Is Bone Nonunion, Vertebral Deformity, or Spinopelvic Malalignment the Best Therapeutic Target for Amelioration of Low Back Pain After Osteoporotic Vertebral Fracture?
Aged
Aged, 80 and over
Alendronate
/ therapeutic use
Cohort Studies
Conservative Treatment
Female
Humans
Kyphosis
Low Back Pain
/ complications
Male
Middle Aged
Osteoporosis
/ complications
Osteoporotic Fractures
/ complications
Risk Factors
Spinal Fractures
/ complications
Spine
Teriparatide
/ therapeutic use
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Jul 2020
01 Jul 2020
Historique:
pubmed:
13
2
2020
medline:
15
9
2020
entrez:
13
2
2020
Statut:
ppublish
Résumé
Cohort study (level 3). The aim of this study was to identify independent risk factors for residual low back pain (LBP) following osteoporotic vertebral fracture (OVF). Nonunion has been proposed as the primary cause of residual LBP following OVF. However, LBP can occur even when union is maintained. Other reported causes of LBP after OVF include vertebral deformities and spinopelvic malalignment. Sixty-seven patients with single-level thoracolumbar OVF who had not received previous osteoporotic treatment were enrolled. Conservative treatment was conducted using a soft lumbosacral orthosis plus osteoporosis drugs, either weekly alendronate (bisphosphonate) or daily teriparatide. Pain scores, kyphosis angle of fractured vertebra (VKA), and spinopelvic alignment, including pelvic incidence minus lumbar lordosis (PI-LL), were assessed periodically during treatment. Radiographic union was evaluated independently by three specialists at 24 weeks post-admission. Patients were divided by pain scores >40% at 24 weeks into the LBP (n = 36) and non-LBP (n = 31) groups. Temporal changes and statistical associations were examined to identify risk factors for LBP at 24 weeks. At 24 weeks, 25% of OVFs failed to achieve union. The LBP group consisted of 71% of nonunion and 48% of union cases. Stepwise multinomial regression analysis showed VKA at 24 weeks >25° was significant risk factor for the LBP group (odds ratio: 6.24, 95% confidence interval: 1.77-22.02, P = 0.004). Significant differences in VKA emerged during treatment in the LBP group, but PI-LL showed the tendency not to change throughout the treatment period. Non-union was correlated with VKA (area under the curve: 0.864). Although spinopelvic malalignment is considered as a preexisting factor for LBP, VKA exacerbated by nonunion predominantly led to LBP after a new OVF. Each incidence of OVF should be treated to limit further morphological changes to the fractured vertebra. 3.
Sections du résumé
STUDY DESIGN
METHODS
Cohort study (level 3).
OBJECTIVE
OBJECTIVE
The aim of this study was to identify independent risk factors for residual low back pain (LBP) following osteoporotic vertebral fracture (OVF).
SUMMARY OF BACKGROUND DATA
BACKGROUND
Nonunion has been proposed as the primary cause of residual LBP following OVF. However, LBP can occur even when union is maintained. Other reported causes of LBP after OVF include vertebral deformities and spinopelvic malalignment.
METHODS
METHODS
Sixty-seven patients with single-level thoracolumbar OVF who had not received previous osteoporotic treatment were enrolled. Conservative treatment was conducted using a soft lumbosacral orthosis plus osteoporosis drugs, either weekly alendronate (bisphosphonate) or daily teriparatide. Pain scores, kyphosis angle of fractured vertebra (VKA), and spinopelvic alignment, including pelvic incidence minus lumbar lordosis (PI-LL), were assessed periodically during treatment. Radiographic union was evaluated independently by three specialists at 24 weeks post-admission. Patients were divided by pain scores >40% at 24 weeks into the LBP (n = 36) and non-LBP (n = 31) groups. Temporal changes and statistical associations were examined to identify risk factors for LBP at 24 weeks.
RESULTS
RESULTS
At 24 weeks, 25% of OVFs failed to achieve union. The LBP group consisted of 71% of nonunion and 48% of union cases. Stepwise multinomial regression analysis showed VKA at 24 weeks >25° was significant risk factor for the LBP group (odds ratio: 6.24, 95% confidence interval: 1.77-22.02, P = 0.004). Significant differences in VKA emerged during treatment in the LBP group, but PI-LL showed the tendency not to change throughout the treatment period. Non-union was correlated with VKA (area under the curve: 0.864).
CONCLUSION
CONCLUSIONS
Although spinopelvic malalignment is considered as a preexisting factor for LBP, VKA exacerbated by nonunion predominantly led to LBP after a new OVF. Each incidence of OVF should be treated to limit further morphological changes to the fractured vertebra.
LEVEL OF EVIDENCE
METHODS
3.
Identifiants
pubmed: 32049935
doi: 10.1097/BRS.0000000000003422
pii: 00007632-202007010-00005
doi:
Substances chimiques
Teriparatide
10T9CSU89I
Alendronate
X1J18R4W8P
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E760-E767Références
Francis RM, Aspray TJ, Hide G, et al. Back pain in osteoporotic vertebral fractures. Osteoporos Int 2008; 19:895–903.
Roy DK, O’Neill TW, Finn JD, et al. European Prospective Osteoporosis Study (EPOS). Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 2003; 14:19–26.
Adami S, Giannini S, Giorgino R, et al. The effect of age, weight, and lifestyle factors on calcaneal quantitative ultrasound: the ESOPO study. Osteoporos Int 2003; 14:198–207.
Melton LJ, Kan SH, Frye MA, et al. Epidemiology of vertebral fractures in women. Am J Epidemiol 1989; 129:1000–1011.
Iwata A, Kanayama M, Oha F, et al. Effect of teriparatide (rh-PTH 1-34) versus bisphosphonate on the healing of osteoporotic vertebral compression fracture: A retrospective comparative study. BMC Musculoskelet Disord 2017; 18:148.
Robinson Y, Heyde CE, Försth P, et al. Kyphoplasty in osteoporotic vertebral compression fractures—guidelines and technical considerations. J Orthop Surg Res 2011; 6:43.
Wang H, Sribastav SS, Ye F, et al. Comparison of percutaneous vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures: a meta-analysis of the literature. Pain Physician 2015; 18:209–222.
Melton LJ, Kallmes DF. Epidemiology of vertebral fractures: implications for vertebral augmentation. Acad Radiol 2006; 13:538–545.
Iwata A, Kanayama M, Oha F, et al. Does spinopelvic alignment affect the union status in thoracolumbar osteoporotic vertebral compression fracture? Eur J Orthop Surg Traumatol 2016; 27:87–92.
Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 2012; 37:1077–1082.
Laouissat F, Sebaaly A, Gehrchen M, et al. Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J 2018; 27:2002–2011.
McDowell MM, Tempel ZJ, Gandhoke GS, et al. Evolution of sagittal imbalance following corrective surgery for sagittal plane deformity. Neurosurgery 2017; 81:129–134.
Sabou S, Tseng TH, Stephenson J, et al. Correction of sagittal plane deformity and predictive factors for a favourable radiological outcome following multilevel posterior lumbar interbody fusion for mild degenerative scoliosis. Eur Spine J 2016; 25:2520–2526.
Silverman SL, Piziak VK, Chen P, et al. Relationship of health related quality of life to prevalent and new or worsening back pain in postmenopausal women with osteoporosis. J Rheumatol 2005; 32:2405–2409.
Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976) 2000; 25:2940–2952.
Roland M, Morris R. A study of the natural history of low-back pain. Part II: development of guidelines for trials of treatment in primary care. Spine (Phila Pa 1976) 1983; 8:145–150.
Lyritis GP, Mayasis B, Tsakalakos N, et al. The natural history of the osteoporotic vertebral fracture. Clin Rheumatol 1989; 8:66–69.
Briggs AM, Wrigley TV, van Dieën JH, et al. The effect of osteoporotic vertebral fracture on predicted spinal loads in vivo. Eur Spine J 2006; 15:1785–1795.
Tanishima S, Hagino H, Matsumoto H, et al. Association between sarcopenia and low back pain in local residents prospective cohort study from the GAINA study. BMC Musculoskelet Disord 2017; 18:452.
Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 1998; 147:755–763.
Pinheiro MB, Ferreira ML, Refshauge K, et al. Symptoms of depression and risk of new episodes of low back pain: a systematic review and meta-analysis. Arthritis Care Res 2015; 67:1591–1603.
Pinheiro MB, Ferreira ML, Refshauge K, et al. Symptoms of depression as a prognostic factor for low back pain: a systematic review. Spine J 2016; 16:105–116.
Saragiotto BT, Maher CG, Yamato TP, et al. Motor control exercise for nonspecific low back pain: a cochrane review. Spine (Phila Pa 1976) 2016; 41:1284–1295.
Gomes-Neto M, Lopes JM, Conceição CS, et al. Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: a systematic review and meta-analysis. Phys Ther Sport 2017; 23:136–142.