• Pei-Jie Luo, Yong-Chao Tang, Teng-Peng Zhou, Hui-Zhi Guo, Dan-Qing Guo, Guo-Ye Mo, Yan-Huai Ma, Pan-Jie Liu, Shun-Cong Zhang, and Liang De The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China..
• First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Baiyun District, Guangdong, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
• World Neurosurg. 2020 Mar 1; 135: e87-e93.

ObjectiveThis study aimed to evaluate the risk factors for adjacent vertebral compression fractures after lumbar spinal fusion with instrumentation.MethodsA total of 669 patients who received lumbar instrumented spinal fusion between January 2012 and December 2015 were divided into 2 groups according to whether the adjacent vertebral body was fractured. The covariates recorded were age, sex, bone mineral density, and the number of fixed segments. The anatomic variables were pelvic incidence angle (PI), preoperative lumbar lordosis angle (Pre-LL), postoperative lumbar lordosis angle (Post-LL), Pre-LL minus Post-LL (Loss of LL), postoperative pelvic tilt (Post-PT), postoperative sacral slope, Pre-PI-LL mismatch (Pre-PI minus Pre-LL), and Post-PI-LL mismatch (Post-PI minus Post-LL). A 1-way analysis of variance (ANOVA) was performed with the aforementioned parameters, and binary logistic regression analysis was used to determine the relative risk factors.ResultsThe 669 patients were followed-up for a mean of 2.7 ± 1.1 years (range, 2-4 years). Twenty-seven patients demonstrated fractures in the adjacent vertebral body after surgery. Analysis by 1-way ANOVA demonstrated that age, PI, Pre-LL, Post-LL, Loss of LL, Post-PI-LL mismatch, Post-PT, and osteoporosis were potential risk factors (all parameters, P < 0.001). Furthermore, binary logistic regression analysis showed that a large Loss of LL, osteoporosis, and old age were also risk factors for adjacent vertebral compression fractures.ConclusionsA greater Loss of LL, osteoporosis, and advanced age may be risk factors for fractures in the adjacent vertebral body of the fixed segment after lumbar fusion fixation.Copyright © 2019 Elsevier Inc. All rights reserved.

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