The role of bone mineral density in adult spinal deformity patients undergoing corrective surgery: a matched analysis,Acta Neurochirurgica

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The role of bone mineral density in adult spinal deformity patients undergoing corrective surgery: a matched analysis
Acta Neurochirurgica ( IF 1.9 ) Pub Date : 2022-08-04 , DOI: 10.1007/s00701-022-05317-4
Syed I Khalid ₁ , Ravi S Nunna ₁ , Jennifer S Smith ₂ , Rachyl M Shanker ₂ , Alecia A Cherney ₂ , Kyle B Thomson ₂ , Sai Chilakapati ₃ , Ankit I Mehta ₁ , Owoicho Adogwa ₄

Affiliation

Study design

Retrospective cohort.

Background

Over 44 million adults are estimated to have either osteoporosis or osteopenia. Adult spinal deformity (ASD) is estimated to affect between 32 and 68% of the elderly population.

Objective

Retrospective investigation comparing rates of postoperative complications following thoracolumbar scoliosis surgery in patients with normal bone mineral density (BMD) to those with osteopenia or osteoporosis in addition to analyzing the effects of pretreatment with anti-osteoporotic medications in patients with low BMD.

Methods

Using administrative database of Humana beneficiaries, ICD-9 and ICD-10 diagnosis codes were used to identify ASD patients undergoing multilevel thoracolumbar fusions between 2007 and 2017.

Results

The propensity matched population analyzed in this study contained 1044 patients equally represented by those with a history of osteopenia, osteoporosis, or normal BMD. Osteopenia and osteoporosis were associated with increased odds of revision surgery (OR 2.01 95% CI 1.36–2.96 and OR 1.57, 95% CI 1.05–2.35), respectively. Similarly, there was an almost twofold increased odds of proximal and distal junctional kyphosis in patients with osteopenia and osteoporosis (OR 1.95, 95% CI 1.40–2.74 and OR 1.88, 95% CI 1.34–2.64), respectively. A total of 258 (37.1%) patients with osteoporosis were pretreated with anti-osteoporotic medications and there was no statistically significant decrease in odds of proximal or distal junctional kyphosis or revision surgery in these patients.

Conclusion

Patients with ASD undergoing multilevel thoracolumbar fusion surgery have significantly higher rates of postoperative pseudarthrosis, proximal and distal junctional kyphosis, and revision surgery rates compared to patients with normal BMD.

中文翻译：

骨密度在接受矫正手术的成人脊柱畸形患者中的作用：匹配分析

学习规划

回顾性队列。

背景

据估计，超过 4400 万成年人患有骨质疏松症或骨质减少症。据估计，成人脊柱畸形 (ASD) 会影响 32% 至 68% 的老年人口。

客观的

回顾性研究比较正常骨密度 (BMD) 患者与骨质减少或骨质疏松症患者胸腰椎侧弯术后并发症的发生率，并分析抗骨质疏松药物预处理对低 BMD 患者的影响。

方法

使用 Humana 受益人的行政数据库，使用 ICD-9 和 ICD-10 诊断代码来识别 2007 年至 2017 年间接受多节段胸腰椎融合术的 ASD 患者。

结果

本研究中分析的倾向匹配人群包含 1044 名患者，这些患者均有骨质减少、骨质疏松症或 BMD 正常的病史。骨质减少和骨质疏松症与翻修手术几率增加相关（OR 2.01 95% CI 1.36–2.96 和 OR 1.57，95% CI 1.05–2.35）。同样，骨质减少和骨质疏松症患者近端和远端交界处后凸畸形的几率增加了近两倍（分别为 OR 1.95，95% CI 1.40-2.74 和 OR 1.88，95% CI 1.34-2.64）。共有 258 名 (37.1%) 骨质疏松症患者接受了抗骨质疏松药物治疗，这些患者近端或远端交界处后凸畸形或翻修手术的几率没有统计学显着降低。