Introduction:Pedicle screws are commonly used for spinal procedures for fusion stability, which is particularly important in osteoporotic patients, who are at an increased risk of requiring revision procedures. Areas covered: A systematic review and meta-analysis were conducted to compare clinical effectiveness of conventional pedicle screws (CPS) vs fenestrated pedicle screws (FPS) in patients undergoing spinal surgery. Primary outcomes included screw loosening, revision surgeries (involving an implant) and reoperations (not involving intervention on an implant) in patients treated with CPS vs FPS, substratified by with and without osteoporosis. Secondary outcomes included changes in pain scores. Forty-eight studies with 8,302 patients were included, with 1,565 (19.18%) treated with FPS and 6,710 (80.82%) treated with CPS. FPS was associated with a lower risk of screw loosening (p = 0.001) vs CPS. In the general population, there was a non-significant trend of lower revision rate, but no difference in reoperation rate, between patients treated with FPS vs CPS. In osteoporotic patients, revision rates were significantly lower for FPS vs CPS (p = 0.009). Expert opinion: This review suggests that FPS are effective for surgical fixation and reduce rates of screw loosening, and in osteoporotic patients, revision surgeries, compared to CPS.
BackgroundOsteoporosis is common among elderly patients and can result in vertebral fractures requiring surgical treatment. This study assessed clinical outcomes associated with spinal surgery in patients with osteoporosis/osteopenia with an additional focus on Asian patients.
MethodsA PRISMA-compliant systematic review and meta-analysis were conducted using the PubMed and ProQuest databases to identify articles published up to May 27, 2021, that included outcomes for patients with osteoporosis or osteopenia undergoing spinal surgery. Statistical analysis was conducted comparing rates of proximal junctional kyphosis (PJK)/proximal junctional failure (PJF), implant loosening, and revision surgery. A qualitative summary of Asian studies was also conducted.
ResultsA total of 16 studies comprising 133,086 patients were included; among the 15 studies reporting rates of osteoporosis/osteopenia, 12.1% (16,127/132,302) of patients overall and 38.0% (106/279) of Asian patients (n = 4 studies) had osteoporosis/osteopenia. The risks of PJK/PJF (relative risk [RR] = 1.89; 95% confidence interval [CI] = 1.22-2.92, p = 0.004), screw loosening (RR = 2.59; 95% CI = 1.67-4.01, p < 0.0001), and revision surgery (RR = 1.65; 95% CI = 1.13-2.42, p = 0.010) were higher in patients with poor bone quality compared with those with healthy bone. In the qualitative review of Asian studies, all studies found that osteoporosis increased the risk of complications and/or revision for spinal surgery patients.
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