Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY.
Rush University Medical Center, Chicago, IL.
Spine (Phila Pa 1976). 2022 Jan 15;47(2):128-135. doi: 10.1097/BRS.0000000000004268.
Expert consensus study.
This expert panel was created to establish best practice guidelines to identify and treat patients with poor bone health prior to elective spinal reconstruction.
Currently, no guidelines exist for the management of osteoporosis and osteopenia in patients undergoing spinal reconstructive surgery. Untreated osteoporosis in spine reconstruction surgery is associated with higher complications and worse outcomes.
A multidisciplinary panel with 18 experts was assembled including orthopedic and neurological surgeons, endocrinologists, and rheumatologists. Surveys and discussions regarding the current literature were held according to Delphi method until a final set of guidelines was created with over 70% consensus.
Panelists agreed that bone health should be considered in every patient prior to elective spinal reconstruction. All patients above 65 and those under 65 with particular risk factors (chronic glucocorticoid use, high fracture risk or previous fracture, limited mobility, and eight other key factors) should have a formal bone health evaluation prior to undergoing surgery. DXA scans of the hip are preferable due to their wide availability. Opportunistic CT Hounsfield Units of the vertebrae can be useful in identifying poor bone health. In the absence of contraindications, anabolic agents are considered first line therapy due to their bone building properties as compared with antiresorptive medications. Medications should be administered preoperatively for at least 2 months and postoperatively for minimum 8 months.
Based on the consensus of a multidisciplinary panel of experts, we propose best practice guidelines for assessment and treatment of poor bone health prior to elective spinal reconstructive surgery. Patients above age 65 and those with particular risk factors under 65 should undergo formal bone health evaluation. We also established guidelines on perioperative optimization, utility of various diagnostic modalities, and the optimal medical management of bone health in this population.Level of Evidence: 5.
专家共识研究。
本专家小组的成立旨在制定最佳实践指南，以在择期脊柱重建之前识别和治疗骨骼健康不良的患者。
目前，对于接受脊柱重建手术的患者的骨质疏松症和骨量减少症的管理尚无指南。脊柱重建手术中未治疗的骨质疏松症与更高的并发症和更差的结果相关。
组建了一个由 18 名专家组成的多学科小组，包括骨科和神经外科医生、内分泌学家和风湿病学家。根据 Delphi 方法进行了有关当前文献的调查和讨论，直到达成共识并制定出一套超过 70%的最终指南。
小组成员一致认为，在进行择期脊柱重建之前，应考虑每位患者的骨骼健康状况。所有 65 岁以上的患者以及 65 岁以下具有特定危险因素（长期使用糖皮质激素、高骨折风险或既往骨折、活动能力受限和其他 8 个关键因素）的患者，在接受手术前应进行正式的骨骼健康评估。由于其广泛的可用性，髋部 DXA 扫描是首选。椎体的机会性 CT 亨氏单位（Hounsfield units）也可以用于识别骨骼健康不良。在没有禁忌症的情况下，由于其具有骨形成特性，合成代谢药物被认为是一线治疗药物，与抗吸收药物相比。应在术前至少 2 个月和术后至少 8 个月内给予药物。
根据多学科专家小组的共识，我们提出了在择期脊柱重建手术之前评估和治疗骨骼健康不良的最佳实践指南。年龄在 65 岁以上和 65 岁以下有特定危险因素的患者应进行正式的骨骼健康评估。我们还制定了围手术期优化、各种诊断方式的使用以及该人群中骨骼健康的最佳药物管理的指南。
5。
