The role of bone mineral density in adult spinal deformity patients undergoing corrective surgery: a matched analysis

Khalid, Syed I.; Nunna, Ravi S; Smith, Jennifer S.; Shanker, Rachyl M.; Cherney, Alecia A.; Thomson, Kyle B.; Chilakapati, Sai; Mehta, Ankit I.; Adogwa, Owoicho

doi:10.1007/s00701-022-05317-4

Cited by 8 publications

(5 citation statements)

References 44 publications

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“…13 Low bone mineral density could significantly reduce the rigidity of vertebral and ultimately result in junctional fracture and looseness of internal fixation. 34,35 Junctional failures in our study were all caused by junctional fracture and implant/bone interface failure, which were closely associated with low bone mineral density (Fig. 3).…”

Section: Risk Factor Of Junctional Failurementioning

confidence: 67%

Junctional Kyphosis after Correction with Long Instrumentation for Late Posttraumatic Thoracolumbar Kyphosis: Characteristics and Risk Factors

Zhou

et al. 2023

Orthopaedic Surgery

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Objective Junctional kyphosis is a common complication after corrective long spinal fusion for adult spinal deformity. Whereas there is still a paucity of data on junctional kyphosis, specifically among late posttraumatic thoracolumbar kyphosis (LPTK) patients. Thus, the aim of this study was to investigate the characteristics and risk factors of junctional kyphosis in LPTK patients receiving long segmental instrumented fusion. Methods We retrospectively reviewed a cohort of LPTK patients who had received long segmental instrumented fusion (>4 segments) in our center between January 2012 and January 2019. Radiographic assessments included the sagittal alignment, pelvic parameters, bone quality on CT images, and measurements of the cross‐sectional area (CSA, cross‐sectional area of muscle‐vertebral body ratio × 100) and fat saturation fraction (FSF, cross‐sectional area of fat‐muscle body ratio × 100) of paraspinal muscles. Patients in this study were divided into those with junctional kyphosis or failure (Group J) and those without (Group NJ) during follow‐up. Group J included patients with junctional kyphosis (Group JK) and patients with junctional failure (Group JF). Results A total of 65 patients (16 males and 49 females, average age 56.5 ± 23.4 years) were enrolled in this study. After (32.7 ± 8.5) months follow‐up, 15 patients (23.1%) experienced junctional kyphosis, and four of them deteriorated into junctional failure. Eighty percent (12/15) of junctional kyphosis was identified within 6 months after surgery. In comparison with Group NJ, Group J were older (P = 0.026), longer fusion levels (P < 0.001), greater thoracic kyphosis (P = 0.01), greater global kyphosis (P = 0.023), lower bone quality (P < 0.001), less CSA (P = 0.005) and higher FSF (P <0.001) of paraspinal muscles. Preoperative global kyphosis more than 48.5° (P = 0.001, odds ratio 1.793) and FSF more than 48.4 (P = 0.010, odds ratio 2.916) were identified as independent risk factors of junctional kyphosis. Based on the statistical differences among Group NJ, Group JK and Group JF (P < 0.001), Group JF had lower bone quality than Group NJ (P < 0.001) and Group JK (P = 0.015). In terms of patient‐reported outcomes, patients in Group JF had worse outcomes in ODI and VAS scores, and PCS and MCS of SF‐36 than Group NJ and group JK Conclusion The prevalence of junctional kyphosis was 23.1% in LPTK patients after long segmental instrumented fusion. Preoperative hyperkyphosis and advanced fatty degeneration of paraspinal muscles were independent risk factors of junctional kyphosis. Patients with lower bone quality were more likely to develop junctional failure.

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Section: Risk Factor Of Junctional Failurementioning

confidence: 67%

Junctional Kyphosis after Correction with Long Instrumentation for Late Posttraumatic Thoracolumbar Kyphosis: Characteristics and Risk Factors

Zhou

et al. 2023

Orthopaedic Surgery

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“…Previous literature has demonstrated rates of osteoporosis in ASD as high as 32.8%, with only 34.4% of those patients receiving treatment 12,13 . Osteoporosis is a well-established risk factor for complications after spinal fusion, including proximal junctional kyphosis, pseudoarthrosis, fracture, and revision surgery 14–17 …”

Section: Methodsmentioning

confidence: 99%

“…12,13 Osteoporosis is a well-established risk factor for complications after spinal fusion, including proximal junctional kyphosis, pseudoarthrosis, fracture, and revision surgery. [14][15][16][17] Given the high rate of osteoporosis in ASD patients, the criteria for screening for osteoporosis have been challenging and expanded to increase sensitivity. In the 2022 best practice guidelines for osteoporosis in ASD, it is concluded that the following 12 risk factors should be screened for chronic 18,19 Bone health assessment in ASD is multifaceted.…”

Section: Osteoporosis and Bone Mineral Densitymentioning

confidence: 99%

Preoperative Optimization for Adult Spinal Deformity Surgery

Katiyar,

Reyes,

Coury

et al. 2023

Spine

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Study Design. Systematic Review Objective. The purpose of this review is to identify modifiable risk factors in patients undergoing adult spinal deformity surgery and compile literature recommendations for preoperative optimization of these risk factors. Summary of Background Data. Optimization of modifiable risk factors not only benefits the patient but also lessens resource and cost burdens on the healthcare system, allowing for better quality and value-based care. There is limited but applicable literature discussing preoperative optimization in adult spinal deformity surgery patients specifically. Methods. We searched PubMed for studies that looked at one of the variables of interest (e.g. osteoporosis, prehabilitation and functional status, multidisciplinary preoperative screening, infection, obesity, nutrition, smoking, diabetes, blood loss, chronic opioid use and psychosocial factors) in adult patients with spinal deformity according to PRISMA guidelines. Results. 70 studies were included in the final review and synthesis of information. Guidelines and recommendations from these studies were compared and compiled into evidence based action items for preoperative optimization of modifiable risk factors prior to adult spinal deformity surgery. Conclusions. While the approach of preoperative optimization of modifiable risk factors may incur additional planning efforts and patient care time, it has the potential to significantly reduce perioperative complications and reduce morbidity and mortality during surgery, thus allowing for improved outcomes, increased quality of life, and satisfaction from this patient population. Level of Evidence. III

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“…Similarly, in a propensity matched cohort of 1044 patients, Khalid et al reported that osteopenia and osteoporosis were associated with increased odds of revision surgery [odds ratio (OR) 2.01 and 1.57], respectively. There was an almost two-fold increased odds of proximal and distal junctional kyphosis in patients with osteopenia and osteoporosis (OR 1.95 and OR 1.88), respectively 14. Zhao et al 15 reported on 242 patients undergoing oblique lumbar interbody fusion and found that osteoporosis was a significant risk factor for cage subsidence (OR=6.0).…”

Section: Rational For Preoperative Screening and Treatmentmentioning

confidence: 99%

“…There was an almost two-fold increased odds of proximal and distal junctional kyphosis in patients with osteopenia and osteoporosis (OR 1.95 and OR 1.88), respectively. 14 Zhao et al 15 reported on 242 patients undergoing oblique lumbar interbody fusion and found that osteoporosis was a significant risk factor for cage subsidence (OR = 6.0). The poor outcomes associated with osteoporosis have been reported both in the lumbar and the cervical spine.…”

Section: Rational For Preoperative Screening and Treatmentmentioning

confidence: 99%

Bone Health Optimization (BHO) in Spine Surgery

Anderson

Binkley

Bernatz

2023

Spine

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Study Design. Literature review Objective. To educate spine surgeons on the importance of bone health optimization in surgical patients. Summary of Background Data. Osteoporosis is common and underdiagnosed in spine surgery patients. Poor bone health has been linked to worse outcomes and complications after spine surgery. Guidelines are available to inform decision making on screening and treatment in this population. Methods. Available literature is reviewed regarding bone health screening and treatment. Studies reporting outcomes related to osteoporosis, bone density, and vitamin D status are summarized. Pharmacologic treatment and nutritional considerations are discussed. Bone health optimization practice models and outcomes are also reviewed.Results. Bone health screening should be considered in all adults over age 50. Gender-specific guidelines are available to determine which patients need dual-energy x-ray absorptiometry. Osteoporosis can be diagnosed by dual-energy x-ray absorptiometry T-score, fracture risk calculator or by history of low-energy fracture. Advanced imaging including computed tomography and magnetic resonance imaging can be used to opportunistically assess bone health. If diagnosed, osteoporosis can be treated with either antiresorptive or anabolic agents. These medications can be started preoperatively or postoperatively and, in high-risk patients, surgical delay can be considered. The implementation of bone health optimization programs has been shown to greatly increasing screening and treatment rates. Conclusion. Bone health assessment and optimization are important for decreasing surgical risks and improving outcomes in spine surgery patients.

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The role of bone mineral density in adult spinal deformity patients undergoing corrective surgery: a matched analysis

Cited by 8 publications

References 44 publications

Junctional Kyphosis after Correction with Long Instrumentation for Late Posttraumatic Thoracolumbar Kyphosis: Characteristics and Risk Factors

Junctional Kyphosis after Correction with Long Instrumentation for Late Posttraumatic Thoracolumbar Kyphosis: Characteristics and Risk Factors

Preoperative Optimization for Adult Spinal Deformity Surgery

Bone Health Optimization (BHO) in Spine Surgery

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