Spinal Pseudarthrosis Following Osteoporotic Vertebral Fracture: Prevalence, Risk Factors, and its Influence on the Activities of Daily Living among Patients

Abstract

Introduction: Spinal pseudarthrosis was defined in the revised guideline on osteoporotic vertebral fracture (OVF) in 2012 as the absence of visible signs of bone union 12 months following the injury. However, the clinical feature of pseudarthrosis remains unclear.

Methods: Among a total of 684 patients treated for OVF from January 2012 to February 2019 at our institution, 551 patients (mean age 81.9±7.4 years, male:female = 152:399) who could be followed up to 1 year were included in this study. The prevalence, risk factors, and its influence on the activities of daily living among patients with pseudarthrosis were investigated. The authors set pseudarthrosis as the objective variable, and total bone mineral density, skeletal muscle mass index, gender, age, history of osteoporosis treatment, presence of dementia, vertebral kyphosis angle, fracture type (presence of posterior wall injury), degree of independence in life before admission, history of steroid use, albumin level, renal function, presence of diabetes, and diffuse idiopathic skeletal hyperostosis as explanatory variables for multivariate analysis. The influence of pseudarthrosis on the walking ability and independence of daily living before and 1 year after OVF was studied.

Results: Fifty-four cases (9.8%) were diagnosed as having pseudarthrosis after 1 year (mean age 81.3±6.5 years, male:female = 18:36). Multivariate analysis showed that only presence of posterior wall injury showed statistical significance (OR = 2.059, p = 0.039). There was no significant difference between the pseudarthrosis group and the non-pseudarthrosis group in terms of walking ability and independence of daily living at 1 year.

Conclusions: The prevalence of pseudarthrosis following OVF was 9.8% and presence of posterior wall injury was its risk factor.