Increased risks of vertebral fracture and reoperation in primary spinal fusion patients who test positive for osteoporosis by Biomechanical Computed Tomography analysis

Keaveny, Tony M.; Adams, Annette L.; Fischer, Heidi; Brara, Harsimran S.; Burch, Shane; Guppy, Kern H.; Kopperdahl, David L.

doi:10.1016/j.spinee.2022.10.018

Cited by 10 publications

(6 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although poor bone quality has been reported to be associated with nonunion after spinal fusion surgery in several previous studies, 20 21) some authors have reported no correlation between bone quality and nonunion. 2 12 22) Our results revealed that BMD had a noticeable effect on the development of pseudarthrosis at L5–S1.…”

Section: Discussionmentioning

confidence: 94%

Fusion Length Requiring Spinopelvic Fixation in Lumbosacral Fusion with Anterior Column Support at L5–S1: Assessment of Fusion Status Using Computed Tomography

Park,

Lee

et al. 2024

Clin Orthop Surg

View full text Add to dashboard Cite

Background The lumbosacral (LS) junction has a higher nonunion rate than other lumbar segments, especially in long-level fusion. Nonunion at L5–S1 would result in low back pain, spinal imbalance, and poor surgical outcomes. Although anterior column support at L5–S1 has been recommended to prevent nonunion in long-level LS fusion, fusion length requiring additional spinopelvic fixation (SPF) in LS fusion with anterior column support at L5–S1 has not been evaluated thoroughly. This study aimed to determine the number of fused levels requiring SPF in LS fusion with anterior column support at L5–S1 by assessing the interbody fusion status using computed tomography (CT) depending on the fusion length. Methods Patients who underwent instrumented LS fusion with L5–S1 interbody fusion without additional augmentation and CT > 1 year postoperatively were included. The fusion rates were assessed based on the number of fused segments. Patients were divided into two groups depending on the L5–S1 interbody fusion status: those with union vs. those with nonunion. Binary logistic regression analyses were performed to identify risk factors for LS junctional nonunion. Results Fusion rates of L5–S1 interbody fusion were 94.9%, 90.3%, 80.0%, 50.0%, 52.6%, and 43.5% for fusion of 1, 2, 3, 4, 5, and ≥ 6 levels, respectively. The number of spinal levels fused ≥ 4 ( p < 0.001), low preoperative bone mineral density (BMD; adjusted odds ratio [aOR], 0.667; p = 0.035), and postoperative pelvic incidence (PI) – lumbar lordosis (LL) mismatch (aOR, 1.034; p = 0.040) were identified as significant risk factors for nonunion of L5–S1 interbody fusion according to the multivariate logistic regression analysis. Conclusions Exhibiting ≥ 4 fused spinal levels, low preoperative BMD, and large postoperative PI–LL mismatch were identified as independent risk factors for nonunion of anterior column support at L5–S1 in LS fusion without additional fixation. Therefore, SPF should be considered in LS fusion extending to or above L2 to prevent LS junctional nonunion.

show abstract

Section: Discussionmentioning

confidence: 94%

Fusion Length Requiring Spinopelvic Fixation in Lumbosacral Fusion with Anterior Column Support at L5–S1: Assessment of Fusion Status Using Computed Tomography

Park,

Lee

et al. 2024

Clin Orthop Surg

View full text Add to dashboard Cite

show abstract

“…22 While to date, dual-energy x-ray absorptiometry (DXA) imaging has been the clinical standard for measuring BMD, quantitative CT imaging and, more recently, biomechanical computed tomography analysis (BCT) have been investigated increasingly as alternatives and provide additional diagnostic information such as bone strength. Furthermore, in 2019, Ehresman et al 23 introduced the vertebral bone quality (VBQ) score which allows assessment of bone quality using magnetic resonance imaging 24 and recently, there have been first attempts at developing machine learning algorithms predicting bone health status and in finding novel risk factors for reduced BMD in patients requiring spine surgery. 25 Preoperatively, any modifiable risk factors need to be addressed including adequate calcium and vitamin D intakes, exercise, and cessation of excessive alcohol or smoking.…”

Section: Facilitating Positive Bone Remodelingmentioning

confidence: 99%

Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review

Schömig

Becker

Schönnagel

et al. 2023

Global Spine Journal

View full text Add to dashboard Cite

Study design Narrative review. Objectives With an aging population, the prevalence of osteoporosis is continuously rising. As osseous integrity is crucial for bony fusion and implant stability, previous studies have shown osteoporosis to be associated with an increased risk for implant failure and higher reoperation rates after spine surgery. Thus, our review’s purpose was to provide an update of evidence-based solutions in the surgical treatment of osteoporosis patients. Methods We summarize the existing literature regarding changes associated with decreased bone mineral density (BMD) and resulting biomechanical implications for the spine as well as multidisciplinary treatment strategies to avoid implant failures in osteoporotic patients. Results Osteoporosis is caused by an uncoupling of the bone remodeling cycle based on an unbalancing of bone resorption and formation and resulting reduced BMD. The reduction in trabecular structure, increased porosity of cancellous bone and decreased cross-linking between trabeculae cause a higher risk of complications after spinal implant-based surgeries. Thus, patients with osteoporosis require special planning considerations, including adequate preoperative evaluation and optimization. Surgical strategies aim towards maximizing screw pull-out strength, toggle resistance, as well as primary and secondary construct stability. Conclusions As osteoporosis plays a crucial role in the fate of patients undergoing spine surgery, surgeons need to be aware of the specific implications of low BMD. While there still is no consensus on the best course of treatment, multidisciplinary preoperative assessment and adherence to specific surgical principles help reduce the rate of implant-related complications.

show abstract

“…Recent medical advancements have significantly increased life expectancy, leading to a rise in the number of aged patients undergoing surgeries (1)(2)(3). The significant shift in the aging population highlights osteoporosis as an enormous problem in orthopedic surgery due to its impact on postoperative complications (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

“…(6,18,19). Furthermore, Keaveney et al demonstrated the superiority of CT-based biomechanical analysis over BMD testing alone in terms of predicting reoperation following spinal instrumentation surgery (5). Thus, a multidisciplinary approach including bone health assessment of the heterogeneity of the BMD in the vertebra as well as biomechanical analysis is recommended prior to surgery to an ensure optimal and safe outcome.…”

Section: Introductionmentioning

confidence: 99%

The potential effect of romosozumab on perioperative management for instrumentation surgery

Ishikawa,

Tani,

Toyone

et al. 2023

Preprint

View full text Add to dashboard Cite

BackgroundAge-related changes in bone health increase the risk for complications in elderly patients undergoing orthopedic surgery. Osteoporosis is a key therapeutic target that needs to be addressed to ensure successful instrumentation surgery. The effectiveness of pharmacological interventions in orthopedic surgery, particularly the new drug romosozumab, is still unknown. We aim to evaluate the effect of 3-month romosozumab treatment on biomechanical parameters related to spinal instrumentation surgery, using the Quantitative Computed Tomography (QCT)-based Finite Element Method (FEM).MethodsThis open-labeled, prospective study included 81 patients aged 60 to 90 years, who met the osteoporosis criteria and were scheduled for either romosozumab or eldecalcitol treatment. Patients were assessed using blood samples, dual-energy absorptiometry (DXA), and QCT. Biomechanical parameters were evaluated using FEM at baseline and 3 months post-treatment. The primary endpoints were biomechanical parameters at 3 months, while secondary endpoints included changes in regional volumetric bone mineral density around the pedicle (P-vBMD) and vertebral body (V-vBMD).ResultsRomosozumab treatment led to significant gains in P-vBMD, and V-vBMD compared to eldecalcitol at 3 months. Notably, the romosozumab group showed greater improvements in all biomechanical parameters estimated by FEM at 3 months compared to the eldecalcitol group.ConclusionRomosozumab significantly increased the regional vBMD as well as biomechanical parameters, potentially offering clinical benefits in reducing post-operative complications in patients with osteoporosis undergoing orthopedic instrumentation surgery. This study highlights the novel advantages of romosozumab treatment and advocates further research on its effectiveness in perioperative management.

show abstract

Increased risks of vertebral fracture and reoperation in primary spinal fusion patients who test positive for osteoporosis by Biomechanical Computed Tomography analysis

Cited by 10 publications

References 60 publications

Fusion Length Requiring Spinopelvic Fixation in Lumbosacral Fusion with Anterior Column Support at L5–S1: Assessment of Fusion Status Using Computed Tomography

Fusion Length Requiring Spinopelvic Fixation in Lumbosacral Fusion with Anterior Column Support at L5–S1: Assessment of Fusion Status Using Computed Tomography

Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review

The potential effect of romosozumab on perioperative management for instrumentation surgery

Contact Info

Product

Resources

About