Osteoporosis in Cervical Spine Surgery

Guzman, Javier Z.; Feldman, Zach M.; McAnany, Steven J.; Hecht, Andrew C.; Qureshi, Sheeraz A.; Cho, Samuel K.

doi:10.1097/brs.0000000000001347

Cited by 57 publications

(48 citation statements)

References 26 publications

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“…Osteoporosis affects a significant number of Americans, with the highest prevalence among the older adults and women [10]. Patients with osteoporosis have associated increases in comorbidities, and those undergoing spine surgery are at a greater risk for fusion construct failure and pseudoarthrosis [22]. Treating surgeons must identify patients at risk for osteoporosis and initiate medical optimization before surgery.…”

Section: Resultsmentioning

confidence: 99%

Strategies to Achieve Spinal Fusion in Multilevel Anterior Cervical Spine Surgery: An Overview

McCarthy

Weiner

Patel

2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Anterior cervical fusion offers surgeons a safe and reliable surgical option for single-level and multilevel pathology; however, multilevel fusions pose a higher risk of complications than single-level fusions, including possible pseudoarthrosis, adjacent segment disease, sagittal imbalance, and construct subsidence. Various techniques can be used to mitigate risk in multilevel anterior cervical fusion. Questions/Purposes: We reviewed the literature to determine the best surgical strategies in multilevel anterior cervical fusion. Methods: We searched the PubMed database for articles published from January 1980 through July 2019. Two authors identified relevant articles and then manually screened them for others to include in this review. Results: We initially identified 1936 articles and included 48 in our review. We found that clinical outcomes of multilevel anterior cervical fusion can be optimized through the use of biologics and graft selection, the evaluation of pre-existing deformity, the assessment of comorbidities, and the selection of fusion levels. Meticulous surgical technique in conjunction with modern surgical tools, such as instrumentation and biologics, allow surgeons to address complex cervical problems while limiting morbidity and enhancing clinical outcomes. Conclusions: Multilevel anterior cervical fusions offer a relatively safe and reliable treatment option for both single-level and multilevel pathology. Keywords current concepts . fusion . multilevel anterior cervical . anterior cervical discectomy and fusion (ACDF)

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Section: Resultsmentioning

confidence: 99%

Strategies to Achieve Spinal Fusion in Multilevel Anterior Cervical Spine Surgery: An Overview

McCarthy

Weiner

Patel

2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

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“…Osteoporosis can negatively affect cervical spine surgery and postoperative rehabilitation. In patients undergoing surgery due to degenerative cervical spine disorders, osteoporosis patients are more likely to receive posterior cervical fusion surgery than non osteoporosis patients; also, they tend to have more postoperative bleeding, higher probability of revision surgery, longer hospital stay, and higher hospitalization expenditure [9] .…”

Section: Discussionmentioning

confidence: 99%

The Use of CT Hounsfield Unit Values to Identify The Bone Quality in Patients With Cervical Degenerative Diseases.

He¹,

Zhou²,

Sun³

et al. 2020

Preprint

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Background It is well known that osteoporosis may lead to the failure of spinal surgery. As the gold standard, dual-energy X-ray absorptiometry (DXA) is used to evaluate the overall bone mineral density (BMD). Previous studies have used CT (Computed tomography) value to evaluate local bone mineral density. The objective of this study was to investigate the application value of cervical CT value in preoperative bone quality evaluation of cervical degenerative diseases. Methods A total of 939 patients who received surgical treatment for cervical degenerative diseases in our center from January 2015 to December 2017 were retrospectively reviewed. The Hounsfield unit (HU) values were measured in middle transverse CT images of the C2–C7 on the picture archiving and communication system (PACS), and the total bone mineral density T-score of L1–L4 was obtained by dual-energy X-ray absorptiometry. The changes in the HU values of C2–C7 were observed, the correlation between the HU value of C2–C7 and the total BMD T-score of L1–L4 was analyzed, and the HU thresholds of C2–C7 for different T-scores (-2.5 < T-score <-1 or T-score ≤2.5, respectively) were identified. Results The HU values of C2–C7 show a decreasing trend. The mean HU value of C2–C7 was 322.52 ± 89.27 HU. The average BMD T-score of L1-L4 was -0.73. The average HU value of C2–C7 was positively correlated with the average BMD T-score of L1–L4 (r = 0.487, P < 0.001). The HU threshold of C2–C7 was 269 HU when -2.5＜T-score＜-1, and it had a sensitivity of 75.7% and a specificity of 59.8% when used for screening for osteopenia; the HU threshold of C2–C7 was 269H U when T-score ≤-2.5, and it had a sensitivity of 63.8% and a specificity of 80.8% when used for screening for osteoporosis. Conclusions The HU values of cervical vertebrae gradually decrease from C2 to C7 in patients undergoing surgical treatment for cervical degenerative disorders. The CT HU value of cervical vertebrae is positively correlated with the BMD T-score provided by lumbar DXA, which is helpful for clinical evaluation of bone quality before surgery.

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“…9 In a review of immediate postoperative complications in osteoporotic patients specifically undergoing cervical spine surgery, the authors identified a higher rate of hemorrhage (odds ratio [OR] 1.7), an increased mean length of inpatient postoperative stay by one full day, and nearly 30% higher mean surgeryrelated costs compared to nonosteoporotic patients. 25 This significant and often increased incidence of complications in osteoporotic patients receiving spinal surgery is both dangerous and often manifests in the increased need for surgical revision. In the literature reviewing spinal fusion procedures, rates of nonunion in both osteoporotic and nonosteoporotic patients have been reported between as low as 5% and as high as 35%.…”

Section: Impact Of Osteoporosis On Surgical Outcomesmentioning

confidence: 99%

Special Considerations to Improve Clinical Outcomes in Patients with Osteoporosis Undergoing Spine Surgery

et al. 2021

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Background: Osteoporosis is a condition that is commonly encountered, with increasing diagnosis by the medical community with the aging population. Osteoporosis leaves patients susceptible to fragility fractures in the vertebrae and is also associated with degenerative changes, both of which may require intervention from a spine surgeon. The goal of this review is to concisely outline special nonoperative adjuncts, as well as preoperative, intraoperative, and postoperative considerations of osteoporotic patients undergoing spine intervention.Methods: A literature analysis was completed for this narrative review. A database search of PubMed and Google Scholar was conducted using ''osteoporosis'' combined with ''spine,'' ''spine surgery,'' and ''spinal fusion'' without exclusion based on publication date. Articles were screened to exclude duplicate articles and screened for their full text and English language availability.Results: The database search yielded recent publications from which the narrative review was completed. Conclusions: Preoperatively, screening is traditionally completed with dual-energy x-ray absorptiometry (DEXA). Pharmacological therapy modalities currently include teriparatide, raloxifene, denosumab, bisphosphonates, and calcitonin. In order to prevent operative complications associated with osteoporosis, surgeons have found success in increasing the diameter and the length of pedicle screws, limiting pedicle tapping, achieving bicortical or even tricortical purchase, augmenting with polymethyl methacrylate, using iliosacral stabilization, preventing positive sagittal balance, and using adequate fusion products when necessary. Postoperatively, it is important to implant a care plan that includes adequate pain control and necessary care, and to understand risks associated with falls may increase risk of postoperative fragility fractures as well as instrumentation displacement. At this time there are no recommendations in regard to bracing in the postoperative setting.Clinical Relevance: This review article outlines the most current evidence-based medicine with regard to considerations in spine surgery of the osteoporotic patient, and aims to bring about new questions to be investigated in that paradigm.

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Osteoporosis in Cervical Spine Surgery

Abstract: 3.

Cited by 57 publications

References 26 publications

Strategies to Achieve Spinal Fusion in Multilevel Anterior Cervical Spine Surgery: An Overview

Strategies to Achieve Spinal Fusion in Multilevel Anterior Cervical Spine Surgery: An Overview

The Use of CT Hounsfield Unit Values to Identify The Bone Quality in Patients With Cervical Degenerative Diseases.

Special Considerations to Improve Clinical Outcomes in Patients with Osteoporosis Undergoing Spine Surgery

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