title: Factors affecting postoperative activities of daily living in patients with osteoporotic vertebral collapse with neurological deficits.
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.
authors.affiliation: Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan, mkashii-osk@umin.ac.jp.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kashii
authors.forename: Ryoji
authors.initials: R
authors.lastname: Yamazaki
authors.forename: Tomoya
authors.initials: T
authors.lastname: Yamashita
authors.forename: Shinya
authors.initials: S
authors.lastname: Okuda
authors.forename: Takahito
authors.initials: T
authors.lastname: Fujimori
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Nagamoto
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Tamura
authors.forename: Takenori
authors.initials: T
authors.lastname: Oda
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ohwada
authors.forename: Motoki
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004032:Diet; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000150:complications* / Q000503:physiopathology; D016017:Odds Ratio; D010024:Osteoporosis / Q000150:complications* / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000150:complications / Q000503:physiopathology; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000503:physiopathology* / Q000523:psychology