Department of Neurosurgery, Duke University Medical Center, 200 Trent Drive, Box 3807, Durham, NC 27710, USA.
Department of Orthopedic Surgery, University of California San Francisco, 500 Parnassus Avenue, MU-320-West, San Francisco, CA 94143, USA.
Neurosurg Clin N Am. 2018 Jul;29(3):365-374. doi: 10.1016/j.nec.2018.03.005.
The increase in the aging population has led to an overall increase in the number of elderly patients undergoing spinal fusion surgery. This patient population, however, exhibits significant treatment challenges because of poor bone quality. By virtue of exhibiting decreased pullout strength and insertional torque, osteoporotic patients are at a substantial risk of developing vertebral fractures, instrumentation failure, pseudoarthrosis, and proximal junctional failures. It is, therefore, imperative for the treating surgeon to optimize bone health before recommending a spinal fusion surgery. Several preoperative medical therapies (vitamin D, calcium, bisphosphonates, parathyroid hormone, and so forth) exist to optimize bone health.
人口老龄化的增加导致接受脊柱融合手术的老年患者总数增加。然而，由于骨质量差，这些患者群体存在显著的治疗挑战。由于骨质疏松症患者的拔出强度和插入扭矩降低，他们发生椎体骨折、器械故障、假关节和近端连接失败的风险显著增加。因此，在推荐脊柱融合手术之前，治疗医生有必要优化患者的骨骼健康。有几种术前药物治疗（维生素 D、钙、双磷酸盐、甲状旁腺激素等）可以优化骨骼健康。
