RF90#222
Rapid Fire
Lumbar Osteoporotic Vertebral Fractures Presenting with Radiculopathy: Clinical Characteristics and Surgical Outcomes of Vertebroplasty—a Multicenter Study
Takaki Shimizu, Yasumitsu Toribatake2, Takashi Ota2, Hiroyuki Hayashi3, Tekeshi Sasagawa4, Akira Yoshida5, Yoshiro Yonezawa6, Motoya Kobayashi7, Makoto Handa8, Katsuhito Yoshioka9, Tadashi Okayama10, Yuji Tokuumi11, Takeshi Ohshima12, Koshi Nambu13, Satoshi Kato1, Noriaki Yokogawa1, Satoru Demura1 1Kanazawa University hospital, Department of Orthopaedic surgery, Kanazawa, Japan, 2Kouseiren Takaoka Hospital, Department of Orthopaedic Surgery, Takaoka, Japan 3Tonami General Hospital, Department of Orthopaedic surgery,Tonami, Japan 4Toyama Prefectural Central Hospital, Department of Orthopaedic surgery, Toyama, Japan 5Saiseikai Toyama Hospital, Department of Orthopaedic surgery, Toyama, Japan 6Yonezawa Hospital of Orthopedics, Department of Orthopaedic surgery, Kanazawa, Japan, 7Ishikawa Prfectural Central Hospital, Department of Orthopaedic surgery, Kanazawa, Japan 8Yokohama Sakae Kyosai Hospital, Department of Orthopaedic surgery, Yokohama, Japan 9Kanazawa Medical Center, Department of Orthopaedic surgery, Kanazawa, Japan 10Noto General Hospital, Department of Orthopaedic surgery, Nanao, Japan 11Asanogawa General Hospital, Department of Orthopaedic surgery, Kanazawa, Japan, 12Kanazawa Municipal Hospital, Department of Orthopaedic surgery, Kanazawa, Japan 13Toyama Prefectural Saiseikai Takaoka Hospital, Department of Orthopaedic surgery, Takaoka, Japan
Purpose: Reports on lumbar osteoporotic vertebral fractures (OVFs) accompanied by radiculopathy remain limited, and their pathomechanisms and optimal treatment strategies are not fully understood. This multicenter study aimed to clarify the clinical characteristics of lumbar OVF with radiculopathy, evaluate the surgical outcomes of vertebroplasty (VP) alone, and identify risk factors for reoperation.
Methods: Ninety-eight consecutive patients (mean age, 81 years) with acute or non-union lumbar OVF presenting with radiculopathy were retrospectively reviewed across multiple institutions. Clinical evaluations included baseline characteristics, affected nerve root level, fracture morphology (cranial-, caudal-, and cranio-caudal-type), and radiographic findings. Clinical outcomes were assessed using visual analog scale (VAS) scores for low back and leg pain and the EQ-5D-5L before and after treatment. Among the cohort, 63 patients who underwent VP alone were further divided into a reoperation group and an improved group for multivariate analysis to determine risk factors for reoperation.
Results: L4 was the most frequently affected level (34 cases, 35%), followed by L3 (26 cases, 27%). The affected nerve root corresponded to the fractured vertebral level in 76 cases (78%). Caudal-type fractures commonly caused foraminal stenosis (36 cases, 47%), whereas cranial-type fractures with posterior wall injury resulted in lateral recess stenosis (29 cases, 38%). VP alone significantly improved VAS scores for both low back and leg pain and enhanced EQ-5D-5L scores at final follow-up. However, reoperation was required in 17 patients (27%), primarily due to persistent or recurrent leg pain. Multivariate analysis identified intervertebral vacuum phenomenon (OR, 4.4) and vertebral instability with a mobility angle >10° (OR, 3.9) as independent risk factors for reoperation.
Conclusion: Lumbar OVF with radiculopathy frequently involves the mid-to-lower lumbar spine, and fracture morphology influences the pattern of nerve root compression. Although VP alone generally provides favorable clinical improvement, marked vertebral instability and dynamic intervertebral pathology are associated with poorer outcomes.