Pharmacophysiology of bone and spinal fusion

Kalb, Samuel; Mahan, Mark A.; Elhadi, Ali M.; Dru, Alexander; Eales, Justin; Lemos, Marcelo M.; Theodore, Nicholas

doi:10.1016/j.spinee.2013.06.005

Cited by 16 publications

(5 citation statements)

References 93 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Pharmacological treatment frequently includes bisphosphonates, because scientific evidence of their efficacy. 1,7,8,11,15 However, their effects on spine fusion are unclear. 18 It is reasonable that the spine surgeon refers the patient to the endocrinologist before surgery to optimize treatment.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgeon Management of Osteoporosis in Instrumented Spine Surgery: AOSpine Latin America Survey

Pantoja¹,

Molina²

2018

Global Spine Journal

View full text Add to dashboard Cite

Study Design: Survey study. Objective: To determine the impact of osteoporosis (OP) in instrumented spine surgery among Latin American spine surgeons. Methods: An electronic survey on aspects of instrumented spine surgery and OP was sent electronically to all members of AOSpine Latin America (AOSLA): 16 multiple-choice questions included incidence and type of complications experienced, strategies to avoid intraoperative complications, on prevention of complications and OP assessment and treatment prior to surgery. Results: A total of 349 spine surgeons from a universe of 377 surgeons (230 orthopedic surgeons and 147 neurosurgeons), associated members of AOSLA answered the survey. About 80% recalled complications directly related to OP and 71% had revised instrumentation because of OP-related complications. Techniques for prevention of intraoperative complications varied; 65% extended instrumentation to additional segments, 63% performed vertebral body cement injection alone or associated with instrumentation. Preoperative screening was used by 19% but increased to 75% if patients had risk factors. A limit value of bone mineral density for delaying surgery was not established for 66.4% of respondents. Consultation for OP management was requested by 81%, mostly to endocrinology (56.3%). Interestingly, 19% personally managed their patient's OP. Conclusion: This study provides a global perspective on how Latin American spine surgeons manage patients with OP undergoing instrumented spine surgery. Most have faced complications associated with OP and have had to resolve them surgically. Spine surgeons frequently participate partially in managing patients with OP. Most refer patients with OP for treatment to the endocrinology.

show abstract

Section: Discussionmentioning

confidence: 99%

“…6 Second is to treat patients with lifestyle recommendations and with medications to improve bone mineral density (BMD). 7,8 Third is management of complications related to OP that may occur during spine surgery.…”

Section: Introductionmentioning

confidence: 99%

Surgeon Management of Osteoporosis in Instrumented Spine Surgery: AOSpine Latin America Survey

Pantoja¹,

Molina²

2018

Global Spine Journal

View full text Add to dashboard Cite

show abstract

“…Despite the advancement of surgical techniques, pseudoarthrosis remains one of the most common complications, resulting in poor functional outcomes and increasing risk of reoperation after spinal fusion [6][7][8]. The process of bony fusion is a dynamic bone remodeling process [9]. A variety of risk factors have been identified to contribute to pseudoarthrosis, for example, osteoporosis, long-term steroid use, and smoking [7,8,10,11].…”

Section: Introductionmentioning

confidence: 99%

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

Tseng

Chung

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background Previous studies have reported that vitamin D supplement could improve fracture healing, but evidence regarding the role of vitamin D supplements in spinal fusion was limited. Thus, this study aimed to evaluate the effectiveness of oral vitamin D supplements on fusion outcomes in patients undergoing lumbar spinal fusion. Methods This randomized, double-blind, parallel-designed, active-control trial included the patients who planned for elective lumbar spinal fusion. Eligible patients were randomly assigned to receive either daily vitamin D3 (cholecalciferol) 800 IU and daily calcium citrate 600 mg (experimental group) or only daily calcium citrate 600 mg (control group). All supplements were given from postoperative day 1 and lasted for 3 months. Primary outcome was postoperative 1-year fusion rate, and secondary outcomes included time to fusion, Oswestry Disability Index (ODI), and visual analogue scale (VAS) for pain. Results Among the included 34 patients (21 in the experimental group and 13 in the control group), baseline 25-hydroxyvitamin D (25[OHVitD) level was 26.7 (10.4) ng/ml. Preoperative prevalence of vitamin D deficiency and insufficiency were 23.5% and 47.1%, respectively. Postoperative 1-year fusion rate was not significantly different between the two groups (95.2% vs. 84.6%, P = 0.544). The experimental group had significantly shorter time to fusion (Kaplan–Meier estimated: 169 days vs. 185 days [interquartile range: 88–182 days vs. 176–324 days], log-rank test: P = 0.028), lower postoperative 6-month ODI (P < 0.001), and lower postoperative 6-month VAS (P < 0.001) than the control group. Time to fusion was significantly and negatively correlated with preoperative, postoperative 3-month, and 6-month 25(OH)VitD levels (all P < 0.01). Conclusion The patient with vitamin D supplements had shorter time to fusion, better spinal function and less pain after elective spinal fusion. Further research is warranted to identify the patients who can benefit the most from vitamin D supplements and the appropriate dose of vitamin D supplements. Trial registration ClinicalTrials.gov, NCT05023122. Registered 20 August 2021. Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT03793530.

show abstract

“…As prior studies have demonstrated, low bone mineral density is a significant risk factor for vertebral fracture, instrumentation failure, and pseudarthrosis, signifying the fundamental role bone health plays in the fusion process. [11][12][13][14][15][16][17][18][19][20][21] Until recently, although hypovitaminosis D (the accepted term for insufficient or deficient levels of vitamin D) was significantly associated with low bone mineral density, [22][23][24] the effect of vitamin D levels on outcomes following spinal fusion were not well studied. Within the past several years, literature has indicated that patients' bone and disc health as well as spinal fusion outcomes all may benefit from correcting their vitamin D levels.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

Pharmacophysiology of bone and spinal fusion

Cited by 16 publications

References 93 publications

Surgeon Management of Osteoporosis in Instrumented Spine Surgery: AOSpine Latin America Survey

Surgeon Management of Osteoporosis in Instrumented Spine Surgery: AOSpine Latin America Survey

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

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

Contact Info

Product

Resources

About