Activities of Daily Living after Surgical Treatment for Osteoporotic Vertebral Fracture with or without Diffuse Idiopathic Skeletal Hyperostosis: A Retrospective Single-Institutional Study

Abstract

Study design: This investigation was a retrospective observational study.

Purpose: The aim of this study was to evaluate whether having diffuse idiopathic skeletal hyperostosis (DISH) as a comorbidity affects the patient's ability to perform activities of daily living (ADL) after surgical treatment for osteoporotic vertebral fracture (OVF).

Overview of literature: A few studies have extensively evaluated elderly patients with comorbidities such as DISH and OVFinduced persistent back pain and their ability to perform ADL postoperatively.

Methods: In this study, 63 patients (21 men and 42 women) who underwent surgical treatment for OVF were enrolled. Of these patients, 26 had DISH (D+) and 37 did not have DISH (D-). Patient demographic characteristics and surgical, clinical, and radiological findings were compared between those with and without DISH. The change in their ability to perform ADL after surgery was also evaluated.

Results: Age, number of comorbidities, and 1-year mortality rate were significantly higher in the D+ group (p<0.05). Postoperative Visual Analog Scale (VAS) scores were significantly higher in patients with impaired (n=6, p=0.04) abilities to perform ADL, and improvements in VAS scores were significantly higher in patients with unchanged abilities to perform ADL (n=54, p=0.03) after surgery. The average postoperative VAS scores were 2.2 for the D+ group and 2.3 for the D- group, which were not significantly different.

Conclusions: The frequency of OVF with DISH was higher in elderly men with multiple comorbidities and contributed to a higher 1-year mortality rate than those in patients without DISH. However, preoperative and postoperative VAS scores and improvements in VAS scores were similar between those with and without DISH. Postoperative impaired ability to perform ADL was associated with old age, high postoperative VAS scores, and little improvements in VAS scores, which were limitedly influenced by DISH. Surgical treatment of OVF combined with DISH is effective and appropriate for elderly patients.

Keywords: Activities of daily living; Comorbidity; Diffuse idiopathic skeletal hyperostosis; Osteoporotic fractures; Visual Analog Scale.

Fig. 1.

Anterior column reconstruction. (A) OVF at L4 with an intervertebral instability observed on the magnetic resonance imaging T2-weighted sagittal plane. (B) Posterior fixation from L3 to L5 and posterior lumbar interbody fusion. (C) OVF at Th12 with a cleft observed on the computed tomography sagittal plane. (D) Posterior fixation from Th10 to L2 and vertebroplasty. (E) OVF at L1 with a massive vertebral collapse observed on the X-ray lateral view. (F) Posterior fixation from Th11 to L3 and anterior fixation with vertebral replacement. OVF, osteoporotic vertebral fracture.