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Vertebral Compression Fractures after Lumbar Instrumentation.
Michelle Granville1, Aldo Berti1, Robert E Jacobson1
1Miami Neurosurgical Center, University of Miami Hospital.
Cureus
|December 5, 2017
Summary
Patients with prior lumbar surgery for spinal stenosis may develop vertebral compression fractures (VCFs) in specific spinal locations. Instrumentation, especially short-segment, is linked to fractures near the implant, often due to osteoporosis and inactivity.
Area of Science:
- Orthopedics
- Neurosurgery
- Geriatric Medicine
Background:
- Lumbar spinal stenosis (LSS) commonly affects older adults, a demographic also at risk for osteoporosis and vertebral compression fractures (VCFs).
- Previous lumbar surgery for LSS may influence fracture patterns in this patient group.
Purpose of the Study:
- To report the incidence of lumbar and sacral osteoporotic fractures in patients with prior lumbar instrumentation surgery.
- To identify factors contributing to these fractures, including lack of osteoporosis treatment and postsurgical inactivity.
Main Methods:
- Retrospective review of patients treated for VCF following lumbar surgery for spinal stenosis.
- Comparison of VCF distribution in patients with and without spinal instrumentation.
Main Results:
- Patients without spinal instrumentation showed VCF distribution similar to the general population.
- Patients with short-segment spinal instrumentation experienced VCFs more frequently in the mid-lumbar spine or sacrum, adjacent to the instrumentation.
- Adjacent-level fractures after long-segment instrumentation were noted, consistent with existing literature.
Conclusions:
- Previous lumbar instrumentation surgery, particularly short-segment, is associated with a higher prevalence of VCFs in adjacent lumbar or sacral segments.
- Inadequate preventative medical treatment for osteoporosis and postsurgical inactivity are significant contributing factors to VCF development in these patients.
