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01.04.2020 | Original Article

Low volumetric bone density is a risk factor for early complications after spine fusion surgery

verfasst von: Y. Liu, A. Dash, A. Krez, H. J. Kim, M. Cunningham, F. Schwab, A. Hughes, B. Carlson, A. Samuel, E. Marty, H. Moore, D. J. McMahon, J. A. Carrino, R. S. Bockman, E. M. Stein

Erschienen in: Osteoporosis International | Ausgabe 4/2020

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Abstractx

Summary

This study aims to investigate lumbar spine (LS) volumetric bone density (vBMD) as a risk factor for complications (pseudoarthrosis, instrumentation failure, adjacent fractures), re-operation, and time to complication after fusion.

Introduction

Lumbar spine (LS) fusion surgery is increasingly performed worldwide. Complications after fusion result in significant morbidity and healthcare costs. Multiple factors, including osteoporosis, have been suggested to contribute to risk of complications and re-operation. However, most studies have used DXA, which is subject to artifact in patients with spine pathology, and none have investigated the relationship between BMD and timing of post-operative complications. This study aims to investigate LS volumetric bone density (vBMD) as a risk factor for complications (pseudoarthrosis, instrumentation failure, adjacent fractures), re-operation, and time to complication after fusion.

Methods

We evaluated a cohort of 359 patients who had initial LS fusion surgery at our institution, had pre-operative LS CTs and post-operative imaging available for review. Demographic factors, smoking status, vBMD, and details of surgical procedure were related to likelihood and timing of post-operative complications.

Results

Mean age was 60 ± 14 years, vBMD 122 ± 37 g/cm³. Median follow-up was 11 months. Skeletal complications occurred in 47 patients (13%); 34 patients (10%) required re-operation. Low vBMD (directly measured and estimated using HU) and smoking were associated with increased risk of skeletal complications. Each increase in baseline vBMD of 10 g/cm³ decreased the complication hazard and increased the complication-free duration in time-to-event analysis (hazard ratio 0.91, 95% CI 0.83–0.98, p < 0.02).

Conclusions

Low vBMD was a significant risk factor for early post-operative complications in patients undergoing LS fusion. Prospective studies are needed to confirm these findings and to elucidate the optimal timing for follow-up and strategies for prevention of post-operative complications in this population.

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Titel: Low volumetric bone density is a risk factor for early complications after spine fusion surgery
verfasst von: Y. Liu
A. Dash
A. Krez
H. J. Kim
M. Cunningham
F. Schwab
A. Hughes
B. Carlson
A. Samuel
E. Marty
H. Moore
D. J. McMahon
J. A. Carrino
R. S. Bockman
E. M. Stein
Publikationsdatum: 01.04.2020
Verlag: Springer London
Erschienen in: Osteoporosis International / Ausgabe 4/2020
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-019-05245-7

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Low volumetric bone density is a risk factor for early complications after spine fusion surgery