Concurrent Treatment with Vitamin K2 and D3 on Spine Fusion in Patients with Osteoporosis-Associated Lumbar Degenerative Disorders

Abstract

A prospective and nonrandomized concurrent controlled trial. Objective. To address the early effects of concurrent treatment with vitamin K 2 and vitamin D 3 on fusion rates in patients who have undergone spinal surgery. Summary of Background Data. Intervertebral pseudarthrosis has been reported after transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF), especially in patients with osteopenia or osteoporosis. No study has assessed the early effects of concurrent treatment with vitamin K 2 and vitamin D 3 on fusion rates. Methods. Patients with osteopenia or osteoporosis who underwent TLIF or PLIF in our department were included. Patients in the VK 2 þVD 3 group received vitamin K 2 , vitamin D 3 , and calcium treatment, whereas subjects in the control group only received calcium and vitamin D 3 . Spine fusion was evaluated by computed tomography. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and visual analog scale (VAS) were used to assess the clinical and neurological symptoms. Bone mineral density (BMD) and bone metabolism markers were measured for osteoporotic evaluation.Results. Seventy-eight patients were included, and nine patients subsequently discontinued because of 2019-nCoV. At six months postoperatively, complete fusion rates were significantly higher in the VK 2 þVD 3 group than that in the control group (91.18% vs 71.43%, P ¼ 0.036). At six months postoperatively, BMD was increased in the VK 2 þVD 3 group and was higher than that in the control group, although there was no significant difference. At three months postoperatively, a significant increase in procollagen type I amino terminal propeptide (91.81%) and a slight decrease in C-terminal end peptide (8.06%) were observed in the VK 2 þVD 3 group. In both groups, the JOA-BPEQ and VAS scores were significantly improved after spine surgery. Conclusion. Administration of vitamin K 2 and vitamin D 3 can increase lumbar interbody fusion rates, improve clinical symptoms, promote bone information, and avoid further decline in BMD within six months after TLIF or PLIF.

Risk factors affecting spinal fusion: A meta-analysis of 39 cohort studies

“…Diabetes is a multiorgan disease, and its complications may lead to multisystem organ failure, resulting in poor surgical outcomes [58]. Additionally, studies have confirmed that vitamin D levels are significantly associated with bone mineral density; thus, vitamin D deficiency may result in bone nonunion or prolonged fusion time [20,21]. This is consistent with our findings (OR, 2.47; 95% CI, 1.25 to 4.91).…”

“…After a full-text review, we excluded 79 studies that did not have access to patient outcome data, non-population-based cohorts, meta-analyses, systematic reviews, RCTs, and non-English literature (S4 Table ). Finally, this meta-analysis included 39 cohort studies [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], comprising 7,145 participants satisfied the inclusion criteria (Fig 1).…”

“…Vitamin D deficiency. Three studies [20][21][22] reported the effect of vitamin D deficiency on spinal fusion. In our outcome, the risk of fusion failure in patients with vitamin D deficiency was significantly higher than that in patients without vitamin D deficiency (OR, 2.46; 95% CI, 1.24 to 4.90) (Fig 5), and we did not observe significant heterogeneity (I 2 = 13.5%).…”

“…However, many other observational studies have not found a significant correlation between the use of BMP-2 and successful fusion [14][15][16][17][18][19]. Moreover, Zhang et al reported that vitamin D deficiency could decrease spine fusion rates [20,21], while Ravindra et al found that there was no significant difference in spine fusion rates between vitamin D-deficient and non-vitamin D deficient patients [22].…”

Efficacy and safety of different anti-osteoporotic drugs for the spinal fusion surgery: A network meta-analysis

“…Spinal fusion surgery is common in geriatrics, especially in aged women[ 7 ]. In general, spinal fusion patients are more likely to have low bone mass and osteoporosis[ 8 , 9 ]. Complications that have been reported in the surgical treatment of an osteoporotic spine using instrumentation include spinal instability, implant migration leading to pseudarthrosis, instrumentation failure, and other related issues[ 10 , 11 ].…”