Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China.
BMC Musculoskelet Disord. 2024 Apr 3;25(1):262. doi: 10.1186/s12891-024-07314-3.
Radiculopathy of the lower limb after acute osteoporotic vertebral fractures (OVFs) in the lower lumbar spine is uncommon in geriatric patients. Moreover, surgical intervention is generally recommended in patients who are irresponsive to conservative treatment. Determining an optimum surgical strategy is challenging considering the poor general condition of this population. Thus, herein, we established an algorithm for surgically managing this clinical scenario, hoping to provide a reference for making a surgical decision.
We retrospectively studied patients who suffered from new-onset radiculopathy of the lower limb after acute single-level OVFs in the lower lumbar spine and eventually underwent surgical intervention at our department. Information on the demographics, bone quality, AO spine classification of the vertebral fracture, pre-existing degenerative changes, including foraminal stenosis and lumbar disc herniation, and surgical intervention type was collected. Additionally, clinical outcomes, including preoperative and postoperative visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI), and MacNab criterion for response to surgery, were evaluated.
From September 2019 to December 2021, a total of 22 patients with a mean age of 68.59 ± 9.74 years were analyzed. The most involved vertebra was L5 (54.5%), followed by L4 (27.3%) and L3 (18.2%). Among the 22 patients, 15 (68.2%) were diagnosed with the A1 type fracture of AO classification, and among them, 11 (73.3%) were characterized by the collapse of the inferior end plate (IEP). Three patients (13.6%) suffered from A2-type fractures, whereas four patients (18.2%) suffered from A3-type fractures. Pre-existing degenerative changes were observed in 12 patients (54.5%) of the patients. A total of 16 patients (72.7%) were treated by percutaneous kyphoplasty (PKP). Additionally, three patients underwent posterior instrumentation and fusion, two patients underwent a secondary endoscopic foraminoplasty, and one patient underwent a secondary radiofrequency ablation. The mean follow-up period was 17.42 ± 9.62 months. The mean VAS scores for leg and back pain and ODI decreased significantly after the surgery (P < 0.05). The total satisfaction rate at the last follow-up was 90.9% per the Macnab criterion.
Patients with OVFs in the IEP are predisposed to suffer from radiculopathy of the lower limb. PKP alone or in combination with other minimally invasive surgical strategies is safe and effective in treating stable fractures. Additionally, aggressive surgical intervention should be considered in patients with unstable fractures or severe foraminal encroachment.
老年患者的下腰椎急性骨质疏松性椎体骨折（OVF）后出现下肢神经根病并不常见。而且，对于对保守治疗无反应的患者，一般建议进行手术干预。考虑到该人群的一般状况较差，确定最佳手术策略具有挑战性。因此，本文建立了一种手术治疗这种临床情况的算法，希望为手术决策提供参考。
我们回顾性研究了在我院接受手术干预的下腰椎单节段 OVF 后新发下肢神经根病的患者。收集患者的人口统计学、骨质量、AO 脊柱骨折分类、术前存在的退行性改变，包括椎间孔狭窄和腰椎间盘突出症以及手术干预类型等信息。此外，评估临床结果，包括术前和术后腰背疼痛的视觉模拟量表（VAS）评分、Oswestry 残疾指数（ODI）和 MacNab 手术反应标准。
2019 年 9 月至 2021 年 12 月，共分析了 22 例平均年龄为 68.59±9.74 岁的患者。受累最常见的椎体是 L5（54.5%），其次是 L4（27.3%）和 L3（18.2%）。22 例患者中，15 例（68.2%）诊断为 AO 分类的 A1 型骨折，其中 11 例（73.3%）表现为下终板（IEP）塌陷。3 例（13.6%）为 A2 型骨折，4 例（18.2%）为 A3 型骨折。12 例（54.5%）患者存在术前退行性改变。16 例（72.7%）患者接受经皮椎体后凸成形术（PKP）治疗。此外，3 例患者行后路内固定融合术，2 例患者行二期内镜下椎间孔成形术，1 例患者行射频消融术。平均随访时间为 17.42±9.62 个月。术后下肢和腰背疼痛的 VAS 评分以及 ODI 明显降低（P<0.05）。末次随访时，MacNab 标准的总满意度为 90.9%。
IEP 中的 OVF 患者易患下肢神经根病。PKP 单独或联合其他微创外科策略治疗稳定型骨折是安全有效的。此外，对于不稳定骨折或严重椎间孔侵占的患者，应考虑积极的手术干预。
