Sardar Zeeshan, Coury Josephine, Polly David, Cheung Kenneth, Lewis Stephen J
Department of Orthopedic Surgery, The Och Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA.
Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA.
Global Spine J. 2025 Jul;15(3_suppl):61S-74S. doi: 10.1177/21925682241289899. Epub 2025 Jul 9.
Study DesignLiterature review.ObjectivesTo provide an overview of the complications associated with and management strategies for adult patients with osteoporosis requiring spinal reconstructive surgery. Emphasis will be placed on screening, diagnosis, and perioperative medical and surgical management of these patients.MethodsA review of the literature was performed for studies examining osteoporosis in adult patients undergoing spine surgery, associated complications, treatment and prevention methodologies.ResultsThe reported incidence of osteoporosis in adult patients undergoing spinal reconstructive surgery was found to be 10% - 50%, whereas the incidence of osteopenia was 41.4% - 58.6%. DEXA scan is the most widely used modality for assessing bone mineral density (BMD) despite its limitations. Quantitative CT has been found to be the most optimal method for measuring BMD in the spine, yet, its availability is limited. Opportunistic CT scan-based Hounsfield Units (CTHU) have been found to correlate with osteoporosis and osteopenia, instrumentation loosening, proximal and distal junctional kyphosis, and pseudarthrosis. Patients treated with Teriparatide preoperatively and postoperatively were found to have a decreased rate of pseudarthrosis, screw loosening, and reoperation. Modifying surgical techniques can also improve outcomes. Such strategies could involve vertebral cement augmentation, iliac fixation in long constructs to the sacrum, and utilizing longer constructs when addressing spinal deformity or spinal instability.ConclusionsThe incidence of osteoporosis in patients undergoing spinal reconstruction is high. Appropriate preoperative and postoperative medical treatment can result in lower rates of adverse events related to osteoporosis. Surgical treatment and fixation can also be modified to account for suboptimal bone health.
研究设计
文献综述。
目的
概述成年骨质疏松症患者进行脊柱重建手术的相关并发症及管理策略。重点将放在这些患者的筛查、诊断以及围手术期的药物和手术管理上。
方法
对有关接受脊柱手术的成年患者骨质疏松症、相关并发症、治疗及预防方法的研究进行文献综述。
结果
接受脊柱重建手术的成年患者中，骨质疏松症的报告发病率为10% - 50%，而骨质减少的发病率为41.4% - 58.6%。尽管存在局限性，双能X线吸收法扫描仍是评估骨密度（BMD）最广泛使用的方法。定量CT已被发现是测量脊柱骨密度的最佳方法，然而，其应用并不广泛。基于机会性CT扫描的亨氏单位（CTHU）已被发现与骨质疏松症和骨质减少、内固定松动、近端和远端交界性后凸畸形以及假关节形成相关。术前和术后使用特立帕肽治疗的患者假关节形成、螺钉松动和再次手术的发生率降低。改进手术技术也可改善治疗效果。这些策略可能包括椎体强化骨水泥、在长节段结构中骶骨与髂骨固定以及在处理脊柱畸形或脊柱不稳时使用更长的结构。
结论
接受脊柱重建手术的患者骨质疏松症发病率较高。适当的术前和术后药物治疗可降低与骨质疏松症相关的不良事件发生率。手术治疗和固定方式也可进行调整以适应欠佳的骨骼健康状况。
