Factors affecting bone formation in patients with degenerative lumbar spine pathology

The most frequently reported risk factors for pseudarthrosis formation after spinal fusion are old age, overweight, autoimmune connective tissue disorders and tobacco smoking, nevertheless bone radiodensity as a prognostic factor has not been sufficiently studied.

THE AIM OF THE STUDY. To evaluate impact of risk factors on quality of bone fusion formation in patients with degenerative diseases of the lumbar spine treated with TLIF and PF procedures.

MATERIALS AND METHODS. The results of surgical interventions using TLIF (transforaminal interbody fusion) and PF (posterior fusion) were investigated in 93 patients. By the end of 12 months after surgical intervention anterior and posterior fusion was assessed using CT. Using logistic regression analysis patient’s age, tobacco smoking, cardiovascular diseases and vertebral bodies cancellous bone radiodensity impact on quality of bone fusion was estimated.

THE RESULTS. Only a decrease in bone radiodensity of vertebral bodies in Hounsfield units (p=0.0033) patient’s age (p=0.0146) affects interbody fusion formation. The only detected factor that has a statistically significant influence on posterior fusion formation was patient’s age (p=0.01457).

CONCLUSION. Bone radiodensity decline is a considerable risk factor for pseudarthrosis formation after interbody fusion, however no correlation between this parameter and quality of posterior fusion was detected. Posterior and interbody fusion is less likely to get formed in elderly patients. When using TLIF technology for lumbar spine degenerative pathology treatment, it is beneficial to supplement it with a posterior bone fusion, especially in patients with impaired bone quality.

1. Колесов С.В. Применение стержней из нитинола при хирургическом лечении дегенеративных заболеваний позвоночника с фиксацией пояснично-крестцового перехода / Колесов С.В., Колбовский Д.А., Казьмин А.И., Морозова Н.С. // Хирургия позвоночника — 2016.— Т. 13 — № 1 — С. 41–49.

2. Katz J.N. Lumbar Disc Disorders and Low-Back Pain: Socioeconomic Factors and Consequences / Katz J.N. // The Journal of Bone and Joint Surgery (American) — 2006.— Т. 88 — № suppl_2 — С. 21.

3. Errico T.J. A fair and balanced view of spine fusion surgery / Errico T.J., Gatchel R.J., Schofferman J., Benzel E.C., Faciszewski T., Eskay-Auerbach M., Wang J.C. // Spine Journal — 2004.— Т. 4 — № 5 SUPPL.— С.S129–S138.

4. Фадеев Е.М. Частота и структура осложнений при операциях на позвоночнике / Фадеев Е.М., Хайдаров В.М., Виссарионов С.В. // Ортопедия, травматология и восстановительная хирургия детского возраста — 2017.— Т. 5 — № 2 — С. 75–83.

5. Eliyas J.K. Surgery for Degenerative Lumbar Spine Disease / Eliyas J.K., Karahalios D. // Disease-a-Month — 2011.— Т. 57 — № 10 — С. 592–606.

6. José-Antonio S. Philosophy and Concepts of Modern Spine Surgery / под ред. A. Alexandre, M. Masini, P. Menchetti. Springer, Vienna, 2011.

7. Mobbs R.J. Anterior Lumbar Interbody Fusion as a Salvage Technique for Pseudarthrosis following Posterior Lumbar Fusion Surgery / Mobbs R.J., Phan K., Thayaparan G.K., Rao P.J. // Global Spine Journal — 2015.

8. HEGGENESS M.H. Classification of Pseudarthroses of the Lumbar Spine / HEGGENESS M.H., ESSES S.I. // Spine — 2006.

9. Mobbs R. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MITLIF, OLIF/ATP, LLIF and ALIF / Mobbs R., Phan K., Malham G., et al. // J Spine Surg — 2015.

10. Hu R.W. A population-based study of reoperations after back surgery / Hu R.W., Jaglal S., Axcell T., Anderson G. // Spine — 1997.

11. Schoell K. Depression Increases the Rates of Neurological Complications and Failed Back Surgery Syndrome in Patients Undergoing Lumbar Spine Surgery / Schoell K., Wang C., D’Oro A., Heindel P., Lee L., Wang J.C., Buser Z. // Clinical Spine Surgery — 2019.— Т. 32 — № 2 — С.E78–E85.

12. Chapin L. Preoperative Depression, Smoking, and Employment Status are Significant Factors in Patient Satisfaction After Lumbar Spine Surgery / Chapin L., Ward K., Ryken T. // Clinical Spine Surgery — 2017.— Т. 30 — № 6 — С.E725–E732.

13. Harms J. A one-stager procedure in operative treatment of spondylolistheses-dorsal traction-reposition and anterior fusion / Harms J., Rolinger H. // Zeitschrift für Orthopädie und ihre Grenzgebiete — 1982.

14. Pickhardt P.J. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications / Pickhardt P.J., Pooler B.D., Lauder T., Rio A.M. del, Bruce R.J., Binkley N. // Annals of Internal Medicine — 2013.

15. Tan G.H. CT-based classification of long spinal allograft fusion / Tan G.H., Goss B.G., Thorpe P.J., Williams R.P. // European Spine Journal — 2007.— Т. 16 — № 11 — С. 1875–1881.

16. Hadley M.N. Smoking and the human vertebral column: A review of the impact of cigarette use on vertebral bone metabolism and spinal fusion // Neurosurgery. — 1997.

17. Raizman N. M. Pseudarthrosis of the Spine / Raizman N. M., OʼBrien J.R., Poehling-Monaghan K.L., Yu W.D. // Journal of the American Academy of Orthopaedic Surgeons — 2009.— Т. 17 — № 8 — С. 494–503.

18. Schreiber J.J. Use of computed tomography for assessing bone mineral density / Schreiber J.J., Anderson P.A., Hsu W.K. // Neurosurgical Focus — 2014.— Т. 37 — № 1 — С.E4.

19. Seo J.H. Clinical Efficacy of Bone Cement Augmented Screw Fixation for the Severe Osteoporotic Spine / Seo J.H., Ju C. Il, Kim S.W., Kim J.K., Shin H. // Korean Journal of Spine — 2012.— Т. 9 — № 2 — С. 79.

20. Zaidi Q. Measurement Techniques and Utility of Hounsfield Unit Values for Assessment of Bone Quality Prior to Spinal Instrumentation / Zaidi Q., Danisa O.A., Cheng W. // SPINE — 2019.— Т. 44 — № 4 — С.E239–E244.

21. Schwaiger B.J. Bone Mineral Density Values Derived from Routine Lumbar Spine Multidetector Row CT Predict Osteoporotic Vertebral Fractures and Screw Loosening / Schwaiger B.J., Gersing A. S., Baum T., Noel P.B., Zimmer C., Bauer J.S. // American Journal of Neuroradiology — 2014.— Т. 35 — № 8 — С. 1628–1633.

22. Karikari I.O. Minimally Invasive Lumbar Interbody Fusion in Patients Older Than 70 Years of Age: Analysis of Peri- and Postoperative Complications / Karikari I.O., Grossi P.M., Nimjee S.M., Hardin C., Hodges T.R., Hughes B.D., Brown C.R., Isaacs R.E. // Neurosurgery — 2011.— Т. 68 — № 4 — С. 897–902.

23. Симонович А.Е. Применение имплантатов из пористого никелида титана в хирургии дегенеративных поражений поясничного отдела позвоночника / Симонович А.Е. // Хирургия позвоночника — 2004.— Т. 4 — С. 8–17.

24. Bydon M. Impact of smoking on complication and pseudarthrosis rates after single- and 2-level posterolateral fusion of the lumbar spine / Bydon M., La Garza-Ramos R. De, Abt N.B., Gokaslan Z.L., Wolinsky J.P., Sciubba D.M., Bydon A., Witham T.F. // Spine—2014.