Vijay M Ravindra1, Jakub Godzik2, Jian Guan1, Andrew T Dailey1, Meic H Schmidt1, Erica F Bisson1, Robert S Hood1, Wilson Z Ray3. 1. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah. 2. Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, USA. 3. Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, USA. Electronic address: rayz@wudosis.wustl.edu.
Abstract
OBJECTIVE: Decreased bone density secondary to osteoporosis and osteomalacia represents a significant risk factor for bony fracture and spinal instrumentation failure. We evaluated the incidence of vitamin D deficiency in patients undergoing elective spinal instrumentation to investigate which patient-level risk factors are associated with deficient vitamin D levels. METHODS: Serum 25-OH vitamin D levels were evaluated postoperatively (<72 hours) in patients undergoing elective spinal fusion from 2011 through 2012. Patients >18 years with a diagnosis of degenerative spinal spondylosis or spinal instability treated with spinal fusion were included. Risk factors for vitamin D deficiency (<20 ng/mL) were analyzed using univariate and multiple logistic regression to identify independent predictors of deficiency. RESULTS: The mean preoperative neck and Oswestry disability indexes of the 230 consecutive patients (mean, 57 ± 13.9 years) were 21.0 ± 9.8 and 22.2 ± 8.5, respectively. Mean 25-OH vitamin D level was 25.9 ± 12.4 ng/mL (range, 6-77 ng/mL). Sixty-nine (30.0%) patients had laboratory-confirmed vitamin D deficiency and 89 (38.9%) had laboratory-confirmed vitamin D insufficiency (20-30 ng/mL). The risk of vitamin D deficiency was greater in men (odds ratio [OR] 2.53; P = 0.009), patients aged 40-60 years (OR 2.45; P = 0.018), and those who had body mass index >40 (OR 7.55; P = 0.004), an existing diagnosis of diabetes (OR 3.29; P = 0.019), or no vitamin D supplementation (OR 4.96; P = 0.043). CONCLUSIONS: Vitamin D deficiency was common in patients with degenerative spondylosis undergoing spinal fusion. Middle-aged patients, men, the morbidly obese, those with a history of diabetes, and those with no history of supplementation had a higher incidence of vitamin D deficiency.
OBJECTIVE: Decreased bone density secondary to osteoporosis and osteomalacia represents a significant risk factor for bony fracture and spinal instrumentation failure. We evaluated the incidence of vitamin Ddeficiency in patients undergoing elective spinal instrumentation to investigate which patient-level risk factors are associated with deficient vitamin D levels. METHODS: Serum 25-OH vitamin D levels were evaluated postoperatively (<72 hours) in patients undergoing elective spinal fusion from 2011 through 2012. Patients >18 years with a diagnosis of degenerative spinal spondylosis or spinal instability treated with spinal fusion were included. Risk factors for vitamin Ddeficiency (<20 ng/mL) were analyzed using univariate and multiple logistic regression to identify independent predictors of deficiency. RESULTS: The mean preoperative neck and Oswestry disability indexes of the 230 consecutive patients (mean, 57 ± 13.9 years) were 21.0 ± 9.8 and 22.2 ± 8.5, respectively. Mean 25-OH vitamin D level was 25.9 ± 12.4 ng/mL (range, 6-77 ng/mL). Sixty-nine (30.0%) patients had laboratory-confirmed vitamin Ddeficiency and 89 (38.9%) had laboratory-confirmed vitamin Dinsufficiency (20-30 ng/mL). The risk of vitamin Ddeficiency was greater in men (odds ratio [OR] 2.53; P = 0.009), patients aged 40-60 years (OR 2.45; P = 0.018), and those who had body mass index >40 (OR 7.55; P = 0.004), an existing diagnosis of diabetes (OR 3.29; P = 0.019), or no vitamin D supplementation (OR 4.96; P = 0.043). CONCLUSIONS:Vitamin Ddeficiency was common in patients with degenerative spondylosis undergoing spinal fusion. Middle-aged patients, men, the morbidly obese, those with a history of diabetes, and those with no history of supplementation had a higher incidence of vitamin Ddeficiency.
Authors: Bayard C Carlson; William A Robinson; Nathan R Wanderman; Arjun S Sebastian; Ahmad Nassr; Brett A Freedman; Paul A Anderson Journal: Geriatr Orthop Surg Rehabil Date: 2019-07-17