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Factors affecting postoperative activities of daily living in patients with osteoporotic vertebral collapse with neurological deficits

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Abstract

Surgical treatment of osteoporotic vertebral collapse (OVC) with neurological deficits presents significant clinical challenges because some patients have fragile bones and often have medical comorbidities, which affect the severity of osteoporosis. We hypothesized that clinical results of surgery in these patients depend on the extent of medical comorbidities that induce secondary osteoporosis. The aim of this study is to examine the effects of medical history and comorbidities on surgical outcomes for these patients, along with the factors that predict postoperative function in activities of daily living (ADL). We retrospectively reviewed data for 88 patients with OVC and neurological deficits who underwent surgery. We assessed clinical results regarding neurological deficits and function in ADL. The presence or absence of comorbidities responsible for secondary osteoporosis and treatments or medical events that affect bone metabolism were examined. We performed statistical analysis to examine prognostic factors for postoperative function in ADL. Of 88 patients, the distributions of comorbidities, treatment, and events in medical history were as follows: hypertension, 57 patients (64.8 %); chronic kidney disease (CKD) stage 3 or 4, 32 (36.4 %); diabetes mellitus, 16 (18.2 %); liver dysfunction, 11 (12.5 %); cardiovascular disease, 10 (11.4 %); rheumatoid arthritis, 9 (10.2 %); and glucocorticoid intake, 8 (9.1 %). Twenty-five patients (28.4 %) represented poor postoperative ADL (chair-bound or bed-bound), and 11 of 25 patients with poor postoperative ADL represented full neurological recovery. Multivariate analysis revealed decreased estimated glomerular filtration rate (odds ratio 0.96; 95 % confidence interval 0.93–0.99; p = 0.005) and a high serum alkaline phosphatase (ALP) level (odds ratio 1.01; 95 % CI 1.00–1.02; p = 0.01) were strong predictive factors for poor postoperative function in ADL. The majority of patients with poor postoperative function in ADL had advanced CKD with a disorder of bone metabolism as well as bone fragility.

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Acknowledgments

Katharine O’Moore-Klopf, ELS (East Setauket, NY) provided English-language editing of this article before its final acceptance for publication.

Conflict of interest

This work was supported by Health and Labour Sciences Research Grants for Comprehensive Research on Aging and Health from the Ministry of Health, Welfare, and Labor of Japan. None of the authors has any financial interest with any of the commercial entities mentioned in this article.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Masafumi Kashii, Takahito Fujimori, Yukitaka Nagamoto, Motoki Iwasaki & Hideki Yoshikawa

  2. Department of Orthopedic Surgery, Osaka Rousai Hospital, 1179-3 Nagasonecho, Sakai, Osaka, 591-8025, Japan

    Ryoji Yamazaki, Shinya Okuda & Takenori Oda

  3. Department of Orthopedic Surgery, Kansai Rousai Hospital, 3-1-69 Inabasou, Amagasaki, Hyogo, 660-8511, Japan

    Tomoya Yamashita & Tetsuo Ohwada

  4. Department of Orthopedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan

    Yuichi Tamura

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  1. Masafumi Kashii
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  2. Ryoji Yamazaki
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  3. Tomoya Yamashita
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  4. Shinya Okuda
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Correspondence to Masafumi Kashii.

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Kashii, M., Yamazaki, R., Yamashita, T. et al. Factors affecting postoperative activities of daily living in patients with osteoporotic vertebral collapse with neurological deficits. J Bone Miner Metab 33, 422–431 (2015). https://doi.org/10.1007/s00774-014-0604-8

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  • DOI: https://doi.org/10.1007/s00774-014-0604-8

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