A Review of Vitamin D in Spinal Surgery: Deficiency Screening, Treatment, and Outcomes

Abstract

In this review, we discuss the demonstrated value of vitamin D in bone maintenance, fracture resistance, spinal health, and spine surgery outcomes. Despite this, the effect of vitamin D levels in spine surgery has not been well described. Through this review of literature, several conclusions were drawn. First, despite the fact that a high number of spine surgery patients are vitamin D deficient, screening is not commonly performed. Second, adequate vitamin D levels will not be achieved in a majority of these patients without supplementation. Last, inadequate vitamin D levels may increase the risk of pseudarthrosis. Given these findings, we suggest that many patients undergoing spinal surgery could be treated with vitamin D supplementation prior to surgery without the need for confirmatory testing for vitamin D deficiency. This is a more cost-effective method than screening all patients. However, future randomized trials and cost-effectiveness analyses are needed to determine the ultimate effects of vitamin D supplementation on clinical morbidity and surgical outcomes.

The efficacy of oral vitamin D supplements on fusion outcome in patients receiving elective lumbar spinal fusion—a randomized control trial

“…An animal model with rats after spinal fusion surgery revealed a dose dependent relationship between vitamin D supplements and fusion rate [28]. Several studies have also observed that higher 25(OH)VitD level was associated with the improvement of pain and function [21]. Waikakul et al reported that nine patients with failed back surgery syndrome had significantly improved pain and back function after vitamin D2 and vitamin D3 supplements for 6 months [29].…”

“…Several studies have demonstrated the inverse relationship of baseline 25(OH)VitD level with response to vitamin D supplements [32,33]. Therefore, if we consider to provide vitamin D supplements before spine surgery by a routine approach, it need to identify the patients who can benefit the most from vitamin D supplements and to determine the appropriate dosage of vitamin D supplements [21].…”

“…In this study, the duration of vitamin D supplement was 3 months because previous studies have demonstrated that vitamin D deficiency can typically be corrected in 6 to 12 weeks, leading to stabilization of bone turnover [21]. Furthermore, the design of 3-month vitamin D supplement has been used in several randomized controlled trials, for example, in one trial of the effect of vitamin D supplement on musculoskeletal function [34] and in the other one of the effect of vitamin D supplement on healing process of osteoporotic fracture [18].…”

“…However, as the review article presented, it lacks highquality evidence to investigate the role of vitamin D supplements in spinal fusion [21]. Therefore, this randomized controlled trial aimed to evaluate the effectiveness of oral vitamin D supplements on fusion outcomes in patients receiving elective lumbar spinal fusion.…”

Vitamin D supplementation is a cost-effective intervention after posterolateral lumbar fusion: a systematic review

“…12 Although hypovitaminosis D is common in spinal fusion patients, the published prevalence varies greatly because evidence on 25(OH)D levels in spinal surgery is limited. 14 In posterolateral fusion (PLF), the interest in vitamin D deficiency as a risk factor stems from the relatively high rate of hypovitaminosis D and because 25(OH)D supplementation appears to be a quick, low-risk, highly reliable, and potentially cost-effective strategy at reducing pseudarthrosis rates after spinal fusion. 6,7,11,[14][15][16][17][18][19] This study investigated whether preoperative vitamin D supplementation can be used as a cost-effective mechanism to reduce postsurgical pseudarthrosis rates, clinical morbidity, and costly revision surgery for PLF patients.…”