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

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

Affiliations

¹Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, New York, USA

²Department of Medicine, Lahey Clinic, Burlington, USA

³Department of Orthopedics, Hospital for Special Surgery, New York, USA

⁴Department of Orthopedics, University of Kansas Medical Center, Kansas City, USA

⁵Weill Cornell Medical College, New York, USA

⁶Department of Radiology, Hospital for Special Surgery, New York, USA

Abstract and keywords

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.

Keywords: Complications; Osteoporosis; Spine fusion; Volumetric bone density

Links

DOI: 10.1007/s00198-019-05245-7

PubMed: 31919536

WoS: 000519860300005

History

Received: 2019-06-21

Accepted: 2019-11-20

Online: 2020-01-09

Cited Works (1)

Year	Entry
2010	Liu XS, Cohen A, Shane E, Yin PT, Stein EM, Rogers H, Kokolus SL, McMahon DJ, Lappe JM, Recker RR, Lang T, Guo XE. Bone density, geometry, microstructure, and stiffness: relationships between peripheral and central skeletal sites assessed by DXA, HR‐pQCT, and cQCT in premenopausal women. J Bone Miner Res. October 2010;25(10):2229-2238.

Cited By (2)

Year	Entry
2023	Heilbronner AK, Dash A, Straight BE, Snyder LJ, Ganesan S, Adu KB, Jae A, Clare S, Billings E, Kim HJ, Cunningham M, Lebl DR, Donnelly E, Stein EM. Peripheral cortical bone density predicts vertebral bone mineral properties in spine fusion surgery patients. Bone. April 2023;169:116678.
2020	Dubé-Cyr R. Étude biomécanique de la jonction sacro-iliaque par approche hybride numérique et expérimentale [PhD thesis]. École polytechnique de Montréal; November 2020.