient suffered from increased weakness of both lower extremities and urinary retention after surgery, and was treated with vertebral canal decompression and bone cement screw lengthening and fixation again, while after revision surgery, the patient suffered from temporary cardiac insufficiency, and recovered after treatment of salt and water restriction, cardiotonic diuresis, etc; One patient developed vertebral compression fracture after surgery and was treated with PKP bone cement reinforcement; One patient developed AVCF again and combined with intervertebral disc herniation and spinal stenosis after surgery, who underwent further revision and extended fixation. Conclusions: AVCF after lumbar fusion mostly occurs in the thoracolumbar segment and in elderly women, and simple AVCF without neurological symptoms can be treated with PKP, while AVCF with intervertebral disc herniation or spinal stenosis can be treated with lumbar revision and spinal decompression, and good clinical results can be achieved.