Practice Patterns of Spine Surgeons Regarding Osteoporosis: An International Survey

Abstract

Background: Osteoporosis (OP) represents a great challenge for the spine surgeon. Despite having effective pharmacological treatments for OP and surgical technical innovations, the awareness of spine surgeons regarding OP seems low. The purpose of this research was to assess practice patterns on the diagnosis and treatment of spine surgeons regarding OP.Methods: An electronic survey of ten multiple-choice questions was administered to members of the European Association of Neurosurgical Societies (EANS). The survey asked about the specialty, the workplace, and practice patterns and attitudes regarding OP and spine fusion surgery, pseudoarthrosis, and vertebral compression fractures (VCF).Results: A total of 122 surgeons completed the survey. In patients with suspected OP, 31.4% of surgeons would refer the patient to the OP specialist before surgery and 21.5% chose to perform the surgery without additional studies. A 66.4% of respondents would modify the surgical strategy in the case of OP. The most popular surgical techniques elected were cemented augmented screws (77.9%) and long-segment instrumentation (45.1%). Regarding pseudoarthrosis, 29.5% of surgeons opted to refer to the OP specialist, and 23.8% didn't consider any additional studies Concerning VCF management, 41.32% of respondents would refer the patient for treatment of OP, and the most common therapeutic strategy was conservatively treatment for 4 to 6 weeks and vertebroplasty or kyphoplasty if no improvement (55.74%). There was a higher proportion of surgeons that would not consider preoperative studies or referring patients with suspected OP for spine surgery (v 2 ¼ 4.48, p ¼0.03) and pseudoarthrosis (v 2 ¼ 9.5, p ¼0.002) compared to VCF.Conclusions: There was a greater awareness regarding optimizing OP management in VCF compared to patients with suspected OP for spine arthrodesis or pseudoarthrosis. There still opportunities for improvement for the timely diagnosis and treatment of OP in spine surgery patients.

Implantatversagen nach Instrumentierungen bei Osteoporose: Ursachen und Behandlungskonzepte

“…Im klinischen Bereich können wir mit den aktuell gängigen Verfahren der DXA (Dual-Röntgen-Absorptiometrie) oder qCT (quantitative Computertomografie) nur den BMD messen. Die Knochendichte wird also als Surrogatparameter für die gesamte Knochenfes- [7]. Weiterhin kann eine Bestimmung auch bei schon einliegenden Metallimplantaten, dann allerdings mit möglichen Artefakten, erfolgen.…”

“…Die klassische Methode, um eine verringerte Verankerung der Implantate im Knochen zu überwinden, ist die Erhöhung der Fixationspunke, also mehr Wirbel zu instrumentieren. In einer Umfrage unter 122 Chirurgen der EANS war dies bei 45% die Methode der Wahl [7]. Dies führt allerdings, neben verlängerter OP-Zeit, Blutverlust etc.…”

Survey on Actual Management of Osteoporosis with the Japanese Medical Data Vision Database in Elderly Patients Undergoing Spinal Fusion

“…Additionally, it has been considered an adverse prognostic factor, definitely leading to higher re-operation rates. Nevertheless, screening and treatment rates for osteoporosis during the peri-operative period of spinal operation remain low [7][8][9][10]. Some reports indicate that the screening implementation rate is only 19% [7].…”

Bone Health Optimization (BHO) in Spine Surgery

“…However, poor bone health has received much less attention despite it being common in spine surgery patients and being associated with poorer outcomes and increased likelihood of adverse events. 2 Bone health optimization (BHO) is the process to identify those at risk for osteoporosis, identify and correct metabolic and nutritional abnormalities and, when indicated, provide bone-active medical treatment preoperatively and postoperatively. 3 The goal of BHO is to improve outcomes and reduce complications in a cost-effective manner.…”

“…Examples include assuring adequate glucose control in diabetic patients, stratifying cardiac risk to determine who needs further evaluation, nasal screening and decolonization for staphylococcus and correcting nutritional deficits. However, poor bone health has received much less attention despite it being common in spine surgery patients and being associated with poorer outcomes and increased likelihood of adverse events 2. Bone health optimization (BHO) is the process to identify those at risk for osteoporosis, identify and correct metabolic and nutritional abnormalities and, when indicated, provide bone-active medical treatment preoperatively and postoperatively 3.…”