Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA.
Spine (Phila Pa 1976). 2013 Mar 15;38(6):507-15. doi: 10.1097/BRS.0b013e3182739ad1.
Retrospective investigation of cross-sectional data.
To define the prevalence and determinants of preoperative vitamin D deficiency among adults undergoing spinal fusion.
Vitamin D plays a critical role in establishing optimal bone health, which, in turn, is vital to the success of spinal arthrodesis. Recently, hypovitaminosis D was documented in 43% of adults undergoing any orthopedic surgery.
Serum 25-hydroxyvitamin D levels were routinely measured in adults undergoing spinal fusion at a single institution. Between January 2010 and March 2011, 313 patients were retrospectively identified for inclusion. Risk factors for vitamin D deficiency (<20 ng/mL) were analyzed using univariate analysis and multivariate logistic regression.
The rates of inadequacy (<30 ng/mL) and deficiency were 57% and 27%, respectively. Although 260 patients were diagnosed with degenerative disease (spondylosis), 99 had deformity, and there were 73 revision cases. There was a higher rate of smoking (P = 0.03) and lower age (P < 0.01) in the vitamin D-deficient subset. There was no sex difference. Increasing body mass index (P < 0.01), increasing Neck and Oswestry Disability Index scores (P = 0.03), and lack of vitamin D and/or multivitamin supplementation (P < 0.01) remained predictors of deficiency after multivariate analysis. Those with previous supplementation were older (P < 0.01) and more likely to be at least 50 years old than those without repletion (P < 0.01).
Our investigation revealed a substantially high prevalence of vitamin D abnormality in the analyzed population. Although advanced age is a well-established risk factor for hypovitaminosis, young adults undergoing fusion should not be overlooked with regard to vitamin D screening; this age bracket is less likely to have been previously supplemented. In the absence of better-recognized determinants, spinal disability indices may also be useful in identifying those with deficiency.
回顾性横断面数据分析。
明确成人脊柱融合术前维生素 D 缺乏的发生率及其决定因素。
维生素 D 在维持最佳骨骼健康方面起着至关重要的作用，而骨骼健康对于脊柱融合术的成功至关重要。最近，在接受任何骨科手术的成年人中，有 43%存在维生素 D 缺乏症。
在一家机构中，对接受脊柱融合术的成年人常规测量血清 25-羟维生素 D 水平。在 2010 年 1 月至 2011 年 3 月期间，回顾性地确定了 313 名患者纳入研究。使用单因素分析和多因素 logistic 回归分析维生素 D 缺乏症（<20ng/ml）的危险因素。
维生素 D 不足（<30ng/ml）和缺乏（<20ng/ml）的发生率分别为 57%和 27%。尽管 260 名患者被诊断为退行性疾病（颈椎病），但 99 名患者有畸形，73 名患者为翻修病例。维生素 D 缺乏组的吸烟率较高（P=0.03），年龄较小（P<0.01）。男女之间没有差异。多因素分析显示，体重指数增加（P<0.01）、颈和 Oswestry 功能障碍指数评分增加（P=0.03）、缺乏维生素 D 和/或多种维生素补充剂（P<0.01）仍然是缺乏的预测因素。与未补充者相比，有补充史的患者年龄较大（P<0.01），且更有可能在 50 岁以上（P<0.01）。
我们的研究发现，在所分析的人群中，维生素 D 异常的发生率相当高。虽然年龄较大是维生素 D 缺乏症的一个既定危险因素，但在接受融合术的年轻成年人中，不应忽视维生素 D 的筛查；这一年龄段不太可能以前有过补充。在缺乏更好的确定因素的情况下，脊柱残疾指数也可能有助于识别缺乏症患者。
