Abstract

Summary

We investigated the effect of posterior lumbar fusion surgery on the regional volumetric bone mineral density (vBMD) measured by quantitative computed tomography. Surgery negatively affected the regional vBMD in adjacent levels. Interbody fusion was independently associated with vBMD decline and preoperative epidural steroid injections (ESIs) were associated with less postoperative vBMD decline.

Introduction

Few studies investigate postoperative BMD changes after lumbar fusion surgery utilizing quantitative computed tomography (QCT). Additionally, it remains unclear what preoperative and operative factors contribute to postoperative BMD changes. The purpose of this study is to investigate the effect of lumbar fusion surgery on regional volumetric bone mineral density (vBMD) in adjacent vertebrae and to identify potential modifiers for postoperative BMD change.

Methods

The data of patients undergoing posterior lumbar fusion with available pre- and postoperative CTs were reviewed. The postoperative changes in vBMD in the vertebrae one or two levels above the upper instrumented vertebra (UIV+1, UIV+2) and one level below the lower instrumented vertebra (LIV+1) were analyzed. As potential contributing factors, history of ESI, and the presence of interbody fusion, as well as various demographic/surgical factors, were included.

Results

A total of 90 patients were included in the study analysis. Mean age (±SD) was 62.1 ± 11.7. Volumetric BMD (±SD) in UIV+1 was 115.4 ± 36.9 mg/cm³ preoperatively. The percent vBMD change in UIV+1 was − 10.5 ± 12.9% (p < 0.001). UIV+2 and LIV+1 vBMD changes showed similar trends. After adjusting with the interval between surgery and the secondary CT, non-Caucasian race, ESI, and interbody fusion were independent contributors to postoperative BMD change in UIV+1.

Conclusions

Posterior lumbar fusion surgery negatively affected the regional vBMDs in adjacent levels. Interbody fusion was independently associated with vBMD decline. Preoperative ESIs were associated with less postoperative vBMD decline, which was most likely a result of a preoperative decrease in vBMD due to ESIs.

中文翻译：

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腰椎融合手术后相邻椎骨定量定量X线断层扫描术测量的局部骨矿物质密度降低

摘要

概要

我们调查了后路腰椎融合手术对区域体积骨矿物质密度（vBMD）的影响，通过定量计算机断层扫描测量。手术对邻近级别的区域vBMD产生了负面影响。椎间融合术与vBMD下降独立相关，术前硬膜外类固醇注射（ESI）与术后vBMD下降较少相关。

介绍

很少有研究利用定量计算机断层扫描（QCT）研究腰椎融合手术后术后BMD的变化。此外，尚不清楚哪些术前和手术因素会导致术后BMD改变。这项研究的目的是调查腰椎融合手术对邻近椎骨区域体积骨矿物质密度（vBMD）的影响，并确定术后BMD变化的潜在修饰因子。

方法

回顾了接受腰椎后路融合术的患者术前和术后CT资料。分析了上器械椎骨上方（UIV + 1，UIV + 2）或下器械椎骨下方（LIV + 1）一级以上的椎骨中vBMD的术后变化。作为潜在的促成因素，包括ESI的病史，体内融合的存在以及各种人口统计学/外科因素。

结果

总共90名患者被纳入研究分析。平均年龄（±SD）为62.1±11.7。术前UIV + 1的BMD（±SD）为115.4±36.9 mg / cm ³。UIV + 1中的vBMD变化百分比为− 10.5±12.9％（p  <0.001）。UIV + 2和LIV + 1 vBMD的变化显示出相似的趋势。在调整手术与继发CT的间隔后，非高加索人种，ESI和椎间融合是UIV + 1术后BMD变化的独立因素。

结论

后路腰椎融合手术对邻近水平的区域vBMD产生负面影响。椎间融合与vBMD下降独立相关。术前ESI与术后vBMD下降较少相关，这很可能是由于ESI导致术前vBMD下降的结果。