Management of Osteoporotic Bone
As the population ages and life span increases, the prevalence of osteoporosis, defined as a dual-energy X-ray absorptiometry scan (DEXA) value < −2.5, is increasing [12, 59]. Concomitant with this increase is an increase in spinal fractures and deform
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15
John E. Ziewacz, Darryl Lau, Sigurd H. Berven, Armed J. Awad, and Praveen V. Mummaneni
15.1
Introduction
As the population ages and life span increases, the prevalence of osteoporosis, defined as a dual-energy X-ray absorptiometry scan (DEXA) value < −2.5, is increasing [12, 59]. Concomitant with this increase is an increase in spinal fractures and deformity associated with osteoporosis [19, 60]. As techniques for spinal instrumentation improve, spinal surgery is being considered in older patients, many of whom have osteoporosis [9, 12, 17, 19, 30, 33, 35, 36, 38, 45, 52, 57, 59, 64, 66, 70, 72, 74, 76]. It is estimated that in patients over the age of 50 who undergo spine surgery, 51.3 % of females and 14.5 % of males have osteoporosis [12]. Of women who undergo surgery for scoliosis correction, it is estimated that 10 % have osteoporosis [83]. Osteoporosis is a significant independent predictor of complications, particularly hardware related, in spine surgery [17, 64]. As a result, particular attention must be paid when instrumenting the osteoporotic spine [30]. With the advancement and expansion of minimally invasive techniques [18, 36, 37, 45, 51, 58, 66, 69] J.E. Ziewacz • D. Lau • P.V. Mummaneni (*) Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA e-mail: [email protected] S.H. Berven Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA A.J. Awad University of Miami, Miami, FL, USA
including for deformity correction [1, 2, 4, 15, 54, 77], it is important for the spine surgeon to carefully follow patients with osteoporosis undergoing spinal fusions to ensure they do not develop pseudoarthrosis and/or implant loosening.
15.2
Complications of Osteoporosis
Osteoporosis significantly increases the risk of complications of spinal surgery, particularly in multilevel fusions [17, 64]. One study of elderly patients (mean age 68.7 year.) who underwent multilevel fusion noted that 35/80 patients (43.8 %) experienced implant loosening and adjacent segment degeneration occurred in 26 patients (32.5 %) [64]. Of these, 8 (22.8 %) and 17 (65.3 %), respectively, required reoperation [64]. The authors concluded as a result that osteoporosis should be considered preoperatively and that osteoporosis should be corrected prior to surgical treatment [64]. Another study of patients over the age of 65 who underwent fusions at greater than 5 levels noted that early complications included pedicle fractures and compression fractures and occurred in 13 % of patients. Late complications included pseudoarthroses, adjacent level degeneration, compression fractures, and junctional kyphosis, which occurred in 26 % of patients [17]. A study of 66 patients over the age of 70 who underwent minimally invasive lumbar interbody fusions (XLIF and TLIF) noted five major complications (7.4 %) [36]. The major complications
M.Y. Wang et al. (eds.), Minimally Invasive Spinal Deformity Surgery, DOI 10.1007/978-3-7091-1407-0_15, © Springe
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