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

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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.

Graphical abstract

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References

  1. Cheng JC, Guo X, Sher AH (1999) Persistent osteopenia in adolescent idiopathic scoliosis. A longitudinal follow up study. Spine 24:1218–1222

    Article  CAS  PubMed  Google Scholar 

  2. Hung VW, Qin L, Cheung CS et al (2005) Osteopenia: a new prognostic factor of curve progression in adolescent idiopathic scoliosis. J Bone Joint Surg Am 87:2709–2716

    CAS  PubMed  Google Scholar 

  3. Ishida K, Aota Y, Mitsugi N et al (2015) Relationship between bone density and bone metabolism in adolescent idiopathic scoliosis. Scoliosis 10:19

    Article  PubMed  PubMed Central  Google Scholar 

  4. McAfee PC, Farey ID, Sutterlin CE et al (1989) Device-related osteoporosis with spinal instrumentation. Spine 14:919–926

    Article  CAS  PubMed  Google Scholar 

  5. Ito M, Fay LA, Ito Y et al (1997) The effect of pulsed electromagnetic fields on instrumented posterolateral spinal fusion and device-related stress shielding. Spine 22:382–388

    Article  CAS  PubMed  Google Scholar 

  6. Schreiber JJ, Anderson PA, Rosas HG et al (2011) Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am 93:1057–1063

    Article  PubMed  Google Scholar 

  7. Pervaiz K, Cabezas A, Downes K et al (2013) Osteoporosis and shoulder osteoarthritis: incidence, risk factors, and surgical implications. J Shoulder Elbow Surg 22:e1–e8

    Article  PubMed  Google Scholar 

  8. Pickhardt PJ, Pooler BD, Lauder T et al (2013) Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 158:588–595

    Article  PubMed  PubMed Central  Google Scholar 

  9. Meredith DS, Schreiber JJ, Taher F et al (2013) Lower preoperative Hounsfield unit measurements are associated with adjacent segment fracture after spinal fusion. Spine 38:415–418

    Article  PubMed  Google Scholar 

  10. Krappinger D, Bizzotto N, Riedmann S et al (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42:1283–1288

    Article  Google Scholar 

  11. Schreiber JJ, Hughes AP, Taher F et al (2014) An association can be found between Hounsfield units and success of lumbar spine fusion. HSS J 10:25–29

    Article  PubMed  Google Scholar 

  12. Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis. A new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83-A:1169–1181

    Article  Google Scholar 

  13. Ylikoski M (2003) Height of girls with adolescent idiopathic scoliosis. Eur Spine J 12:288–291

    PubMed  PubMed Central  Google Scholar 

  14. Ohashi M, Hirano T, Watanabe K et al (2018) Bone Mineral density after spinal fusion surgery for adolescent idiopathic scoliosis at a minimum 20-year follow-up. Spine Deform 6:170–176

    Article  PubMed  Google Scholar 

  15. Szalay EA, Bosch P, Schwend RM et al (2008) Adolescents with idiopathic scoliosis are not osteoporotic. Spine 33:802–806

    Article  PubMed  Google Scholar 

  16. Zagra A, Lamartina C, Pace A et al (1988) Posterior spinal fusion in scoliosis: computer-assisted tomography and biomechanics of the fusion mass. Spine 13:155–161

    Article  CAS  PubMed  Google Scholar 

  17. Zagra A, Lamartina C, Pace A et al (1990) Computer-assisted tomography of scoliosis operated with or without Harrington’s rod. Biomechanics aspects of the fusion. Spine 15:796–802

    Article  CAS  PubMed  Google Scholar 

  18. Demir Ö, Öksüz E, Deniz FE et al (2017) Assessing the effects of lumbar posterior stabilization and fusion to vertebral bone density in stabilized and adjacent segments by using Hounsfield unit. J Spine Surg 3:548–553

    Article  PubMed  PubMed Central  Google Scholar 

  19. Obid P, Richter A, Ubeyli H et al (2012) Spontaneous bilateral pedicle fracture 30 years after Harrington instrumentation for idiopathic scoliosis: a case report. J Med Case Rep 6:29

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tribus CB, Bradford DS (1993) Bilateral pedicular stress fractures after successful posterior spinal fusion for adult idiopathic scoliosis. Spine 18:1222e5

    Article  Google Scholar 

  21. Knight RQ, Chan DP (1992) Idiopathic scoliosis with unusual stress fracture of the pedicle within solid fusion mass: a case report. Spine 17:849e51

    Article  Google Scholar 

  22. Chaki O, Yoshikata I, Kikuchi R et al (2000) The predictive value of biomechanical markers of bone turnover for bone mineral density in postmenopausal Japanese women. J Bone Miner Res 15:1537–1544

    Article  CAS  PubMed  Google Scholar 

  23. Bergmann P, Body JJ, Boonen S et al (2009) Evidence-based guidelines for the use of biochemical markers of bone turnover in the selection and monitoring of bisphosphonate treatment in osteoporosis: a consensus document of the Belgian Bone Club. Int J Clin Pract 63:19–26

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Potter BK, Kirk KL, Shah SA et al (2006) Loss of coronal correction following instrumentation removal in adolescent idiopathic scoliosis. Spine 31:67–72

    Article  PubMed  Google Scholar 

  25. Farshad M, Sdzuy C, Min K (2013) Late implant removal after posterior correction of AIS with pedicle screw instrumentation—a matched case control study with 10-year follow-up. Spine Deform 1:68–71

    Article  PubMed  Google Scholar 

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Funding

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

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Authors and Affiliations

  1. Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, 951-8510, Niigata, Japan

    Kei Watanabe, Masayuki Ohashi, Toru Hirano, Hirokazu Shoji, Tatsuki Mizouchi, Yuya Ishikawa & Naoto Endo

  2. Department of Orthopedic Surgery, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma City, 949-7302, Niigata, Japan

    Keiichi Katsumi

  3. Niigata Spine Surgery Center, 2-5-22 Nishimachi, Konanku, Niigata City, 950-0165, Niigata, Japan

    Kazuhiro Hasegawa

  4. Niigata Bone Science Institute, 761 Kizaki, Kitaku, Niigata City, 950-3304, Niigata, Japan

    Hideaki E. Takahashi

Authors
  1. Kei Watanabe
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  2. Masayuki Ohashi
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  3. Toru Hirano
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  4. Keiichi Katsumi
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  5. Hirokazu Shoji
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  6. Tatsuki Mizouchi
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  7. Yuya Ishikawa
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  8. Kazuhiro Hasegawa
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  9. Naoto Endo
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  10. Hideaki E. Takahashi
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Corresponding author

Correspondence to Kei Watanabe.

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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.

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

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Electronic supplementary material

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Supplementary material 1 (PPTX 137 kb)

Appendix

Appendix

See Figs. 3 and 4.

Fig. 3
figure 3

a Radiograph of a 20-year-old girl (group R) with Lenke type 2 adolescent idiopathic scoliosis before surgery. b Radiograph 3 years after posterior spinal fusion using Harrington instrumentation from T4 to L1. c Radiograph 33 years after implant removal, demonstrating acceptable correction. d HU values of CT at the UIV−1, apex, LIV+1, and LIV−1 levels showing 101.7, 27.7, 61.8, and 128.8 HU, respectively. HU, Hounsfield units; CT, computed tomography; UIV−1, one level below the uppermost instrumented vertebra; LIV+1, one level above the lowermost instrumented vertebra; LIV−1, one level below the lowermost instrumented vertebra

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Fig. 4
figure 4

a Radiograph of an 18-year-old girl (group NR) with Lenke type 1 adolescent idiopathic scoliosis before surgery. b Radiograph 2 years after posterior spinal fusion using Cotrel–Dubousset instrumentation from T5 to L2. c Radiograph 21 years after initial surgery, demonstrating acceptable correction. d HU values of CT at the UIV−1, apex, LIV+1, and LIV−1 levels showing 169.9, 176.0, 185.5, and 218.1 HU, respectively. HU, Hounsfield units; CT, computed tomography; UIV−1, one level below the uppermost instrumented vertebra; LIV+1, one level above the lowermost instrumented vertebra; LIV−1, one level below the lowermost instrumented vertebra

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Watanabe, K., Ohashi, M., Hirano, T. et al. Can posterior implant removal prevent device-related vertebral osteopenia after posterior fusion in adolescent idiopathic scoliosis? A mean 29-year follow-up study. Eur Spine J 28, 1314–1321 (2019). https://doi.org/10.1007/s00586-019-05921-6

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  • DOI: https://doi.org/10.1007/s00586-019-05921-6

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