Can Posterior Implant Removal Prevent Device-related Vertebral Osteopenia After Posterior Fusion in Adolescent Idiopathic Scoliosis? A Mean 29-year Follow-up Study

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2019 Feb 21

PMID 30783802

Citations 1

Authors

Kei Watanabe

Masayuki Ohashi

Toru Hirano

Keiichi Katsumi

Hirokazu Shoji

Tatsuki Mizouchi

Yuya Ishikawa

Kazuhiro Hasegawa

Naoto Endo

Hideaki E Takahashi

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine whether posterior implant removal prevents stress-shielding-induced vertebral osteopenia within the posterior fusion area in surgically treated patients with adolescent idiopathic scoliosis (AIS).

Methods: Eighteen patients with major thoracic AIS (mean age, 43.3 years; range, 32-56 years; mean follow-up, 28.8 years, range, 20-39 years) who underwent posterior spinal fusion (PSF) alone between 1973 and 1994 were included. Participants were divided into implant removal (group R, n = 10, mean interval until implant removal, 50 months) and implant non-removal groups (group NR, n = 8). Bone mineral density was evaluated using the Hounsfield units (HU) of the computed tomography image of the full spine. The HU values of the UIV-1 (one level below the uppermost instrumented vertebra), apex, LIV+1 (one level above the lowermost instrumented vertebra), and LIV-1 (one level below the lowermost instrumented vertebra; as a standard value) were obtained. Stress-shielding-induced osteopenia was assessed as the UIV-1/LIV-1, apex/LIV-1, and LIV+1/LIV-1 HU ratios (× 100).

Results: Overall (median, 25th-75th percentile), the apex (144.7, 108.6-176.0) and LIV+1 (159.4, 129.7-172.3) demonstrated lower HU values than LIV-1 (180.3, 149.2-200.2) (both comparisons, p < .05). Comparison of groups R and NR showed no significant differences in the scoliosis correction rate, bone mineral density of the proximal femur, the HU absolute values of all investigated vertebrae, or in the HU ratios of the investigated vertebrae to LIV-1.

Conclusion: Instrumented PSF causes stress-shielding-induced osteopenia of the vertebral body within the fusion area in adulthood, which cannot be prevented by posterior implant removal, probably due to firm fusion mass formation. These slides can be retrieved under Electronic Supplementary Material.

Citing Articles

Outcomes following instrumentation removal after posterior corrective fixation in adolescent idiopathic scoliosis.

Yamauchi I, Nakashima H, Ito S, Segi N, Ouchida J, Morita Y Eur Spine J. 2024; 34(2):635-642.

PMID: 39653853 DOI: 10.1007/s00586-024-08519-9.

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