Systematic Literature Review and Meta-Analysis on the Clinical Outcomes of Spine Surgeries in Patients with Concurrent Osteoporosis

Abstract

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.

Bone Quality in Spinal Surgery: Evaluation, Implications, and Treatments

“…The quality of this bone is therefore of importance for achieving and maintaining fixation. Ogiri et al 9 performed a metaanalysis of 133,086 patients, which demonstrated that the relative risk for screw loosening was 2.59 higher in patients with osteopenia and osteoporosis than in those with healthy bone.…”

Bone Quality in Spinal Surgery: Evaluation, Implications, and Treatments

“…The quality of this bone is therefore of importance for achieving and maintaining fixation. Ogiri et al9 performed a meta-analysis of 133,086 patients, which demonstrated that the relative risk for screw loosening was 2.59 higher in patients with osteopenia and osteoporosis than in those with healthy bone.…”

Acute spinal cord compression in the setting of chronic extramedullary hematopoiesis of the thoracic spine

“…The spinal cord was examined and found to be decompressed, and neuromonitoring was stable from baseline. Due to the patient's history of multiple compression fractures, the patient would be at an elevated risk for proximal or distal junctional kyphosis following posterior fixation [6] . Thus, since no evidence of biomechanical instability observed, we did not pursue posterior fixation.…”