The impact of osteoporosis on adult deformity surgery outcomes in Medicare patients

Varshneya, Kunal; Bhattacharjya, Anika; Jokhai, Rayyan T.; Fatemi, Parastou; Medress, Zachary A.; Stienen, Martin N.; Ho, Allen L.; Ratliff, John K.; Veeravagu, Anand

doi:10.1007/s00586-021-06985-z

Cited by 11 publications

(6 citation statements)

References 46 publications

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“…Consistently, multiple studies have demonstrated an increased risk of pseudarthrosis and revision surgery following spinal fusion in patients with osteoporosis compared with those with normal BMD. For example, a recent analysis of 2,293 patients with ASD by Puvanesarajah et al revealed twofold higher odds of reoperation for osteoporotic patients compared with patients with normal BMD 7 , a finding supported by other studies 8,9 .…”

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confidence: 72%

“…This study aimed to address the third line of evidence, by showing that the patients in the OP-T group had reoperation and pseudarthrosis rates similar to those of the normal BMD group. This demonstration is important, as the rate of reoperation has been noted to be 2 times higher among osteoporotic patients than patients with normal BMD in highly powered ASD cohorts [7][8][9] .…”

Section: Discussionmentioning

confidence: 95%

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Impact of Teriparatide on Complications and Patient-Reported Outcomes of Patients Undergoing Long Spinal Fusion According to Bone Density

Mohanty,

Sardar,

Hassan

et al. 2023

Journal of Bone and Joint Surgery

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Background: Surgery for adult spinal deformity (ASD) poses substantial risks, including the development of symptomatic pseudarthrosis, which is twice as prevalent among patients with osteoporosis compared with those with normal bone mineral density (BMD). Limited data exist on the impact of teriparatide, an osteoanabolic compound, in limiting the rates of reoperation and pseudarthrosis after treatment of spinal deformity in patients with osteoporosis. Methods: Osteoporotic patients on teriparatide (OP-T group) were compared with patients with osteopenia (OPE group) and those with normal BMD. OP-T patients were matched with OPE patients and patients with normal BMD at a 1:2:2 ratio. All patients had a minimum 2-year follow-up and underwent posterior spinal fusion (PSF) involving >7 instrumented levels. The primary outcome was the 2-year reoperation rate. Secondary outcomes included pseudarthrosis with or without implant failure, proximal junctional kyphosis (PJK), and changes in patient-reported outcomes (PROs). Clinical outcomes were analyzed using conditional logistic regression. Changes in PROs were analyzed using a mixed-effects model. Results: Five hundred and forty patients (52.6% normal BMD, 32.9% OPE, 14.4% OP-T) were included. In the unmatched cohort, 2-year reoperation rates (odds ratio [OR] = 0.45 [95% confidence interval (CI): 0.20 to 0.91]) and pseudarthrosis rates (OR = 0.25 [95% CI: 0.08 to 0.61]) were significantly lower in the OP-T group than the OPE group. Seventy-eight patients in the OP-T group were matched to 156 patients in the OPE group. Among these matched patients, at 2 years, 23.1% (36) in the OPE group versus 11.5% (9) in the OP-T group had a reoperation (OR = 0.45, p = 0.0188), 21.8% (34) versus 6.4% (5) had pseudarthrosis with or without implant failure (OR = 0.25, p = 0.0048), and 6.4% (10) versus 7.7% (6) had PJK (OR = 1.18, p = 0.7547), respectively. At 2 years postoperatively, PROs were better among OP-T patients than OPE patients. Subsequently, 78 patients in the OP-T group were matched to 156 patients in the normal BMD group. Among these matched patients, there was no significant difference in 2-year reoperation (OR = 0.85 [95% CI: 0.37 to 1.98]), pseudarthrosis (OR = 0.51 [95% CI: 0.181 to 1.44]), and PJK rates (OR = 0.77 [95% CI: 0.28 to 2.06). Conclusions: Osteoporotic patients on teriparatide demonstrated lower reoperation and symptomatic pseudarthrosis rates 2 years postoperatively compared with osteopenic patients. Moreover, patient-reported and clinical outcomes for osteoporotic patients on teriparatide were not different from those for patients with normal BMD. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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confidence: 72%

Section: Discussionmentioning

confidence: 95%

Impact of Teriparatide on Complications and Patient-Reported Outcomes of Patients Undergoing Long Spinal Fusion According to Bone Density

Mohanty,

Sardar,

Hassan

et al. 2023

Journal of Bone and Joint Surgery

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“…Previous studies did not show the difference in age between groups [ 10 , 12 , 13 ], but the current meta-analysis detected that the loosening group was older than the control group. Elderly patients frequently have severe osteopenia and paravertebral muscle degeneration, which may increase the screw loosening rate [ 22 , 23 ]. Previously, Iijima et al [ 13 ] reported a higher obesity rate in the S2AI screw loosening group.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of the Caudal Screw Loosening after Pelvic Fixation for Adult Spinal Deformity: A Systematic Review and Meta-analysis

Zhao,

Nie,

Zhou

et al. 2024

Asian Spine J

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The purpose of this study was to assess the factors affecting caudal screw loosening after spinopelvic fixation for adult patients with spinal deformity. This meta-analysis calculated the weighted mean difference (WMD) and odds ratio (OR) using Review Manager ver. 5.3 (RevMan; Cochrane, London, UK). The loosening group was older than the control group (WMD, 2.17; 95% confidence interval [CI], 0.48–3.87; p=0.01). The S2 alar-iliac (S2AI) could prevent the caudal screw from loosening (OR, 0.43; 95% CI, 0.20–0.94; p=0.03). However, gender distribution (p=0.36), the number of fusion segments (p=0.24), rod breakage (p=0.97), T-score (p=0.10), and proximal junctional kyphosis (p=0.75) demonstrated no difference. Preoperatively, only pelvic incidence (PI) in the loosening group was higher (WMD, 5.08; 95% CI, 2.71–7.45; p<0.01), while thoracic kyphosis (p=0.09), lumbar lordosis (LL) (p=0.69), pelvic tilt (PT) (p=0.31), pelvic incidence minus lumbar lordosis (PI–LL) (p=0.35), sagittal vertical axis (SVA) (p=0.27), and T1 pelvic angle (TPA) demonstrated no difference (p=0.10). PI–LL (WMD, 6.05; 95% CI, 0.96–11.14; p=0.02), PT (WMD, 4.12; 95% CI, 0.99–7.26; p=0.01), TPA (WMD, 4.72; 95% CI, 2.35–7.09; p<0.01), and SVA (WMD, 13.35; 95% CI, 2.83–3.87; p=0.001) were higher in the screw loosening group immediately postoperatively. However, TK (p=0.24) and LL (p=0.44) demonstrated no difference. TPA (WMD, 8.38; 95% CI, 3.30–13.47; p<0.01), PT (WMD, 6.01; 95% CI, 1.47–10.55; p=0.01), and SVA (WMD, 23.13; 95% CI, 12.06–34.21; p<0.01) were higher in the screw loosening group at the final follow-up. However, PI–LL (p=0.17) demonstrated no significant difference. Elderly individuals were more susceptible to the caudal screw loosening, and the S2AI screw might better reduce the caudal screw loosening rate than the iliac screws. The lumbar lordosis and sagittal alignment should be reconstructed properly to prevent the caudal screw from loosening. Measures to block sagittal alignment deterioration could also prevent the caudal screw from loosening.

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“…Obesity (BMI≥30) has also been associated with four times greater risk of infection after ASD surgery 27 and a 2.5 times greater risk after cervical deformity (CD) surgery 28 . Given the known influence of obesity and diabetes on bone quality 29 and the association between osteoporosis and complications, reoperation, and cost following ASD surgery, 30 weight and glycemic optimization are strongly encouraged when considering a patient’s candidacy for ACSD correction. Thoughtful nutritional and weight loss interventions can also improve surgical cost-utility, an increasingly important factor given the growing emphasis on value-based medicine 31,32 .…”

Section: Discussionmentioning

confidence: 99%

One-year Postoperative Radiographic and Patient-reported Outcomes Following Cervical Deformity Correction Are Not Affected by a Short-term Unplanned Return to the OR

Fourman

Lafage

Ames

et al. 2023

Spine

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and on behalf of the International Spine Study Group Study Design. Retrospective analysis of a prospectively collected multicenter database.Objective. The objective of this study was to assess the radiographic and health-related quality of life (HRQoL) impact of a short-term (< 1 y) return to the operating room (OR) after adult cervical spine deformity (ACSD) surgery. Summary of Background Data. Returns to the OR within a year of ACSD correction can be particularly devastating to these vulnerable hosts as they often involve compromise of the soft tissue envelope, neurological deficits, or hardware failure. This work sought to assess the impact of a short-term reoperation on 1-year radiographic and HRQoL outcomes. Materials and Methods. Patients operated on from January 1, 2013, to January 1, 2019, with at least 1 year of follow-up were included. The primary outcome was a short-term return to the OR. Variables of interest included patient demographics, Charlson Comorbidity Index, HRQoL measured with the modified Japanese Orthopaedic Association), Neck Disability Index, and Euro Quol-5D Visual Analog Scale (EQ-5D VAS) and radiographic outcomes, including T1 slope, C2-C7 sagittal Cobb angle, T1 slope-Cobb angle, and cervical sagittal vertical axis. Comparisons between those who did versus did not require a 1-year reoperation were performed using paired t tests. A Kaplan-Meier survival curve was used to estimate reoperation-free survival up to 2 years postoperatively. Results. A total of 121 patients were included in this work (age: 61.9 ± 10.1 yr, body mass index: 28.4 ± 6.9, Charlson Comorbidity Index: 1.0 ± 1.4, 62.8% female). A 1-year unplanned return to the OR was required for 28 (23.1%) patients, of whom 19 followed up for at least 1 year. Indications for a return to the OR were most commonly for neurological complications (5%), infectious/wound complications (5.8%), and junctional failure (6.6%) No differences in demographics, comorbidities, preoperative or 1-year postoperative HRQoL, or radiographic outcomes were seen between operative groups. Conclusion. Reoperation <1 year after ACSD surgery did not influence 1-year radiographic outcomes or HRQoL.

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The impact of osteoporosis on adult deformity surgery outcomes in Medicare patients

Cited by 11 publications

References 46 publications

Impact of Teriparatide on Complications and Patient-Reported Outcomes of Patients Undergoing Long Spinal Fusion According to Bone Density

Impact of Teriparatide on Complications and Patient-Reported Outcomes of Patients Undergoing Long Spinal Fusion According to Bone Density

Incidence and Risk Factors of the Caudal Screw Loosening after Pelvic Fixation for Adult Spinal Deformity: A Systematic Review and Meta-analysis

One-year Postoperative Radiographic and Patient-reported Outcomes Following Cervical Deformity Correction Are Not Affected by a Short-term Unplanned Return to the OR

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