Incidence of Osteoporosis-Related Complications Following Posterior Lumbar Fusion

Abstract

Study Design:Retrospective review.Objectives:This study investigates the prevalence of adverse postsurgical events, or osteoporosis-related complications (ORCs), following spinal fusion.Methods:Patients undergoing primary posterior thoracolumbar or lumbar fusion by 1 of 2 surgeons practicing at a single institution were analyzed from 2007 to 2014. ORCs were defined in one of the following categories: revision surgery, compression fracture, proximal junctional kyphosis, pseudarthrosis, or failure of instrumentation. Patients with a bone mineral density of the hips and/or spine performed within 1 year of the index procedure were included. Patients were stratified into normal bone density, osteopenia, and osteoporosis using WHO guidelines. Patients were excluded if they were younger than 18 years at the time of surgery, with infection, malignancy, skeletal dysplasia, neuromuscular disorders, concomitant or staged anterior-posterior procedure, or fusion performed because of trauma.Results:Out of 140 patients included, the prevalence of normal bone density was 31.4% (44/140), osteopenia 58.6% (82/140), and osteoporosis 10.0% (14/140). There were no differences between groups for gender, age, body mass index, and interbody device rate. The overall prevalence of ORCs was 32.1% (45/140). By group, there was a prevalence of 22.7% (10/44), 32.9% (27/82), and 50.0% (7/14) for normal bone density, osteopenia, and osteoporosis, respectively. These differences were significantly higher for both the osteopenia and osteoporosis groups.Conclusions:Patients with T scores below −1.0 undergoing posterior lumbar fusion have an increased prevalence of ORCs. Consideration of bone density plays a crucial role in patient selection, medical management, and counseling patient expectations.

A Review and Clinical Perspective of the Impact of Osteoporosis on the Spine

“…Fragility fracture and osteoporosis epidemiology References: 1,2,7-21 Treatment strategies and treatment deficiencies following fragility fracture References: [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Bone health and elective spine surgery outcomes References: 3,5,6, Osteoporosis treatment and elective spine surgery outcomes References: 8,39,[60][61][62][63][64][65][66][67][68] Table 3. 2016 AACE Diagnosis of Osteoporosis in Postmenopausal Women.…”

“…43,44 Bjerke et al compared osteoporotic, osteopenic, and normal patients undergoing thoracolumbar fusion. 3 They found that "osteoporosis-related complications" (such as proximal junctional fracture or kyphosis and screw pullout) occurred in 50% of osteoporotic, 34% of osteopenic, and in 23% of patients with normal bone. 3 Bernstein et al also found that, when compared to patients without rheumatoid arthritis, patients with rheumatoid arthritis had a significantly higher implant-related complication rate; osteoporosis was significantly more prevalent in this cohort of patients.…”

“…3 They found that "osteoporosis-related complications" (such as proximal junctional fracture or kyphosis and screw pullout) occurred in 50% of osteoporotic, 34% of osteopenic, and in 23% of patients with normal bone. 3 Bernstein et al also found that, when compared to patients without rheumatoid arthritis, patients with rheumatoid arthritis had a significantly higher implant-related complication rate; osteoporosis was significantly more prevalent in this cohort of patients. 45 Additionally, Formby et al and Tempel et al both report that low BMD is associated with significantly increased cage or graft subsidence in patients undergoing transforaminal lumbar interbody fusions or lateral lumbar interbody fusions, respectively.…”

“…As the vertebral column represents the most common anatomic site of osteoporosis-related fractures, spine surgeons are uniquely positioned to help with the detection, evaluation, and management of low bone density. [3][4][5][6][7] Moreover, diminished bone quality plays a large role in the ultimate success of elective spine surgery. 3 The purpose of this review article is 3-fold: first, we will review the impact low bone density has on the spine; second, we will review the negative consequences of low bone density on clinical outcomes following elective spine surgery; third, we will review the clinical importance of bone density assessment and optimization.…”

“…[3][4][5][6][7] Moreover, diminished bone quality plays a large role in the ultimate success of elective spine surgery. 3 The purpose of this review article is 3-fold: first, we will review the impact low bone density has on the spine; second, we will review the negative consequences of low bone density on clinical outcomes following elective spine surgery; third, we will review the clinical importance of bone density assessment and optimization. Our intent is to provide a concise summary of the literature regarding the impact of low bone density and the importance of bone health optimization in patients with spinal disease.…”