Perioperative Medical Management of Spine Surgery Patients With Osteoporosis

Lubelski, Daniel; Choma, Theodore J.; Steinmetz, Michael P.; Mroz, Thomas E.

doi:10.1227/neu.0000000000000939

Cited by 43 publications

(32 citation statements)

References 57 publications

(64 reference statements)

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“…There are no guidelines for the spine surgeon to manage patients with OP, in spite of the fact that they are a growing population. 11…”

Section: Introductionmentioning

confidence: 99%

Surgeon Management of Osteoporosis in Instrumented Spine Surgery: AOSpine Latin America Survey

Pantoja¹,

Molina²

2018

Global Spine Journal

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Study Design: Survey study. Objective: To determine the impact of osteoporosis (OP) in instrumented spine surgery among Latin American spine surgeons. Methods: An electronic survey on aspects of instrumented spine surgery and OP was sent electronically to all members of AOSpine Latin America (AOSLA): 16 multiple-choice questions included incidence and type of complications experienced, strategies to avoid intraoperative complications, on prevention of complications and OP assessment and treatment prior to surgery. Results: A total of 349 spine surgeons from a universe of 377 surgeons (230 orthopedic surgeons and 147 neurosurgeons), associated members of AOSLA answered the survey. About 80% recalled complications directly related to OP and 71% had revised instrumentation because of OP-related complications. Techniques for prevention of intraoperative complications varied; 65% extended instrumentation to additional segments, 63% performed vertebral body cement injection alone or associated with instrumentation. Preoperative screening was used by 19% but increased to 75% if patients had risk factors. A limit value of bone mineral density for delaying surgery was not established for 66.4% of respondents. Consultation for OP management was requested by 81%, mostly to endocrinology (56.3%). Interestingly, 19% personally managed their patient's OP. Conclusion: This study provides a global perspective on how Latin American spine surgeons manage patients with OP undergoing instrumented spine surgery. Most have faced complications associated with OP and have had to resolve them surgically. Spine surgeons frequently participate partially in managing patients with OP. Most refer patients with OP for treatment to the endocrinology.

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“…There are no guidelines for the spine surgeon to manage patients with OP, in spite of the fact that they are a growing population. 11…”

Section: Introductionmentioning

confidence: 99%

Surgeon Management of Osteoporosis in Instrumented Spine Surgery: AOSpine Latin America Survey

Pantoja¹,

Molina²

2018

Global Spine Journal

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“…Emerging recent reports are attempting to answer this question by utilizing osteoporosis pharmacotherapy pre-and postoperatively to prevent surgical complications. [70][71][72][73] These recent studies further emphasize the importance of screening and diagnosing metabolic bone disease in spinal fusion patients.…”

Section: Discussionmentioning

confidence: 95%

Prevalence of osteoporosis and osteopenia diagnosed using quantitative CT in 296 consecutive lumbar fusion patients

Carlson

Salzmann²,

Shirahata³

et al. 2020

Neurosurgical Focus

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OBJECTIVEOsteoporosis is a metabolic bone disease that increases the risk for fragility fractures. Screening and diagnosis can be achieved by measuring bone mineral density (BMD) using quantitative CT tomography (QCT) in the lumbar spine. QCT-derived BMD measurements can be used to diagnose osteopenia or osteoporosis based on American College of Radiology (ACR) thresholds. Many reports exist regarding the disease prevalence in asymptomatic and disease-specific populations; however, osteoporosis/osteopenia prevalence rates in lumbar spine fusion patients without fracture have not been reported. The purpose of this study was to define osteoporosis and osteopenia prevalence in lumbar fusion patients using QCT.METHODSA retrospective review of prospective data was performed. All patients undergoing lumbar fusion surgery who had preoperative fine-cut CT scans were eligible. QCT-derived BMD measurements were performed at L1 and L2. The L1–2 average BMD was used to classify patients as having normal findings, osteopenia, or osteoporosis based on ACR criteria. Disease prevalence was calculated. Subgroup analyses based on age, sex, ethnicity, and history of abnormal BMD were performed. Differences between categorical groups were calculated with Fisher’s exact test.RESULTSOverall, 296 consecutive patients (55.4% female) were studied. The mean age was 63 years (range 21–89 years). There were 248 (83.8%) patients with ages ≥ 50 years. No previous clinical history of abnormal BMD was seen in 212 (71.6%) patients. Osteopenia was present in 129 (43.6%) patients and osteoporosis in 44 (14.9%). There were no prevalence differences between sex or race. Patients ≥ 50 years of age had a significantly higher frequency of osteopenia/osteoporosis than those who were < 50 years of age.CONCLUSIONSIn 296 consecutive patients undergoing lumbar fusion surgery, the prevalence of osteoporosis was 14.9% and that for osteopenia was 43.6% diagnosed by QCT. This is the first report of osteoporosis disease prevalence in lumbar fusion patients without vertebral fragility fractures diagnosed by QCT.

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“…Both patients have inherently weak bone suggested by their ages, medical comorbidities, chronic medications and an objective BMD T-score of −2.3 and −1.6 respectively. While this complication may not be totally unavoidable, surgery should ideally be deferred to allow medical optimization of bone quality (12). Unfortunately, both patients had severe symptoms and surgery was allowed to proceed following detailed discussions and counseling with the patients on the increased risk of junctional failure and revision surgery.…”

Section: Discussionmentioning

confidence: 99%

Distal junctional failure secondary to L5 vertebral fracture—a report of two rare cases

Tan

Hey

et al. 2017

J. Spine Surg.

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Distal junctional failure (DJF) with fracture at the last instrumented vertebra is a rare occurrence. In this case report, we present two patients with L5 vertebral fracture post-instrumented fusion of the lumbar spine. The first patient is a 78-year-old female who had multi-level degenerative disc disease, spinal stenosis and degenerative scoliosis involving levels T12 to L5. She underwent instrumented posterolateral fusion (PLF) from T12 to L5, and transforaminal lumbar interbody fusion (TLIF) at L2/3 and L4/5. Six months after her operation, she presented with a fracture of the L5 vertebral body necessitating revision of the L5 pedicle screws, with additional TLIF of L5/S1. The second patient is a 71-year-old female who underwent decompression and TLIF of L3/4 and L4/5 for degenerative spondylolisthesis. Six months after the surgery, she developed a fracture of the L5 vertebral body with loosening of the L5 screws. The patient declined revision surgery despite being symptomatic. DJF remains poorly understood as its rare incidence precludes sufficiently powered studies within a single institution. This report aims to contribute to the currently scarce literature on DJF.

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Perioperative Medical Management of Spine Surgery Patients With Osteoporosis

Cited by 43 publications

References 57 publications

Surgeon Management of Osteoporosis in Instrumented Spine Surgery: AOSpine Latin America Survey

Surgeon Management of Osteoporosis in Instrumented Spine Surgery: AOSpine Latin America Survey

Prevalence of osteoporosis and osteopenia diagnosed using quantitative CT in 296 consecutive lumbar fusion patients

Distal junctional failure secondary to L5 vertebral fracture—a report of two rare cases

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