Díaz-Romero Ricardo, Henríquez Manuel Sosa, Melián Kevin Armas, Balhen-Martin Claudia
Universidad de Las Palmas de Gran Canaria, Spain.
Department of Neurosurgery of Hospital Insular of Las Palmas of Spain Neurosurgery.
Int J Spine Surg. 2021 Apr;15(2):376-385. doi: 10.14444/8049. Epub 2021 Mar 11.
Osteoporosis (OP) represents a great challenge for the spine surgeon. Despite having effective pharmacological treatments for OP and surgical technical innovations, the awareness of spine surgeons regarding OP seems low. The purpose of this research was to assess practice patterns on the diagnosis and treatment of spine surgeons regarding OP.
An electronic survey of ten multiple-choice questions was administered to members of the European Association of Neurosurgical Societies (EANS). The survey asked about the specialty, the workplace, and practice patterns and attitudes regarding OP and spine fusion surgery, pseudoarthrosis, and vertebral compression fractures (VCF).
A total of 122 surgeons completed the survey. In patients with suspected OP, 31.4% of surgeons would refer the patient to the OP specialist before surgery and 21.5% chose to perform the surgery without additional studies. A 66.4% of respondents would modify the surgical strategy in the case of OP. The most popular surgical techniques elected were cemented augmented screws (77.9%) and long-segment instrumentation (45.1%). Regarding pseudoarthrosis, 29.5% of surgeons opted to refer to the OP specialist, and 23.8% didn't consider any additional studies Concerning VCF management, 41.32% of respondents would refer the patient for treatment of OP, and the most common therapeutic strategy was conservatively treatment for 4 to 6 weeks and vertebroplasty or kyphoplasty if no improvement (55.74%).There was a higher proportion of surgeons that would not consider preoperative studies or referring patients with suspected OP for spine surgery (χ = 4.48, = .03) and pseudoarthrosis (χ = 9.5, = .002) compared to VCF.
There was a greater awareness regarding optimizing OP management in VCF compared to patients with suspected OP for spine arthrodesis or pseudoarthrosis. There still opportunities for improvement for the timely diagnosis and treatment of OP in spine surgery patients.
骨质疏松症（OP）对脊柱外科医生来说是一个巨大的挑战。尽管有针对OP的有效药物治疗和手术技术创新，但脊柱外科医生对OP的认识似乎较低。本研究的目的是评估脊柱外科医生对OP的诊断和治疗的实践模式。
对欧洲神经外科学会（EANS）成员进行了一项包含10个多项选择题的电子调查。该调查询问了专业、工作场所，以及关于OP和脊柱融合手术、假关节形成和椎体压缩骨折（VCF）的实践模式和态度。
共有122名外科医生完成了调查。在疑似OP的患者中，31.4%的外科医生会在手术前将患者转诊给OP专科医生，21.5%的医生选择在不进行额外检查的情况下进行手术。66.4%的受访者会在OP的情况下修改手术策略。最常用的手术技术是骨水泥增强螺钉（77.9%）和长节段内固定（45.1%）。关于假关节形成，29.5%的外科医生选择转诊给OP专科医生，23.8%的医生不考虑任何额外检查。关于VCF的处理，41.32%的受访者会将患者转诊进行OP治疗，最常见的治疗策略是保守治疗4至6周，若没有改善则进行椎体成形术或后凸成形术（55.74%）。与VCF相比，不考虑对疑似OP患者进行术前检查或转诊进行脊柱手术（χ = 4.48，P = .03）和假关节形成（χ = 9.5，P = .002）的外科医生比例更高。
与疑似OP患者进行脊柱融合或假关节形成相比，在VCF中对优化OP管理的认识更高。在脊柱手术患者中，OP的及时诊断和治疗仍有改进的空间。
