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Article: A prospective cohort analysis of adjacent vertebral body bone mineral density in lumbar surgery patients with or without instrumented posterolateral fusion: A 9- to 12-year follow-up

TitleA prospective cohort analysis of adjacent vertebral body bone mineral density in lumbar surgery patients with or without instrumented posterolateral fusion: A 9- to 12-year follow-up
Authors
KeywordsBone mineral density
DEXA
Discectomy
Dual energy radiograph absorptiometry
Fusion
Instrumentation
Lumbar
Posterolateral
Issue Date2005
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
Citation
Spine, 2005, v. 30 n. 15, p. 1750-1755 How to Cite?
AbstractStudy Design. A prospective, cohort study of 11 patients who underwent either a posterior lumbar spinal fusion with instrumentation (n = 7) or a lumbar laminotomy and discectomy alone (n = 4) and who were evaluated by dual energy radiograph absorptiometry (DEXA) to determine bone mineral density (BMD) at the adjacent three cephalad vertebral levels. Objectives. To determine long-term BMD changes that occur at the adjacent three levels above an instrumented posterolateral lumbar fusion or an isolated laminotomy and lumbar discectomy. Summary of Background Data. No long-term prospective study has evaluated the affects of instrumented lumbar fusions on bone remodeling at adjacent vertebral levels. Several studies in animals and humans have reported a decrease in BMD at the adjacent level during the first 6 months after spinal fusion with a return to baseline at 1-year follow-up in up to 60% of patients. Methods. DEXA was performed initially at a mean postoperative follow-up of 4 years (range, 2.3-5.5 years) and again at a mean of 10.8 years (range, 9.1-2.4 years). Eleven patients were divided into two groups: laminotomy and discectomy (n = 4) and instrumented posterior spinal fusion (n = 7). All patients underwent surgical procedures at the L4-L5 or L5-S1 levels with DEXA analysis being performed on the adjacent three cephalad levels. The discectomy group (mean age, 57.8 years) underwent lumbar hemilaminotomy without fusion whereas the other group (mean age, 60 years) underwent pedicle-screw instrumentation and posterolateral lumbar fusion. Peripheral sites, including the femoral neck, were included in the DEXA analysis to normalize for individual differences in bone mineral metabolism. Results. At the mean 10.8-year follow-up, the fusion group was noted to have at the adjacent level, two levels cephalad, and three levels cephalad normalized BMDs of 1.47, 1.39, and 1.27, respectively. A 14.8%, 10.8%, and 9.5% increase respectively in normalized BMD was observed when compared with the mean 4-year fusion values (P < 0.05). This increase was also noted on comparative T-score, 2-score, and absolute BMD values (P < 0.05). The discectomy group when evaluated revealed no statistically significant change from the mean 4 to 10.8-year follow-up (BMD, normalized BMD, T-score, 2-score). No statistically significant difference was noted in hip BMD at the mean 4-year and 10.8-year follow-up (1.05 versus 1.03), suggesting that the effects were local. Conclusions. The local BMD adjacent to an instrumented lumbar fusion is increased at a mean of 10.8-years after surgery. There is a gradual decrease in BMD changes with increasing distance from the fusion level. Alterations in fusion site biomechanics and modulus mismatch between the host bone and the spinal instrumentation most likely result in chronic, localized bone remodeling with an increased BMD that decreases the greater the distance from the fusion mass. © 2005, Lippincott Williams & Wilkins, Inc.
Persistent Identifierhttp://hdl.handle.net/10722/92917
ISSN
2015 Impact Factor: 2.439
2015 SCImago Journal Rankings: 1.459
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorSingh, Ken_HK
dc.contributor.authorAn, HSen_HK
dc.contributor.authorSamartzis, Den_HK
dc.contributor.authorNassr, Aen_HK
dc.contributor.authorProvus, Jen_HK
dc.contributor.authorMickey, Men_HK
dc.contributor.authorAndersson, GBJen_HK
dc.date.accessioned2010-09-22T05:03:43Z-
dc.date.available2010-09-22T05:03:43Z-
dc.date.issued2005en_HK
dc.identifier.citationSpine, 2005, v. 30 n. 15, p. 1750-1755en_HK
dc.identifier.issn0362-2436en_HK
dc.identifier.urihttp://hdl.handle.net/10722/92917-
dc.description.abstractStudy Design. A prospective, cohort study of 11 patients who underwent either a posterior lumbar spinal fusion with instrumentation (n = 7) or a lumbar laminotomy and discectomy alone (n = 4) and who were evaluated by dual energy radiograph absorptiometry (DEXA) to determine bone mineral density (BMD) at the adjacent three cephalad vertebral levels. Objectives. To determine long-term BMD changes that occur at the adjacent three levels above an instrumented posterolateral lumbar fusion or an isolated laminotomy and lumbar discectomy. Summary of Background Data. No long-term prospective study has evaluated the affects of instrumented lumbar fusions on bone remodeling at adjacent vertebral levels. Several studies in animals and humans have reported a decrease in BMD at the adjacent level during the first 6 months after spinal fusion with a return to baseline at 1-year follow-up in up to 60% of patients. Methods. DEXA was performed initially at a mean postoperative follow-up of 4 years (range, 2.3-5.5 years) and again at a mean of 10.8 years (range, 9.1-2.4 years). Eleven patients were divided into two groups: laminotomy and discectomy (n = 4) and instrumented posterior spinal fusion (n = 7). All patients underwent surgical procedures at the L4-L5 or L5-S1 levels with DEXA analysis being performed on the adjacent three cephalad levels. The discectomy group (mean age, 57.8 years) underwent lumbar hemilaminotomy without fusion whereas the other group (mean age, 60 years) underwent pedicle-screw instrumentation and posterolateral lumbar fusion. Peripheral sites, including the femoral neck, were included in the DEXA analysis to normalize for individual differences in bone mineral metabolism. Results. At the mean 10.8-year follow-up, the fusion group was noted to have at the adjacent level, two levels cephalad, and three levels cephalad normalized BMDs of 1.47, 1.39, and 1.27, respectively. A 14.8%, 10.8%, and 9.5% increase respectively in normalized BMD was observed when compared with the mean 4-year fusion values (P < 0.05). This increase was also noted on comparative T-score, 2-score, and absolute BMD values (P < 0.05). The discectomy group when evaluated revealed no statistically significant change from the mean 4 to 10.8-year follow-up (BMD, normalized BMD, T-score, 2-score). No statistically significant difference was noted in hip BMD at the mean 4-year and 10.8-year follow-up (1.05 versus 1.03), suggesting that the effects were local. Conclusions. The local BMD adjacent to an instrumented lumbar fusion is increased at a mean of 10.8-years after surgery. There is a gradual decrease in BMD changes with increasing distance from the fusion level. Alterations in fusion site biomechanics and modulus mismatch between the host bone and the spinal instrumentation most likely result in chronic, localized bone remodeling with an increased BMD that decreases the greater the distance from the fusion mass. © 2005, Lippincott Williams & Wilkins, Inc.en_HK
dc.languageengen_HK
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.comen_HK
dc.relation.ispartofSpineen_HK
dc.subjectBone mineral densityen_HK
dc.subjectDEXAen_HK
dc.subjectDiscectomyen_HK
dc.subjectDual energy radiograph absorptiometryen_HK
dc.subjectFusionen_HK
dc.subjectInstrumentationen_HK
dc.subjectLumbaren_HK
dc.subjectPosterolateralen_HK
dc.titleA prospective cohort analysis of adjacent vertebral body bone mineral density in lumbar surgery patients with or without instrumented posterolateral fusion: A 9- to 12-year follow-upen_HK
dc.typeArticleen_HK
dc.identifier.emailSamartzis, D:dspine@hku.hken_HK
dc.identifier.authoritySamartzis, D=rp01430en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/01.brs.0000172228.74763.99en_HK
dc.identifier.pmid16094277-
dc.identifier.scopuseid_2-s2.0-23244445489en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-23244445489&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume30en_HK
dc.identifier.issue15en_HK
dc.identifier.spage1750en_HK
dc.identifier.epage1755en_HK
dc.identifier.eissn1528-1159-
dc.identifier.isiWOS:000231205200011-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridSingh, K=7404762677en_HK
dc.identifier.scopusauthoridAn, HS=7202277351en_HK
dc.identifier.scopusauthoridSamartzis, D=34572771100en_HK
dc.identifier.scopusauthoridNassr, A=22938531100en_HK
dc.identifier.scopusauthoridProvus, J=8544258500en_HK
dc.identifier.scopusauthoridMickey, M=8544258600en_HK
dc.identifier.scopusauthoridAndersson, GBJ=7202646056en_HK

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