Protein Supplement and Enhanced Recovery After Posterior Spine Fusion Surgery

Abstract

Objective: The objective of this study was to evaluate the effect of protein supplementation on vertebral fusion and enhanced recovery after posterior spine fusion (PSF) surgery.Summary of Background Data: Nonfusion is one of the most common complications of lumbar spine surgery. It has been shown that protein plays an important role in bone repair; however, its correlation to vertebral fusion following PSF surgery is unknown.Patients and Methods: In this randomized, double-blind clinical trial study, the intervention group received a diet with 1.2 g of protein plus high-protein supplement (36 g whey protein), and the control group received a similar diet, except for starch as a placebo from 48 hours before to 1 month after surgery. Results:The intervention group showed a significantly higher rate of vertebral fusion compared with the control group (P = 0.019). Surgical site infection and pain were significantly lower in the intervention group. A significant difference was found in the wound healing rate in favor of the intervention group. The rates of decrease in serum high-sensitivity C-reactive protein levels and increase in serum levels of insulin-like growth factor 1, albumin, total protein, and alkaline phosphatase were greater in the intervention group than in the control group (P < 0.001).Conclusions: Increased protein intake improves vertebral fusion and enhances recovery in patients undergoing PSF. This was the first study to investigate the effect of protein on fusion and healing factors; as a result, further clinical trials are needed to confirm the current results.

Perioperative Nutritional Supplementation Decreases Wound Healing Complications Following Elective Lumbar Spine Surgery: A Randomized Controlled Trial

“…This study found that patients who had perioperative nutritional supplementation had increased cross-sectional areas of their paraspinal muscles, signifying less atrophy than the control group. 26 This group later followed up these results by examining the effects of protein supplementation, as a part of an Enhanced Recovery After Surgery (ERAS) protocol. 26 Patients who underwent posterior spinal fusion and provided with perioperative nutritional supplementation had higher rates of successful vertebral fusions.…”

“…26 This group later followed up these results by examining the effects of protein supplementation, as a part of an Enhanced Recovery After Surgery (ERAS) protocol. 26 Patients who underwent posterior spinal fusion and provided with perioperative nutritional supplementation had higher rates of successful vertebral fusions. 26 In addition, they reported that these patients had increases in their levels of tissue-healing mediators, including albumin and alkaline phosphatase.…”

“…Khalooeifard et al 26 prospectively assessed the use of protein supplementation in patients undergoing posterior spinal fusion during the month following surgery. This study found that patients who had perioperative nutritional supplementation had increased cross-sectional areas of their paraspinal muscles, signifying less atrophy than the control group 26. This group later followed up these results by examining the effects of protein supplementation, as a part of an Enhanced Recovery After Surgery (ERAS) protocol 26.…”

“…Patients who underwent posterior spinal fusion and provided with perioperative nutritional supplementation had higher rates of successful vertebral fusions 26. In addition, they reported that these patients had increases in their levels of tissue-healing mediators, including albumin and alkaline phosphatase 26…”

Albumin-to-Alkaline Phosphatase Ratio as a Prognostic Biomarker for Spinal Fusion in Lumbar Degenerative Diseases Patients Undergoing Lumbar Spinal Fusion

“…Moreover, serum albumin has been shown to enhance osteogenic differentiation and bone formation in bone defect models [ 19 , 20 ]. Khalooeifard et al found that increasing protein intake can improve vertebral fusion rate and enhance the recovery ability of patients after spinal fusion [ 21 ]. There was also a study showing that ALB decreased the risk of non-fusion rate [ 22 ].…”