Short-segmental spinal fusion for chronic low back pain with bone marrow edema adjacent to the vertebral endplate in adult spinal deformity — The International Society for the Study of the Lumbar Spine
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Short-segmental spinal fusion for chronic low back pain with bone marrow edema adjacent to the vertebral endplate in adult spinal deformity (#1247)

Toshio Nakamae 1 , Naosuke Kamei 1 , Yoshinori Fujimoto 2 , Kiyotaka Yamada 2 , Takahiro Harada 1 , Toshiaki Maruyama 1 , Nobuo Adachi 1
  1. Hiroshima University, Hiroshima, Japan
  2. JA Hiroshima General Hospital, Hiroshima, Japan

Introduction:

Corrective long spinal fusion is a widely accepted surgical method for the management of patients with adult spinal deformity. However, instrumented long-fusion for the treatment for elderly patients has been associated with a significant risk of complications and high cost of medical care. The purpose of this study was to assess the success of short-segmental spinal fusion specifically for bone marrow edema (BME) adjacent to the vertebral endplate in patients with chronic low back pain and spinal deformity.

Methods:

A cross-sectional observational study was performed at our hospital, whereby we analyzed patients with spinal deformity and accompanying chronic low back pain. For inclusion in this study, the required patient age was at least 50 years old, with a minimum LBP severity score of 40mm on the visual analogue scale (VAS). Refractory to standard conservative medical treatment was performed. We included patients with lumbar BME on magnetic resonance imaging (MRI) and a lumbar tenderness point on the BME lesion. We defined BME as an area of high signal intensity on T2-weighed fat-saturated MRI. Short spinal fusion was performed on segments of BME. Clinical evaluations of low back pain on VAS, the Oswestry Disability Index (ODI),  the radiological parameter for sagittal vertical axis (SVA)，pelvic incidence (PI)，lumbar lordosis (LL) and pelvic tilt (PT) were carried out. To analyze the clinical and radiological data, we used the Paired t-test, and statistical significance was defined as P < 0.05.

Results:

There were 27 patients (19 men and 8 woman), with a mean age of 64.6 years (range: 51 to 78 years). The mean VAS and ODI scores were 70.2 ± 2.5 mm and 48.4 ± 3.3% before surgery, 20.4 ± 2.5 mm and 31.2 ± 3.1% 1 month after surgery, and 33.4 ± 4.8 mm and 29.3 ± 3.5% 12 months after surgery, respectively. The mean VAS and ODI scores significantly improved after surgery. The mean spinal fusion ranges were 1.3 segments. The SVA, PI-LL, and PT scores were 60.7 ± 10.6 mm, 20.5 ± 3.9 degrees, and 23.8 ± 2.0 degrees before surgery, respectively. These spinal alignment parameters did not change significantly after surgery. MRI showed the BME to decrease after surgery.

Discussion:

Short-segmental spinal fusion is an effective procedure for chronic low back pain and spinal deformity with BME adjacent to the vertebral endplate.

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