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  #1  
Old 20-05-2011, 11:13 AM
Amanda Amanda is offline
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Default Osteopenia in fused spine

I had a spinal fusion surgery (for scoliosis) with Harrington instrumentation (one rod) in 1972; the fusion is from T1 or T2 down to L1. Up to now I have not had any problems with my spine so I assume the fusion has remained intact. A recent bone densitometry shows that I have severe osteopenia in my lumbar spine (L1-L4), the BMD is 0.90 g/cm2 and the T score is -2.3. A general question: if any of the fused thoracic vertebrae were to fracture, would the fusion be compromised and the rod may become less stable. Or could it be the case that the fused vertebrae – as a rigid structure? - are ‘protected’ from osteoporotic fracture(s)?
  #2  
Old 23-05-2011, 06:17 PM
Dr Scoliosis Dr Scoliosis is offline
 
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Default Re: Osteopenia in fused spine

Thank you for your enquiry. First, there is no relation between scoliosis and osteoporosis. Because, presumably, you have a solid spinal fusion with such a long clinical history and no significant problems, the spinal fusion is solid and hence you would be protected in the area from osteoporotic fracture. From my own extensive experience I have never seen an osteoporotic fracture within that area of the spine successfully fused for scoliosis.

As osteoporosis is a generalised problem, or tends to be, I cannot answer precisely whether or not the fused vertebrae are in any way "protected" (to use your terminology) from the osteoporotic process. I will make enquiries and report back to you within a week or so.

Dr Scoliosis
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Old 24-05-2011, 10:42 AM
Amanda Amanda is offline
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Default Re: Osteopenia in fused spine

Dear Dr.Scoliosis

Thank you so much for your prompt respond to my query. I am most grateful. I would wish to pose this query to the orthopaedic surgeon who successfully performed the spinal fusion surgery but regrettably this is not possible.

It is reassuring to hear that from your extensive experience you have not seen an osteoporotic fracture within the area of the spine successfully fused for scoliosis. To my knowledge spinal fusions with Harrington instrumentation for the treatment of scoliosis in Australia began in the early 1960s. I would assume that any presentation of osteoporotic problems among patients who had spinal fusion surgery for scoliosis would be a relatively recent phenomenon?

I have little understanding of how fusion has altered the thoracic vertebrae apart from making them into a solid and rigid structure. Could this rigid structure be at risk of weakening if the bone density of these vertebrae has decreased? I understand that in general osteopenia or osteoporosis leads to an increased risk of fracture but does not in itself mean a fracture will occur. If possible I would wish to take whatever available preventative measures to avoid any fracture which may affect the fusion.

I look forward to receiving more information once you have made your enquiries.

Once again my grateful thanks to you for taking an interest in this matter.

Amanda

Last edited by Amanda; 24-05-2011 at 10:47 AM. Reason: Deletion of computer jargons.
  #4  
Old 27-06-2011, 11:15 AM
Amanda Amanda is offline
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Default Re: Osteopenia in fused spine

Dear Dr.Scoliosis

On 23 May 2011 you responded to my initial query and indicated that you will ‘report back’ to me. You wrote:

“As osteoporosis is a generalised problem, or tends to be, I cannot answer precisely whether or not the fused vertebrae are in any way "protected" (to use your terminology) from the osteoporotic process. I will make enquiries and report back to you within a week or so.”

I am looking forward to your ‘report’ and hope to hear from you soon. I am very grateful for your attention and interest in this matter.


Amanda
  #5  
Old 28-07-2011, 04:54 PM
Dr Scoliosis Dr Scoliosis is offline
 
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Default Re: Osteopenia in fused spine

Re Osteopenic fractures beneath a solid spinal fusion for scoliosis.

Further to our earlier exchange of correspondence I regret that my further enquiries have not been enlightening.

When a spinal fusion is carried out in the manner which it was in you, the bone graft becomes transformed into a solid mass and that segment of the spine is akin to a long bone. It bears weight through the upright stance. The surface of the bone, what we call the cortex, becomes quite thick. When osteoporosis becomes a significant clinical problem it affects cancellous bone first. Cancellous bone is the honeycomb on the inside of bones like the vertebrae. Cancellous bone is much more metabolically active than cortical bone. The latter has a primary mechanical function, that is, weight bearing. In osteoporosis the cortex is involved only late in the process.

As I indicated earlier, in my long experience I have never seen an osteoporotic fracture in vertebrae encompassed by a posterior spinal fusion. The presence of the rods is of no consequence. Once the fusion heals they play no role.

I suppose with very major trauma that a fused spine could fracture but then I have not seen that problem either.

I suggest that you Google osteopenia and the Wikipedia entry is a very conservative and precise statement. There is an important distinction to be drawn between osteopenia and osteoporosis.

In short, I do not think you have anything to be worried about. If you were to be subject to osteoporosis then those vertebrae not encompassed by the fusion mass would be susceptible to the process.

I will keep this question in mind and if any further information comes to hand I will be in touch again.

I trust this is helpful to you.

Dr Scoliosis
  #6  
Old 30-07-2011, 12:11 PM
Amanda Amanda is offline
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Default Re: Osteopenia in fused spine

Dear Dr Scoliosis

Many thanks for the recent detailed information you provided – it is very helpful and is much appreciated. Your explanation of cancellous bone and cortical bone is particularly useful as I had not been aware of this. Overall I now have a better understanding of how a posterior spinal fusion has altered the structure of the vertebrae. You have also reassured me that if I were to be subject to osteoporosis these vertebrae encompassed by the fusion are not likely to be susceptible to fracture. I have read the Wikipedia entry on osteopenia and understand the distinction between osteopenia and osteoporosis.

Still, I believe that prevention is better than cure. I am doing all I can to minimise risks of any kind of fracture by engaging in regular strengthening and balancing exercises at a gym and through practising Tai Chi.

Thank you again and should you come by any further information I would be glad to receive it.

Amanda
  #7  
Old 11-10-2011, 11:26 AM
Amanda Amanda is offline
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Default Re: Further queries Osteopenia in fused spine

Dear Dr Scoliosis

I seek your further advice following a recent thoracolumbar spine x-ray I had as ordered by my endocrinologist to determine if I need to go on osteoporosis medication. The x-ray showed “Multiple end plate depressions in thoracic vertebrae”. My questions to you are:

(1) Assuming end plate ‘depressions’ represent a symptom of generalised osteopenia (which I have), are they likely to lead to “compressions” or spinal fractures should my bone density continue to decline to osteoporosis? Or rather, as discussed earlier, because these thoracic vertebrae are encompassed by a solid fusion then these end plate ‘depressions’ will not progress to osteoporotic compressions? You have indicated earlier to me that “in my long experience I have never seen an osteoporotic fracture in vertebrae encompassed by a posterior spinal fusion”. Do you know of patients who have had posterior spinal fusion similar to mine and who also have generalised osteoporosis?

(2) Would you advise that I consult a scoliosis specialist who can assess and evaluate this matter more thoroughly, in particular the solidity of the fusion? On the whole I am disinclined to take osteoporosis medication (like Fosamax or Actonel) as it has undesirable side effects. If I know with a high degree of certainty that the spinal fusion is likely to keep the thoracic vertebrae from osteoporotic fracture, would I then have a good reason not to need osteoporosis medication?

Thank you


Amanda
  #8  
Old 12-10-2011, 05:40 PM
Dr Scoliosis Dr Scoliosis is offline
 
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Default Re: Osteopenia in fused spine

Thank you for your further contribution to the topic.

Unless one had the opportunity of perusing the x-rays and discussing them with you it would be unwise to attempt to interpret them at a distance.

Certainly, I think you should consult a scoliosis specialist and you will need to be referred by your family doctor. There is a directory of spinal specialists on our website.

In general, one is better advised not to take medication for minor alterations in bone density until the matter has been thoroughly evaluated. These days the doctors who deal with osteoporosis are not a recognised specialty but concern their practice with what is called mineral metabolism.

I would be interested to learn the outcome of your further consultations and perhaps you would be kind enough to provide an additional post. I am sure there are many members of the forum who have been following our exchanges.

Dr Scoliosis
  #9  
Old 13-10-2011, 02:45 PM
Amanda Amanda is offline
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Default Re: Osteopenia in fused spine

Dear Dr Scoliosis

Thank you very much for your reply and advice. I will seek a consultation with a scoliosis specialist and will certainly inform you of the outcome via an additional post. I am pleased to know that you share my concern about taking medication for osteoporosis before the matter is thoroughly evaluated.

I remain particularly grateful for your interest in my case.

Amanda
  #10  
Old 19-12-2011, 04:42 PM
Amanda Amanda is offline
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Default Re: Osteopenia in fused spine

Dear Dr.Scoliosis

Now I have more to add to my earlier posts as I recently had a helpful consultation with a scoliosis specialist. On the basis of a physical assessment and examination of the thoraco-lumbar X-rays (mentioned to you earlier) I was informed of the following:

(1) My spinal fusion is solid and stable; the Harrington rod is intact and shows no sign of breaking.
(2)The part of the vertebrae which have been fused shows lower than normal bone density; this condition is expected because normal movement in this area has been limited.
(3)A reduction in bone density across the fused vertebrae is irrelevant in terms of increased risks of fractures as the solid fusion keeps these vertebrae together.
(4) Osteoporosis medication is not required or recommended at this stage. A reduction of bone density is a natural process as one gets older. To prevent fractures or to reduce risks of fractures, an active lifestyle and good diet are recommended. In particular, one should do regular weight bearing/resistance exercises as well as those which improve balance. As most fractures result from falls, keeping fit and active should reduce one’s chance of falling.
(5) There is a tendency to ‘medicalise’ reduced bone mass – which occurs naturally as people age. While lower bone mineral density is associated with fractures, it is not an accurate predictor of an individual’s risk of fracture.

Based on this advice and as well as the information you provided me earlier I now have a good understanding of how reduced bone mass may affect me – in particular my fused spine. Moreover, I am now in a better position to make an informed decision on whether or not to take osteoporosis medication in future.

Thank you very much for your interest in this matter and the series of very useful advice you gave over many months.

Amanda
 

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