Prevalence of Osteoporosis Treatment and Its Effect on Post-Operative Complications, Revision Surgery and Costs After Multi-Level Spinal Fusion

et al. 2021

Preprint

Purpose: To compare the biomechanics of cortical bone trajectory screw(CBT) and bone cement screw(BC) in isolated porcine spinal low bone mass model.Method: Ten porcine spines with 3 segments were treated with EDTA decalcification. After 8 weeks, all the models met the criteria of low bone mass. Ten specimens were randomly divided into two groups, one group was implanted with CBT screw(CBT group) and the other group was implanted with bone cement screw(BC group).The biomechanical material testing machine was used to compare the porcine spine activities of the two groups in flexion, extension, bending and axial rotation, and then insertional torque, pull-out force and anti-compression force of two groups were compared. Independent-sample t test was used for comparison between groups.Result: Ten 3 segments porcine spine models with low bone mass were established, the bone mineral density of all models was lower than 0.75g/cm2. The flexion, extension, bending and axial rotation angle of CBT group and BC group respectively were 7.1±1.3°,4.3±0.8°,3.4±0.8°,6.8±0.7°and 6.4±0.8°, 4.5±0.5°, 3.5±0.5°, 6.8±0.8°, there was no significant difference between the two groups,P＞0.05.However, there were significant differences between the two groups and the control group,P＜0.01.The insertional torque of the CBT group and BC group respectively were 0.43±0.09N-m and 0.30±0.07N-m (P=0.03), and the screw pull-out force were 462.67±72.51N and 325.60±77.27N (P=0.021), respectively. There were significant differences between the two groups. The anti-compression forces between the two groups were 3561.81±522.7N and 3586.80±607.42N, respectively, and there was no significant difference between the two groups (P =0.946).Conclusion: The insertional torque and pull-out force of the CBT were higher than those of the BC in the isolated low bone porcine spine model, and the range of motion and anti-compression ability of model were similar between the two fixation methods.

Section: Biomechanical Analysismentioning

confidence: 99%

Biomechanical Analysis of Cortical Bone Trajectory Screw Versus Bone Cement Screw For Fixation In Porcine Spinal Low Bone Mass Model

et al. 2021

Preprint

“…Osteoporosis treatment is bene cial in decreasing the complications and revision rate at 1-year follow-up for elderly individuals following spinal fusion surgery [6]. However, there remains a lack of systemic treatment options for osteopenic patients following spinal fusion [7].…”

Section: Introductionmentioning

confidence: 99%

Denosumab vs placebo efficacy in bone mineral density, bone turnover markers, and function in osteopenic patients with lumbar degenerative diseases after lumbar fusion surgery: a randomized controlled trial

Xiao

et al. 2023

Preprint

Objective: Denosumab has been shown to be effective in increasing bone mineral density (BMD) in postmenopausal women with osteoporosis. However, the effect of denosumab on BMD, bone turnover markers (BTMs), and quality of life in osteopenic patients after spinal fusion remains unknown. Methods: We performed a randomized, double blinded, placebo-controlled clinical trial in osteopenic patients with lumbar degenerative diseases. All participants underwent lumbar fusion, received calcium (1200 mg/day) and vitamin D (800 IU/day) supplementation, and were randomized to receive subcutaneous injection of 60 mg denosumab or placebo every 6 months post-surgery. Patients were followed for up to 12 months post-operation. Results: We found that denosumab significantly improved percentage BMD of lumbar spine by 5.35% vs -0.45%, total hip by 3.68% vs -0.72%, and femoral neck by 3.41% vs -0.69% compared with placebo, at 12-month timepoint (p<0.05). Denosumab significantly decreased percentage change of amino-terminal propeptide of type 1 procollagen P1NP and β-C-terminal telopeptide of type 1 collagen CTX compared with placebo in osteopenic patients after lumbar fusion at the 12-month follow-up (p<0.05). Denosumab improved the Visual Analogue Scale (VAS) back scores, though no significant difference in VAS leg score, the EuroQol Five-Dimension (EQ-5D) questionnaire, the Quality of Life Questionnaire of the European Foundation for Osteoporosis-31 (QUALEFFO-31), and the Roland-Morris Disability Functioning Questionnaire (RMDQ) compared with the placebo group at the 12-month follow-up. Lastly, no significant difference was observed for the rate of new fractures, re-operation, complications, and adverse events between denosumab and placebo groups at the 12-month follow-up. Conclusion: Ultimately, our data demonstrate that denosumab is effective in increasing BMD of lumbar spine, total hip and femoral neck, suppression of BTMs and maintaining functional status in osteopenic patients after lumbar fusion surgery.

“…5,8,9 These complications can potentially be decreased by preoperatively identifying and treating osteoporosis. [10][11][12][13][14][15] Poor bone health is frequently underdiagnosed and undertreated in spine surgery populations. A survey of 349 spine surgeons found only 19.6% screened their patients for osteoporosis prior to surgery.…”

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confidence: 99%

“…Patients with poor bone health are at an increased risk of pedicle screw loosening, 1,2 instrumentation failure, 1,2 pseudarthrosis, 3–5 vertebral compression fractures, 2,4 proximal junctional kyphosis (PJK), 2,4,6,7 and revision surgery 5,8,9 . These complications can potentially be decreased by preoperatively identifying and treating osteoporosis 10–15 …”

mentioning

confidence: 99%

“…16 Kadri et al 17 found out of 124 patients undergoing arthroplasty or thoracolumbar surgery, 91% met at least one criterion for receiving osteoporosis medications according to the US National Osteoporosis Foundation (NOF) guidelines. Jain et al 10 found in 849 patients diagnosed with osteoporosis undergoing three or more level spinal fusion, only 14.3% were on osteoporosis treatment prior to surgery and 43% for 1 year after surgery.…”

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confidence: 99%

See 1 more Smart Citation

Best Practice Guidelines for Assessment and Management of Osteoporosis in Adult Patients Undergoing Elective Spinal Reconstruction

Sardar

Coury

Cerpa

et al. 2021

Spine

Self Cite

Study Design. Expert consensus study. Objective. This expert panel was created to establish best practice guidelines to identify and treat patients with poor bone health prior to elective spinal reconstruction. Summary of Background Data. Currently, no guidelines exist for the management of osteoporosis and osteopenia in patients undergoing spinal reconstructive surgery. Untreated osteoporosis in spine reconstruction surgery is associated with higher complications and worse outcomes. Methods. A multidisciplinary panel with 18 experts was assembled including orthopedic and neurological surgeons, endocrinologists, and rheumatologists. Surveys and discussions regarding the current literature were held according to Delphi method until a final set of guidelines was created with over 70% consensus.Results. Panelists agreed that bone health should be considered in every patient prior to elective spinal reconstruction. All patients above 65 and those under 65 with particular risk factors (chronic glucocorticoid use, high fracture risk or previous fracture, limited mobility, and eight other key factors) should have a formal bone health evaluation prior to undergoing surgery. DXA scans of the hip are preferable due to their wide availability. Opportunistic CT Hounsfield Units of the vertebrae can be useful in identifying poor bone health. In the absence of contraindications, anabolic agents are considered first line therapy due to their bone building properties as compared with antiresorptive medications. Medications should be administered preoperatively for at least 2 months and postoperatively for minimum 8 months. Conclusion. Based on the consensus of a multidisciplinary panel of experts, we propose best practice guidelines for assessment and treatment of poor bone health prior to elective spinal reconstructive surgery. Patients above age 65 and those with particular risk factors under 65 should undergo formal bone health evaluation. We also established guidelines on perioperative optimization, utility of various diagnostic modalities, and the optimal medical management of bone health in this population.