Anmol Gupta1, Thomas Cha2, Joseph Schwab2, Harold Fogel2, Daniel Tobert2, Afshin E Razi3, Andrew Hecht4, Christopher M Bono2, Stuart Hershman5. 1. Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA. 2. Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA. 3. Department of Orthopaedics, Maimonides Bone and Joint Center, Maimonides Medical Center, 6010 Bay Pkwy, Brooklyn, NY 11204, USA. 4. Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 5 East 98th St, New York, NY 10029, USA. 5. Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA. Electronic address: shhershman@mgh.harvard.edu.
Abstract
BACKGROUND: Adult spinal deformity (ASD) can be a debilitating condition that requires surgical intervention. ASD patients often present with osteoporosis, predisposing them to increased rates of instrumentation failure and postoperative fractures, frequent reasons for revision surgery. We hypothesized that the rate and timing of revision surgery are different in osteoporotic and nonosteoporotic patients undergoing long fusions for ASD. To our knowledge, the timing of revision surgeries, in particular, have not previously been explored. PURPOSE: To determine the rate and timing of revision surgery in osteoporotic and nonosteoporotic patients following a long fusion for ASD. STUDY DESIGN: Retrospective comparative study. PATIENT SAMPLE: ASD patients who underwent a long spinal fusion surgery at two large academic medical centers from 2010 to 2019. OUTCOME MEASURES: Occurrence of revision surgery. METHODS: Inclusion criteria were patient age of least 40 years and spinal fusion spanning at least seven levels for ASD. Patient records were reviewed for a diagnosis of osteoporosis as per ICD codes and revision surgery within 2 years of the index procedure. Revision surgery was defined as an unplanned procedure related to the index surgery for the treatment of a spine-related complication. Chi-squared tests comparing demographic data, revision rates, and multiple revisions were conducted. The incidence and prevalence of revision surgeries as a function of time and osteoporotic status were evaluated for significant differences via the Mann-Whitney U and Mantel-Haenszel log rank tests. Finally, a logistic regression analysis was utilized to determine the predictive value of osteoporosis, age, and gender on the likelihood for complications. RESULTS: Three hundred ninety-nine patients matched the study criteria. In the osteoporotic group, 40.5% of patients underwent a revision surgery compared to 28.0% in the nonosteoporotic group (p=.01). The occurrence of multiple revision surgeries following the index procedure was similar in both groups: 8.4% in osteoporotic patients and 8.6% in nonosteoporotic patients. Age and gender were not statistically correlated with the incidence of revision surgery. CONCLUSIONS: ASD patients with osteoporosis have an increased risk of undergoing revision for a surgery-related complication within 2 years of the index procedure. These complications included failure of hardware, pseudoarthrosis, proximal junction failure, and infection, among other issues that required surgical intervention. As others have also highlighted the importance of poor bone density on construct failure, our data further underscore the importance of preoperative osteoporosis surveillance. Though intuitive, further study is needed to demonstrate that improving patients' bone density can decrease the incidence of related complications and the need or revision surgery.
BACKGROUND: Adult spinal deformity (ASD) can be a debilitating condition that requires surgical intervention. ASD patients often present with osteoporosis, predisposing them to increased rates of instrumentation failure and postoperative fractures, frequent reasons for revision surgery. We hypothesized that the rate and timing of revision surgery are different in osteoporotic and nonosteoporotic patients undergoing long fusions for ASD. To our knowledge, the timing of revision surgeries, in particular, have not previously been explored. PURPOSE: To determine the rate and timing of revision surgery in osteoporotic and nonosteoporotic patients following a long fusion for ASD. STUDY DESIGN: Retrospective comparative study. PATIENT SAMPLE: ASD patients who underwent a long spinal fusion surgery at two large academic medical centers from 2010 to 2019. OUTCOME MEASURES: Occurrence of revision surgery. METHODS: Inclusion criteria were patient age of least 40 years and spinal fusion spanning at least seven levels for ASD. Patient records were reviewed for a diagnosis of osteoporosis as per ICD codes and revision surgery within 2 years of the index procedure. Revision surgery was defined as an unplanned procedure related to the index surgery for the treatment of a spine-related complication. Chi-squared tests comparing demographic data, revision rates, and multiple revisions were conducted. The incidence and prevalence of revision surgeries as a function of time and osteoporotic status were evaluated for significant differences via the Mann-Whitney U and Mantel-Haenszel log rank tests. Finally, a logistic regression analysis was utilized to determine the predictive value of osteoporosis, age, and gender on the likelihood for complications. RESULTS: Three hundred ninety-nine patients matched the study criteria. In the osteoporotic group, 40.5% of patients underwent a revision surgery compared to 28.0% in the nonosteoporotic group (p=.01). The occurrence of multiple revision surgeries following the index procedure was similar in both groups: 8.4% in osteoporoticpatients and 8.6% in nonosteoporotic patients. Age and gender were not statistically correlated with the incidence of revision surgery. CONCLUSIONS: ASD patients with osteoporosis have an increased risk of undergoing revision for a surgery-related complication within 2 years of the index procedure. These complications included failure of hardware, pseudoarthrosis, proximal junction failure, and infection, among other issues that required surgical intervention. As others have also highlighted the importance of poor bone density on construct failure, our data further underscore the importance of preoperative osteoporosis surveillance. Though intuitive, further study is needed to demonstrate that improving patients' bone density can decrease the incidence of related complications and the need or revision surgery.
Authors: Anmol Gupta; Thomas Cha; Joseph Schwab; Harold Fogel; Daniel G Tobert; Afshin E Razi; Carl Paulino; Andrew C Hecht; Christopher M Bono; Stuart Hershman Journal: J Spine Surg Date: 2021-03