Can posterior implant removal prevent device-related vertebral osteopenia after posterior fusion in adolescent idiopathic scoliosis? A mean 29-year follow-up study

European spine journal

article

Kei Watanabe¹  Masayuki Ohashi¹  Toru Hirano¹  Keiichi Katsumi²  Hirokazu Shoji¹  Tatsuki Mizouchi¹  Yuya Ishikawa¹  Kazuhiro Hasegawa³  Naoto Endo¹  Hideaki E. Takahashi⁴ 

[1] Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences;Department of Orthopedic Surgery, Uonuma Kikan Hospital;Niigata Spine Surgery Center;Niigata Bone Science Institute

关键词: Bone mineral density;    Adolescent idiopathic scoliosis;    Spinal fusion;    Spinal instrumentation;    Surgery;    Longterm follow-up;    Body mass index;    Body weight;    Bone metabolism;    Osteopenia;    Osteoporosis;   

DOI  :  10.1007/s00586-019-05921-6

来源: Springer

【 摘 要 】

To determine whether posterior implant removal prevents stress-shielding-induced vertebral osteopenia within the posterior fusion area in surgically treated patients with adolescent idiopathic scoliosis (AIS). Eighteen patients with major thoracic AIS (mean age, 43.3 years; range, 32–56 years; mean follow-up, 28.8 years, range, 20–39 years) who underwent posterior spinal fusion (PSF) alone between 1973 and 1994 were included. Participants were divided into implant removal (group R, n = 10, mean interval until implant removal, 50 months) and implant non-removal groups (group NR, n = 8). Bone mineral density was evaluated using the Hounsfield units (HU) of the computed tomography image of the full spine. The HU values of the UIV−1 (one level below the uppermost instrumented vertebra), apex, LIV+1 (one level above the lowermost instrumented vertebra), and LIV−1 (one level below the lowermost instrumented vertebra; as a standard value) were obtained. Stress-shielding-induced osteopenia was assessed as the UIV−1/LIV−1, apex/LIV−1, and LIV+1/LIV−1 HU ratios (× 100). Overall (median, 25th–75th percentile), the apex (144.7, 108.6–176.0) and LIV+1 (159.4, 129.7–172.3) demonstrated lower HU values than LIV−1 (180.3, 149.2–200.2) (both comparisons, p < .05). Comparison of groups R and NR showed no significant differences in the scoliosis correction rate, bone mineral density of the proximal femur, the HU absolute values of all investigated vertebrae, or in the HU ratios of the investigated vertebrae to LIV−1. Instrumented PSF causes stress-shielding-induced osteopenia of the vertebral body within the fusion area in adulthood, which cannot be prevented by posterior implant removal, probably due to firm fusion mass formation. These slides can be retrieved under Electronic Supplementary Material.

【 授权许可】

Unknown