Abstract
Lumbar spinal stenosis (LSS) is primarily found in an older population. This is a similar demographic group that develops both osteoporosis and vertebral compression fractures (VCF). This report reviewed a series of patients treated for VCF that had previous lumbar surgery for symptomatic spinal stenosis. Patients that only underwent laminectomy or fusion without instrumentation had a similar distribution of VCF as the non-surgical population in the mid-thoracic, or lower thoracic and upper lumbar spine. However, in the patients that had previous short-segment spinal instrumentation, fractures were found to be located more commonly in the mid-lumbar spine or sacrum adjacent to or within one or two spinal segments of the spinal instrumentation. Adjacent-level fractures that occur due to vertebral osteoporosis after long spinal segment instrumentation has been discussed in the literature. The purpose of this report is to highlight the previously unreported finding of frequent lumbar and sacral osteoporotic fractures in post-lumbar instrumentation surgery patients. Important additional factors found were lack of preventative medical treatment for osteoporosis, and secondary effects related to inactivity, especially during the first year after surgery.
Highlights
As the population becomes older, it is common to see patients developing concurrent spinal problems such as lumbar spinal stenosis (LSS), degenerative spondylolisthesis (DSL), and osteoporotic vertebral compression fractures (VCF)
Often patients are being studied for one problem, such as a traumatic VCF, and are found to have previously asymptomatic lumbar stenosis or spondylolisthesis; or the reverse, where a patient is being evaluated for radicular pain or neurogenic claudication, and is found to have a previous VCF [3, 5] (Figure 1)
There were two lumbar fractures located at L3 and one each located at L2 and L5
Summary
As the population becomes older, it is common to see patients developing concurrent spinal problems such as lumbar spinal stenosis (LSS), degenerative spondylolisthesis (DSL), and osteoporotic vertebral compression fractures (VCF). These conditions often affect the same or adjacent regions of the thoracic and lumbar spine [1,2,3]. Large radiologic and anatomic studies have shown a biphasic distribution of VCF with 45% to 55% found in the mid-thoracic spine from T6 to T8, and 10% to 20% from T12 to L2 [4]. Often patients are being studied for one problem, such as a traumatic VCF, and are found to have previously asymptomatic lumbar stenosis or spondylolisthesis; or the reverse, where a patient is being evaluated for radicular pain or neurogenic claudication, and is found to have a previous VCF [3, 5] (Figure 1)
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