European Spine Journal

, Volume 28, Issue 6, pp 1314–1321 | Cite as

Can posterior implant removal prevent device-related vertebral osteopenia after posterior fusion in adolescent idiopathic scoliosis? A mean 29-year follow-up study

  • Kei WatanabeEmail author
  • Masayuki Ohashi
  • Toru Hirano
  • Keiichi Katsumi
  • Hirokazu Shoji
  • Tatsuki Mizouchi
  • Yuya Ishikawa
  • Kazuhiro Hasegawa
  • Naoto Endo
  • Hideaki E. Takahashi
Original Article



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).


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).


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.


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.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Bone mineral density Adolescent idiopathic scoliosis Spinal fusion Spinal instrumentation Surgery Long-term follow-up Body mass index Body weight Bone metabolism Osteopenia Osteoporosis 



No funds were received in support of this work, and no relevant financial activities outside the submitted work exist.

Compliance with ethical standards

Conflict of interest

Kei Watanabe, Masayuki Ohashi, Toru Hirano, Keiichi Katsumi, Hirokazu Shoji, Tatsuki Mizouchi, Kazuhiro Hasegawa, Naoto Endo, and Hideaki E. Takahashi declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethics committee of the Niigata University Graduate School of Medical and Dental Sciences. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

586_2019_5921_MOESM1_ESM.pptx (138 kb)
Supplementary material 1 (PPTX 137 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Kei Watanabe
    • 1
    Email author
  • Masayuki Ohashi
    • 1
  • Toru Hirano
    • 1
  • Keiichi Katsumi
    • 2
  • Hirokazu Shoji
    • 1
  • Tatsuki Mizouchi
    • 1
  • Yuya Ishikawa
    • 1
  • Kazuhiro Hasegawa
    • 3
  • Naoto Endo
    • 1
  • Hideaki E. Takahashi
    • 4
  1. 1.Division of Orthopedic Surgery, Department of Regenerative and Transplant MedicineNiigata University Graduate School of Medical and Dental SciencesNiigata CityJapan
  2. 2.Department of Orthopedic SurgeryUonuma Kikan HospitalMinami-Uonuma CityJapan
  3. 3.Niigata Spine Surgery CenterNiigata CityJapan
  4. 4.Niigata Bone Science InstituteNiigata CityJapan

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