Kusukawa Tomoyuki, Maruo Keishi, Toi Masakazu, Yamaura Tetsuto, Hatano Masaru, Nagao Kazuma, Oishi Hayato, Horinouchi Yutaka, Arizumi Fumihiro, Kishima Kazuya, Tachibana Toshiya
Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya 663-8131, Japan; Department of Orthopaedic Surgery, Osaka Minato Central Hospital, Osaka 552-0003, Japan; Department of Orthopaedic Surgery, Sasayama Medical Center, Hyogo Medical University, Tamba-Sasayama 669-2321, Japan.
Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya 663-8131, Japan; Department of Orthopaedic Surgery, Miyoshi Hospital, Miyoshi 778-0005, Japan; Department of Orthopaedic Surgery, Daiwa Central Hospital, Osaka 557-0025, Japan; Department of Orthopaedic Surgery, Goushi Hospital, Nagasu Nishidori 660-0807, Japan.
Spine J. 2024 Dec;24(12):2356-2365. doi: 10.1016/j.spinee.2024.08.009. Epub 2024 Aug 22.
Domino osteoporotic vertebral fractures (OVFs) involve multiple OVFs occurring simultaneously or sequentially, before healing of the initial OVFs. However, the risk factors and long-term clinical outcomes of domino OVFs are unclear.
To identify the risk factors associated with domino OVFs and to assess their impact on patients' quality of life (QOL).
STUDY DESIGN/SETTING: Multicenter prospective observational cohort study.
Patients (n = 190) treated conservatively for acute OVFs in 8 hospitals with 12-month follow-up.
Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Multivariate analyses were performed to identify risk factors for domino OVFs.
All patients underwent magnetic resonance imaging (MRI) at 3 months to detect subsequent domino OVFs. Domino OVF group included initial domino OVFs (multiple acute OVFs at baseline) and subsequent domino OVFs at 3 months. Paraspinal muscle assessment was performed using the lumbar indentation value and Goutallier classification. Patient characteristics, bone quality, paravertebral muscle degeneration, nutritional status, radiographic parameters, and QOL scores were compared between the nondomino and domino OVF groups.
We evaluated 50 (26.3%) patients with domino OVFs (34 with initial domino OVFs; 20 with subsequent domino OVFs). Walking ability was poorer in the domino than in the nondomino OVF group, from baseline to the 12 months follow-up. Groups with 3 or more adjacent domino OVFs showed worse VAS and ODI scores. Multivariate logistic regression analysis revealed that severe fatty degeneration of the paraspinal muscle was an independent risk factor for domino OVFs.
Severe paraspinal muscle fatty degeneration is an independent risk factor for domino OVFs. Our study showed that the quality, rather than the quantity, of paraspinal muscles had an impact on domino OVFs. Early assessment of fatty degeneration in the paraspinal muscles is essential for predicting the development of domino OVFs.
多米诺骨质疏松性椎体骨折（OVF）是指在初始骨折愈合前同时或相继发生的多个OVF。然而，多米诺OVF的危险因素和长期临床结局尚不清楚。
确定与多米诺OVF相关的危险因素，并评估其对患者生活质量（QOL）的影响。
研究设计/地点：多中心前瞻性观察队列研究。
在8家医院接受急性OVF保守治疗并进行12个月随访的患者（n = 190）。
使用视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）和日本骨科学会背痛评估问卷（JOABPEQ）评估临床结局。进行多变量分析以确定多米诺OVF的危险因素。
所有患者在3个月时接受磁共振成像（MRI）检查以检测后续的多米诺OVF。多米诺OVF组包括初始多米诺OVF（基线时多个急性OVF）和3个月时的后续多米诺OVF。使用腰椎压痕值和Goutallier分级进行椎旁肌评估。比较非多米诺和多米诺OVF组之间的患者特征、骨质、椎旁肌退变、营养状况、影像学参数和QOL评分。
我们评估了50例（26.3%）多米诺OVF患者（34例初始多米诺OVF；20例后续多米诺OVF）。从基线到12个月随访，多米诺OVF组的行走能力比非多米诺OVF组差。有3个或更多相邻多米诺OVF的组VAS和ODI评分更差。多变量逻辑回归分析显示，椎旁肌严重脂肪变性是多米诺OVF的独立危险因素。
椎旁肌严重脂肪变性是多米诺OVF的独立危险因素。我们的研究表明，椎旁肌的质量而非数量对多米诺OVF有影响。早期评估椎旁肌脂肪变性对于预测多米诺OVF的发生至关重要。
