STUDY DESIGN: Retrospective observational study. OBJECTIVE: We investigated whether bone turnover markers could be a useful indicator for prediction of nonunion. SUMMARY OF BACKGROUND DATA: Nonunion is a major complication of lumbar spinal fusion surgery. The involvement of bone turnover in the process of bony union in spinal fusion surgery is, however, poorly understood. METHODS: Of the 74 patients analyzed, 13 were diagnosed with nonunion. We evaluated the significance of the following risk factors: age, sex, number of fused segments, serum levels of total alkaline phosphatase, procollagen type 1 amino-terminal propeptide (P1NP), tartrate-resistant acid phosphatase 5b (TRACP-5b), and albumin, and history of diabetes mellitus, cigarette smoking, or alcohol use. We also defined the bone turnover ratio (BTR) as a value that equals serum TRACP-5b concentration divided by serum P1NP concentration to evaluate patients' individual bone turnover balance and investigated the significance of BTR as a risk factor. RESULTS: Univariate analysis showed that older age, malnutrition, and lower P1NP are risk factors for nonunion. Stepwise logistic regression analysis revealed that in the presence of lower P1NP, higher TRACP-5b becomes a risk factor. Furthermore, we identified BTR as the most significant risk factor for nonunion. The optimum cut-off value of BTR by receiver-operating characteristic curve was 11.74. CONCLUSION: These findings show a relation between bone turnover and nonunion after spinal fusion surgery. The measurement of bone turnover markers could potentially be used to predict nonunion after spinal fusion surgery. LEVEL OF EVIDENCE: 4.
STUDY DESIGN: Retrospective observational study. OBJECTIVE: We investigated whether bone turnover markers could be a useful indicator for prediction of nonunion. SUMMARY OF BACKGROUND DATA: Nonunion is a major complication of lumbar spinal fusion surgery. The involvement of bone turnover in the process of bony union in spinal fusion surgery is, however, poorly understood. METHODS: Of the 74 patients analyzed, 13 were diagnosed with nonunion. We evaluated the significance of the following risk factors: age, sex, number of fused segments, serum levels of total alkaline phosphatase, procollagen type 1 amino-terminal propeptide (P1NP), tartrate-resistant acid phosphatase 5b (TRACP-5b), and albumin, and history of diabetes mellitus, cigarette smoking, or alcohol use. We also defined the bone turnover ratio (BTR) as a value that equals serum TRACP-5b concentration divided by serum P1NP concentration to evaluate patients' individual bone turnover balance and investigated the significance of BTR as a risk factor. RESULTS: Univariate analysis showed that older age, malnutrition, and lower P1NP are risk factors for nonunion. Stepwise logistic regression analysis revealed that in the presence of lower P1NP, higher TRACP-5b becomes a risk factor. Furthermore, we identified BTR as the most significant risk factor for nonunion. The optimum cut-off value of BTR by receiver-operating characteristic curve was 11.74. CONCLUSION: These findings show a relation between bone turnover and nonunion after spinal fusion surgery. The measurement of bone turnover markers could potentially be used to predict nonunion after spinal fusion surgery. LEVEL OF EVIDENCE: 4.
Authors: M Formica; D Vallerga; A Zanirato; L Cavagnaro; M Basso; S Divano; L Mosconi; E Quarto; G Siri; L Felli Journal: Musculoskelet Surg Date: 2020-01-01
Authors: Stephen J Lewis; Chandan Mohanty; Aaron M Gazendam; So Kato; Sam G Keshen; Noah D Lewis; Sofia P Magana; David Perlmutter; Jennifer Cape Journal: Eur Spine J Date: 2017-09-21 Impact factor: 3.134
Authors: Joshua A Shapiro; Matthew R Stillwagon; Paul Tornetta; Thomas M Seaver; Mark Gage; Jeffrey O'Donnell; Keith Whitlock; Seth R Yarboro; Kyle J Jeray; William T Obremskey; Andres Rodriguez-Buitrago; Paul Matuszewski; Feng-Chang Lin; Robert F Ostrum Journal: J Am Acad Orthop Surg Date: 2022-06-07 Impact factor: 4.000