Keywords
Deformity
Osteoporosis
Kyphosis
Scoliosis
Submitted : 2024-02-28
Accepted : 2024-03-14
Published : 2024-03-29
Abstract
Objective: This review aims to present relevant considerations for the surgical treatment of spinal deformities accompanied by osteoporosis, how surgeons are trying to overcome the challenges posed by osteoporosis in patients with spinal deformities, and directions for further development. Summary of literature review: Various trials have been carried out to overcome the short- and long-term complications associated with osteoporosis in order to achieve successful clinical results in the surgical treatment of spinal deformities. Methods: A comprehensive review of relevant articles was conducted. Results: The surgical goal of treating spinal deformities is to reverse neurological compromise and restore balanced spine alignment. To achieve these goals, several surgical considerations should be kept in mind. Osteoporosis is an important issue related to early and long-term complications following surgery. Methods of overcoming the challenges posed by osteoporosis such as rigid fixation techniques, proper selection of the fusion levels, perioperative medical treatment, and effective bone grafting materials are described herein; however, further development in these areas is also necessary. Conclusions: Osteoporosis may be a major obstacle in spinal deformity surgery. Although several effective attempts have been made to overcome these limitations, further research and trials are necessary to obtain better results.
References
Aebi M, 2005, The Adult Scoliosis. Eur Spine J, 2005(14): 925–948.
Glassman SD, Bridwell K, Dimar JR, et al., 2005, The Impact of Positive Sagittal Balance in Adult Spinal Deformity. Spine (Phila Pa 1975), 2005(30): 2024–2029.
Schwab F, Lafage V, Farcy JP, et al., 2007, Surgical Rates and Operative Outcome Analysis in Thoracolumbar and Lumbar Major Adult Scoliosis: Application of the New Adult Deformity Classification. Spine (Phila Pa 1975), 2007(32): 2723–2730.
Leslie WD, Lix LM, Johansson H, et al., 2011, Spine-Hip Discordance and Fracture Risk Assessment: A Physician-Friendly FRAX Enhancement. Osteoporos Int, 22(3): 839–847. http://doi.org/10.1007/s00198-010-1461-5
Ohyama S, Hoshino M, Terai H, et al., 2019, Sarcopenia is Related to Spinal Sagittal Imbalance in Patients with Spinopelvic Mismatch. Eur Spine J, 28(9): 1929–1936. http://doi.org/10.1007/s00586-019-06066-2
Park S, Kim HJ, Ko BG, et al., 2016, The Prevalence and Impact of Sarcopenia on Degenerative Lumbar Spinal Stenosis. Bone Joint J, 98-B(8): 1093–1098. http://doi.org/10.1302/0301-620X.98B8.37623
Ohtori S, Inoue G, Orita S, et al., 2012, Teriparatide Accelerates Lumbar Posterolateral Fusion in Women with Postmenopausal Osteoporosis: Prospective Study. Spine (Phila Pa 1975), 37(23): E1464–1468. http://doi.org/10.1097/BRS.0b013e31826ca2a8
Seki S, Hirano N, Kawaguchi Y, et al., 2017, Teriparatide Versus Low-Dose Bisphosphonates Before and After Surgery For Adult Spinal Deformity in Female Japanese Patients with Osteoporosis. Eur Spine J, 26(8): 2121–2127. http://doi.org/10.1007/s00586-017-4959-0
Hoppe S, Keel MJ, 2017, Pedicle Screw Augmentation in Osteoporotic Spine: Indications, Limitations and Technical Aspects. Eur J Trauma Emerg Surg, 43(1): 3–8. http://doi.org/10.1007/s00068-016-0750-x
Folsch C, Goost H, Figiel J, et al., 2012, Correlation of Pull-Out Strength of Cement-Augmented Pedicle Screws with CT-Volumetric Measurement of Cement. Biomed Tech (Berl), 57(6): 473–480. http://doi.org/10.1515/bmt-2012-0012
Flahiff CM, Gober GA, Nicholas RW, 1995, Pullout Strength of Fixation Screws from Polymethylmethacrylate Bone Cement. Biomaterials, 16(7): 533–536.
Linhardt O, Luring C, Matussek J, et al., 2006, Stability of Anterior Vertebral Body Screws After Kyphoplasty Augmentation. An Experimental Study to Compare Anterior Vertebral Body Screw Fixation in Soft and Cured Kyphoplasty Cement. Int Orthop, 30(5): 366–370.
Chen LH, Tai CL, Lee DM, et al., 2011, Pullout Strength of Pedicle Screws with Cement Augmentation in Severe Osteoporosis: A Comparative Study Between Cannulated Screws with Cement Injection and Solid Screws with Cement Pre-Filling. BMC Musculoskelet Disord, 2011(12): 33. http://doi.org/10.1186/1471-2474-12-33
Choma TJ, Pfeiffer FM, Swope RW, et al., 2012, Pedicle Screw Design and Cement Augmentation in Osteoporotic Vertebrae: Effects of Fenestrations and Cement ViscosIty on Fixation and Extraction. Spine (Phila Pa 1975), 37(26): E1628–1632. http://doi.org/10.1097/ BRS.0b013e3182740e56
Ghobrial GM, Eichberg DG, Kolcun JPG, et al., 2017, Prophylactic Vertebral Cement Augmentation at the Uppermost Instrumented Vertebra and Rostral Adjacent Vertebra for the Prevention of Proximal Junctional Kyphosis and Failure Following Long-Segment Fusion for Adult Spinal Deformity. Spine J, 17(10): 1499–1505. http://doi.org/10.1016/j.spinee.2017.05.015
Liu N, Wood KB, 2017, Multiple-Hook Fixation in Revision Spinal Deformity Surgery for Patients with a Previous Multilevel Fusion Mass: Technical Note and Preliminary Outcomes. J Neurosurg Spine, 26(3): 368–373. http://doi.org/10.3171/2016.8.SPINE16432
Viswanathan VK, Minnema AJ, Viljoen S, et al., 2019, Sublaminar Banding as an Adjunct to Pedicle Screw Rod Constructs: A Review and Technical Note on Novel Hybrid Constructs in Spinal Deformity Surgery. J Neurosurg Spine, 30(6): 1–7. http://doi.org/10.3171/2018.11.SPINE181154
Daniels AH, Reid DBC, Durand WM, et al., 2019, Upper-Thoracic Versus Lower-Thoracic Upper Instrumented Vertebra in Adult Spinal Deformity Patients Undergoing Fusion to the Pelvis: Surgical Decision-Making and Patient Outcomes. J Neurosurg Spine, 32(4): 1–7. http://doi.org/10.3171/2019.9.SPINE19557
Theologis AA, Mundis GM, Jr., Nguyen S, et al., 2017, Utility of Multilevel Lateral Interbody Fusion of the Thoracolumbar Coronal Curve Apex in Adult Deformity Surgery in Combination with Open Posterior Instrumentation and L5-S1 Interbody Fusion: A Case-Matched Evaluation of 32 Patients. J Neurosurg Spine, 26(2): 208–219. http://doi.org/10.3171/2016.8.SPINE151543
How NE, Street JT, Dvorak MF, et al., 2019, Pseudarthrosis in Adult and Pediatric Spinal Deformity Surgery: A Systematic Review of the Literature and Meta-Analysis of Incidence, Characteristics, and Risk Factors. Neurosurg Rev, 42(2): 319–336. http://doi.org/10.1007/s10143-018-0951-3
Karikari IO, Metz LN, 2018, Preventing Pseudoarthrosis and Proximal Junctional Kyphosis: How to Deal with the Osteoporotic Spine. Neurosurg Clin N Am, 29(3): 365–374. http://doi.org/10.1016/j.nec.2018.03.005
Park HY, Ha KY, Kim YH, et al., 2018, Minimally Invasive Lateral Lumbar Interbody Fusion for Adult Spinal Deformity: Clinical and Radiological Efficacy with Minimum Two Years Follow-Up. Spine (Phila Pa 1975), 43(14): E813–E821. http://doi.org/10.1097/BRS.0000000000002507
Daniels AH, DePasse JM, Durand W, et al., 2018, Rod Facture After Apparently Solid Radiographic Fusion in Adult Spinal Deformity Patients. World Neurosurg, 2018(117): e530–e537. http://doi.org/10.1016/j.wneu.2018.06.071
Hyun SJ, Lenke LG, Kim YC, et al., 2014, Comparison of Standard 2-Rod Constructs to Multiple-Rod Constructs for Fixation Across 3-Column Spinal Osteotomies. Spine (Phila pa 1975), 39(22): 1899–1904. http://doi.org/10.1097/BRS.0000000000000556
Poorman GW, Jalai CM, Boniello A, et al., 2017, Bone Morphogenetic Protein in Adult Spinal Deformity Surgery: A Meta-Analysis. Eur Spine J, 26(8): 2094–2102. http://doi.org/10.1007/s00586-016-4841-5
Kim YH, Reoyan GN, Ha KY, et al., 2016, Pseudarthrosis Repair Using Autologous Cultured Osteoblasts in Complex Type- 1 Neurofibromatosis Spinal Deformity: A Case Report and Review of the Literature. Spine (Phila Pa 1975), 41(22): E1372–E1378.
Min HK, Ahn JH, Ha KY, et al., 2019, Effects of Anti-Osteoporosis Medications on Radiological and Clinical Results After Acute Osteoporotic Spinal Fractures: A Retrospective Analysis of Prospectively Designed Study. Osteoporos Int, 30(11): 2249–2256. http://doi.org/10.1007/s00198-019-05125-0
Nakao S, Minamide A, Kawakami M, et al., 2011, The Influence of Alendronate on Spine Fusion in an Osteoporotic Animal Model. Spine (Phila Pa 1975), 36(18): 1446–1452. http://doi.org/10.1097/BRS.0b013e3181f49c47