Vitamin D Levels and 1-Year Fusion Outcomes in Elective Spine Surgery

Ravindra, Vijay M.; Godzik, Jakub; Dailey, Andrew T.; Schmidt, Meic H.; Bisson, Erica F.; Hood, Robert S.; Cutler, Andrew J.; Ray, Wilson Z.

doi:10.1097/brs.0000000000001041

Cited by 71 publications

(60 citation statements)

References 25 publications

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“…44 Recent evidence suggests that vitamin D deficiency may be associated with less favorable surgical outcomes after spinal fusion procedures and increased risk of pseudoarthrosis. 39 Epidemiological studies showed a wider prevalence of vitamin D deficiency than initially thought. One study reported about 41.6% of the general American population was found to be vitamin D deficient.…”

Section: Vitamin D Levelsmentioning

confidence: 98%

“…Such a relationship between vitamin D status and fusion rates was also demonstrated by some previous studies. 39,50 Other studies also reported an influence of vitamin D status on clinical outcome measures. Ravindra et al 39 found that patients with vitamin D deficiency showed significantly higher rates of nonunion and longer mean time to fusion when compared with patients with normal levels.…”

Section: Vitamin D Levelsmentioning

confidence: 99%

“…39,50 Other studies also reported an influence of vitamin D status on clinical outcome measures. Ravindra et al 39 found that patients with vitamin D deficiency showed significantly higher rates of nonunion and longer mean time to fusion when compared with patients with normal levels. Xu et al 50 showed that vitamin D supplementation in deficient patients resulted in better fusion rates and functional outcomes compared to the control group.…”

Section: Vitamin D Levelsmentioning

confidence: 99%

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The Effect Of Cigarette Smoking And Vitamin D Status on Fusion Rates After Posterior Lumbar Interbody Fusion (PLIF) surgery. Does Sound Radiological Fusion Correlates With Better Clinical Outcomes?

Ali

Elnaggar

Elwany

et al. 2019

Egyptian Spine Journal

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Background Data: Lumbar interbody fusion surgeries are the gold standard surgical option in degenerative disc disorders and spondylolisthesis. Achieving solid arthrodesis at the operated segment remains the main goal of surgery. Yet, the correlation of sound radiological fusion with better clinical outcomes is not well established. In recent years, spinal surgeons had much greater awareness of the influence of vitamin D deficiency and cigarette smoking on spinal fusion. Purpose: To assess the influence of vitamin D deficiency and cigarette smoking on the rate of spinal arthrodesis after posterior lumbar interbody fusion (PLIF) in degenerative disc disorders and whether successful fusion correlates with clinical outcomes. Study Design: A prospective cohort study. Patients and Methods: The study was conducted on 67 patients (with a total of 92 levels) who underwent operation for PLIF with pedicle screw fixation. Twenty-six patients had degenerative spondylolisthesis, 20 had herniated discs, and 21 patients showed degenerative disc changes with segmental canal stenosis. In 29 patients, a local bone graft was used as soft PLIF. In the remaining 38 patients, a PEEK interbody cage was utilized. Patients were categorized according to both their serum vitamin D status (39 low; 28 normal) and cigarette smoking habits (18 smokers; 49 non-smokers). The final assessment was done 6 months postoperatively. Clinical outcomes were measured by the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for low back pain. Radiological fusion status was assessed on plain radiographs and graded according to Bridwell's interbody fusion grading system. The relationship between vitamin D status and cigarette smoking and radiological outcomes was also evaluated. Results: Twenty-two males and 45 females were included in this study. The mean age was 55.8±±3.78 years. L4-L5 was the most commonly operated level, followed by L5-S1 and L3-4 (51.1%, 36.95%, Egy Spine J -Volume 32 -October 2019The EGYPTIAN SPINE Journal and 11.95%, resp.). There were significant improvements in the mean ODI and VAS measures at final assessment regardless of the differences in vitamin D status or smoking habits. The fusion rate in the low vitamin D group was 79.5% versus 96.4% in the normal level group (P=0.045). 66.7% of those with poor radiological fusion were smokers versus 20.7% of those with sound fusion (P=0.004). There was no significant difference in fusion rates between the PEEK cage group and the bone graft group (P=0.128). There was no significant correlation between sound radiological fusion and better clinical outcomes (P=0.077 and P=0.157 for ODI and VAS, resp.). Conclusion: Smoking habits and low serum vitamin D seem to have a significant negative effect on the success of radiological spinal fusion. There was no significant relationship between radiological fusion and clinical outcomes. (2019ESJ190)

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Section: Vitamin D Levelsmentioning

confidence: 98%

Section: Vitamin D Levelsmentioning

confidence: 99%

Section: Vitamin D Levelsmentioning

confidence: 99%

See 1 more Smart Citation

The Effect Of Cigarette Smoking And Vitamin D Status on Fusion Rates After Posterior Lumbar Interbody Fusion (PLIF) surgery. Does Sound Radiological Fusion Correlates With Better Clinical Outcomes?

Ali

Elnaggar

Elwany

et al. 2019

Egyptian Spine Journal

View full text Add to dashboard Cite

show abstract

“…For instance, vitamin D deficiency has been shown to be a prevalent issue that can adversely impact elective spine surgery. 6,37,38 Ravindra et al found that 30.0% of patients undergoing elective spine fusion surgery had vitamin D deficiency; Stoker et al similarly found that 27.0% of patients undergoing spine fusion surgery had vitamin D deficiency. 39,40 Subsequent studies have shown that vitamin D deficiency has a negative impact on spine fusion outcomes.…”

Section: Bone Fragility and Its Impact On Elective Spine Surgerymentioning

confidence: 99%

“…Ravindra et al showed that vitamin D deficiency was an independent predictor of nonunion and that the time to fusion in patients with vitamin D deficiency was significantly longer. 38 A literature review performed by Kerezoudis et al found that patients presenting with vitamin D deficiency achieved lower fusion rates and had higher rates of persistent low back pain following spinal fusion. 6 Kim found that functional outcome as measured by Oswestry Disability Index inversely correlated with baseline 25(OH) Vit D after spine surgery.…”

Section: Bone Fragility and Its Impact On Elective Spine Surgerymentioning

confidence: 99%

A Review and Clinical Perspective of the Impact of Osteoporosis on the Spine

Carlson

Robinson

Wanderman

et al. 2019

Geriatr Orthop Surg Rehabil

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Introduction: Osteopenia and osteoporosis are common conditions in the United States. The health consequences of low bone density can be dire, from poor surgical outcomes to increased mortality rates following a fracture. Significance: This article highlights the impact low bone density has on spine health in terms of vertebral fragility fractures and its adverse effects on elective spine surgery. It also reviews the clinical importance of bone health assessment and optimization. Results: Vertebral fractures are the most common fragility fractures with significant consequences related to patient morbidity and mortality. Additionally, a vertebral fracture is the best predictor of a subsequent fracture. These fractures constitute sentinel events in osteoporosis that require further evaluation and treatment of the patient’s underlying bone disease. In addition to fractures, osteopenia and osteoporosis have deleterious effects on elective spine surgery from screw pullout to fusion rates. Adequate evaluation and treatment of a patient’s underlying bone disease in these situations have been shown to improve patient outcomes. Conclusion: With an increased understanding of the prevalence of low bone mass and its consequences as well an understanding of how to identify these patients and appropriately intervene, spine surgeons can effectively decrease the rates of adverse health outcomes related to low bone mass.

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The Seattle Spine Team Approach

Leveque

2019

Value-Based Approaches to Spine Care

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Vitamin D Levels and 1-Year Fusion Outcomes in Elective Spine Surgery

Abstract: 3.

Cited by 71 publications

References 25 publications

The Effect Of Cigarette Smoking And Vitamin D Status on Fusion Rates After Posterior Lumbar Interbody Fusion (PLIF) surgery. Does Sound Radiological Fusion Correlates With Better Clinical Outcomes?

The Effect Of Cigarette Smoking And Vitamin D Status on Fusion Rates After Posterior Lumbar Interbody Fusion (PLIF) surgery. Does Sound Radiological Fusion Correlates With Better Clinical Outcomes?

A Review and Clinical Perspective of the Impact of Osteoporosis on the Spine

The Seattle Spine Team Approach

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