The change of global spinal alignment after osteoporotic vertebral fracture and the change of lumbar pain. — The International Society for the Study of the Lumbar Spine
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  3. The change of global spinal alignment after osteoporotic vertebral fracture and the change of lumbar pain.

The change of global spinal alignment after osteoporotic vertebral fracture and the change of lumbar pain. (#1037)

Akira AI Iwata 1 , Masahiro MK Kanayama 2 , Fumihiro FO Oha 2 , Yukitoshi YS Shimamura 2 , Tomoyuki TH Hashimoto 2 , Masahiko MT Takahata 3 , Norimasa NI Iwasaki 3
  1. Hokkaido Cancer Center, Sapporo, HOKKAIDO, Japan
  2. Spine Center, Hakodate Central General Hospital, Hakodate, HOKKAIDO, Japan
  3. Hokkaido University School of Medicine, Sapporo, HOKKAIDO, Japan

Introduction

Previous study showed that the global spinal alignment would change in the patients with osteoporotic vertebral fracture (OVF). However, it is not clear that the change of global spinal alignment will affect the change of low back pain (LBP). Objective of this study is to show how LBP changes as global spinal alignment changes after OVF.

Methods

Fifty-three patients conservatively treated and followed for 96 weeks after new single-level thoracolumbar OVF were enrolled. Conservative treatment was conducted using soft lumbosacral orthosis plus osteoporosis drugs. Patients were divided into two groups depending on the distribution of the change of pelvic incidence minus lumbar lordosis (PI - LL); there were two group showing the PI-LL improved over 10 degrees (Improved PI-LL group, n = 28) and the group showing the PI-LL improved less than 10 degrees (Worsening PI-LL group, n = 25) from 24 weeks to 96 weeks after OVF. Pain scores were acquired at 24 and 96 weeks after treatment initiation using the Oswestry Disability Index (ODI), Roland–Morris Disability Questionnaire (RDQ), and Visual Analogue Scale (VAS). The differences of pain scores were examined between the two groups.

Results

In the base line of Improved group and Worsening group at 24 weeks after OVF, 20.8 ± 2.7 degrees and 16.4 ± 2.7 degrees of PI-LL (p = 0.244), 86.2% and 71.4% of the union rate (p = 0.207), 20.6 ± 1.6 degrees and 20.9 ± 1.6 degrees of local kyphosis at OVF (p = 0.883), 27.1 ± 3.9 and 19.4 ± 4.0 in VAS (p = 0.172), 39.5 ± 4.3 and 29.3 ± 4.4 in RDQ(%) (p = 0.101), and 27.4 ± 3.0 and 26.1 ± 3.0 in ODI(%) (p = 0.756), respectively. Change of pain scores from 24 weeks to 96 weeks in the Improved PI-LL group and the Worsening PI-LL group were -9.8 ± 4.4 and 7.3 ± 4.5 (p = 0.009) in VAS, -13.3± 3.0 and -5.3 ± 3.1 (p = 0.068) in RDQ(%), and -20.5 ± 4.5 and -7.7 ± 4.6 (p = 0.051) in ODI(%), respectively.

Discussion

Change of global spinal alignment after OVF showed the tendency to affect the change of LBP; pain scores from 24 weeks to 96 weeks were decreased in the patients with PI-LL improved over 10 degrees, and increased in the patients with PI-LL improved less than 10 degrees. Previous study showed that the patients with distance from C7 plumb line to OVF > 60 mm was the candidate to prevent restoration of normal global spinal alignment. So, these patients would be needed to prevent progressing global spinal man-alignment and worsening LBP.

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