Perioperative Medical Complications after Posterior Approach Spinal Instrumentation Surgery for Osteoporotic Vertebral Collapse: A Comparative Study in Patients with Primary Osteoporosis and Those with Secondary Osteoporosis

Abstract

Study DesignA retrospective comparative study.PurposeTo compare perioperative medical complications after posterior approach spinal instrumentation surgery for osteoporotic vertebral collapse (OVC) between patients with primary osteoporosis and those with secondary osteoporosis.Overview of LiteratureWith increased aging of society, the demand for instrumentation surgery for an osteoporotic spine has been increasing. However, no studies have compared the rates or severities of perioperative complications after spinal instrumentation surgery between patients with primary osteoporosis and those with secondary osteoporosis.MethodsNinety-one patients with OVC aged ≥50 years (23 males and 68 females) who underwent posterior approach vertebral replacement with cages or posterior spinal fusion combined with vertebroplasty were divided into primary (n=56) and secondary (n=35) osteoporosis groups. Bone mineral density (BMD), osteoporosis treatment prior to OVC, operative invasiveness, and perioperative medical complications were compared.ResultsDiabetes mellitus (51.4%) was the most common cause of secondary osteoporosis, followed by glucocorticoid use (22.9%). No significant differences were seen in terms of age, gender, BMD, osteoporosis treatment, or operative invasiveness, including the number of levels fused, estimated blood loss, and number of patients requiring transfusion. No significant difference in the incidence of perioperative complications were observed between the primary and secondary osteoporosis groups (16.1% vs. 22.9%). However, surgical site infection (SSI) was significantly more frequently seen in the secondary osteoporosis group (11.4%) than in the primary osteoporosis group (1.8%; p<0.05). One patient in the secondary osteoporosis group developed methicillin-resistant Staphylococcus aureus infection that ultimately required instrument removal.ConclusionsThe overall incidence of perioperative medical complications after posterior approach spinal instrumentation surgery for OVC was comparable between the primary and secondary osteoporosis groups under conditions of similar background characteristics and operative invasiveness. However, SSI (particularly more severe cases) occurred more frequently in patients with secondary osteoporosis.

Surgical Strategies for Tuberculous Spondylodiscitis With Severe Osteoporosis: A Case Illustrating the Challenges of Delayed Intervention

“…The case underscores a significant challenge of late referral to neurosurgery following an extended period of TB treatment. Despite the successful management of TB, the patient's persistent axial pain led to prolonged immobilization, likely contributing to the development of severe osteoporosis, as indicated by a t-score of -5.7 on bone densitometry -a factor well-documented to have a substantial impact on surgical outcomes [5][6][7]. Osteoporosis, characterized by reduced bone mineral density, introduces an elevated risk of implant failure following spinal procedures, particularly in regions like the lumbosacral junction, which demands substantial mechanical stability [5].…”

Surgical Results of Patients with Myelopathy due to Ossification of the Ligamentum Flavum with Ossification of the Posterior Longitudinal Ligament or a Vertebral Fracture at the Same Level of the Thoracic Spine: A Retrospective Comparative Study

“…Many surgical procedures to treat clinical or non-union VFs have been reported, such as anterior decompression and fusion [19], balloon kyphoplasty [20], vertebroplasty with polymethylmethacrylate [21] or hydroxyapatite [11] blocks, and posterior-approach vertebral replacement with rectangular parallelepiped cages [22]. In one study, the rate of perioperative complications associated with the posterior approach using spinal instrumentation for osteoporotic VF reportedly ranged from 16.1% to 22.9% in patients with primary or secondary osteoporosis [23]. We usually perform posterior surgery for patients with osteoporotic VFs.…”

The Associations between Bone Mineral Density and Oxidative Stress Biomarkers in Postmenopausal Women

“…Osteoporosis is a more severe reduction in BMD, and decreased bone strength is also observed. Primary osteoporosis is characterized by type I (caused by menopause and decreased estrogen levels) and type II (caused by aging) [ 3 ]. Affecting more than 200 million people worldwide, osteopenia, osteoporosis, and osteoporotic fractures are major health problems in old age [ 4 ].…”

“…Primary osteoporosis is characterized by type I (caused by menopause and decreased estrogen levels) and type II (caused by aging). 3) Affecting more than 200 million people worldwide, osteopenia, osteoporosis, and osteoporotic fractures are major health problems in old age. 4) According to the World Health Organization, osteoporosis has affected 75 million people in the United States, Europe, and Japan, with a prevalence of one per three menopausal women.…”