A Systematic Review of Treatment Strategies for Degenerative Lumbar Spine Fusion Surgery in Patients With Osteoporosis

Purpose: To evaluate the current evidence in the literature on treatment strategies for degenerative lumbar spine fusion in patients with osteoporosis. Methods: A systematic review of the literature from 1950 to 2015. Results: The review of the literature yielded 15 studies on the effect of treatment options for osteoporosis on lumbar fusion rates. This study evaluated only degenerative lumbar spine conditions and excluded deformity patients. One study demonstrated an association between low bone mass as measured by Hounsfield units and lower fusion rates. Six studies evaluated perioperative medical treatment of osteoporosis and showed higher fusion rates in patients treated with alendronate and teriparatide. The strongest evidence was for perioperative teriparatide. Eight studies evaluated surgical treatment strategies in patients with osteoporosis and showed that cement augmentation of pedicle screws and expandable pedicle screws demonstrated improved fusion rates than traditional pedicle screws. The strongest evidence was for expandable pedicle screws. Conclusion: There are 15 articles evaluating osteoporosis in patients undergoing lumbar fusion and the highest level of evidence is for perioperative use of teriparatide.

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A Systematic Review of Treatment Strategies for Lumbar Spine Fusion Surgery in Osteoporotic Patients

Journal of Orthopedics & Rheumatology ◽

10.13188/2334-2846.1000022 ◽

2016 ◽

Vol 3 (1) ◽

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Treatment Strategies ◽

Spine Fusion ◽

Fusion Surgery ◽

Lumbar Spine Fusion

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Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion

Global Spine Journal ◽

10.1177/21925682211010740 ◽

2021 ◽

pp. 219256822110107

Author(s):

Robert J. Owen ◽

Noah Quinlan ◽

Addisyn Poduska ◽

William Ryan Spiker ◽

Nicholas T. Spina ◽

...

Keyword(s):

Lumbar Spine ◽

Length Of Stay ◽

Lumbar Fusion ◽

Spine Fusion ◽

Erector Spinae ◽

Control Group ◽

Block Group ◽

Opioid Use ◽

Lumbar Spine Fusion ◽

Delivery Technique

Study Design: Retrospective review. Objective: To determine the effectiveness of erector spinae plane (ESP) blocks at improving perioperative pain control and function following lumbar spine fusions. Methods: A retrospective analysis was performed on patients undergoing < 3 level posterolateral lumbar fusions. Data was stratified into a control group and a block group. We collected postop MED (morphine equivalent dosages), physical therapy ambulation, and length of stay. PROMIS pain interference (PI) and physical function (PF) scores, ODI, and VAS were collected preop and at the first postop visit. Chi-square and student’s t-test ( P = .05) were used for analysis. We also validated a novel fluoroscopic technique for ESP block delivery. Results: There were 37 in the block group and 39 in the control group. There was no difference in preoperative opioid use ( P = .22). On postop day 1, MED was reduced in the block group (32 vs 51, P < .05), and more patients in the block group did not utilize any opioids (22% vs 5%, P < .05). The block group ambulated further on postop day 1 (312 ft vs 204 ft, P < .05), and had reduced length of stay (2.4 vs 3.2 days, P < .05). The block group showed better PROMIS PI scores postoperatively (58 vs 63, P < .05). The novel delivery technique was validated and successful in targeting the correct level and plane. Conclusions: ESP blocks significantly reduced postop opioid use following lumbar fusion. Block patients ambulated further with PT, had reduced length of stay, and had improved PROMIS PI postoperatively. Validation of the block demonstrated the effectiveness of a novel fluoroscopic delivery technique. ESP blocks represent an underutilized method of reducing opioid consumption, improving postoperative mobilization and reducing length of stay following lumbar spine fusion.

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A comparative study on screw loosening in osteoporotic lumbar spine fusion between expandable and conventional pedicle screws

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-011-1439-6 ◽

2011 ◽

Vol 132 (4) ◽

pp. 471-476 ◽

Cited By ~ 85

Author(s):

Zi-xiang Wu ◽

Fu-tai Gong ◽

Li Liu ◽

Zhen-sheng Ma ◽

Yang Zhang ◽

...

Keyword(s):

Lumbar Spine ◽

Comparative Study ◽

Pedicle Screws ◽

Spine Fusion ◽

Screw Loosening ◽

Lumbar Spine Fusion

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Clinical outcomes and complication profile of total hip arthroplasty after lumbar spine fusion: a meta-analysis and systematic review

European Spine Journal ◽

10.1007/s00586-019-06201-z ◽

2019 ◽

Vol 29 (2) ◽

pp. 282-294 ◽

Cited By ~ 3

Author(s):

James Randolph Onggo ◽

Mithun Nambiar ◽

Jason Derry Onggo ◽

Kevin Phan ◽

Anuruban Ambikaipalan ◽

...

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Clinical Outcomes ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Spine Fusion ◽

Total Hip ◽

Lumbar Spine Fusion

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Infection risk for primary and revision instrumented lumbar spine fusion in the Medicare population

Journal of Neurosurgery Spine ◽

10.3171/2012.7.spine12203 ◽

2012 ◽

Vol 17 (4) ◽

pp. 342-347 ◽

Cited By ~ 81

Author(s):

Steven M. Kurtz ◽

Edmund Lau ◽

Kevin L. Ong ◽

Leah Carreon ◽

Heather Watson ◽

...

Keyword(s):

Lumbar Spine ◽

Surgical Approach ◽

Cox Regression ◽

Lumbar Fusion ◽

Posterior Instrumentation ◽

Infection Risk ◽

Spine Fusion ◽

Medicare Population ◽

Lumbar Spine Fusion ◽

Large Patient

Object This retrospective analysis of Medicare administrative data was performed to evaluate the risk of infection following instrumented lumbar fusion over a 10-year follow-up period in the Medicare population. Although infection can be a devastating complication, due to its rarity it is difficult to characterize infection risk except in large patient populations. Methods Using ICD-9-CM and CPT4 procedure codes, the Medicare 5% analytical research files for inpatient, outpatient, and physician carrier claims were checked to identify patients who were treated between 1997 and 2009 with lumbar spine fusion in which cages or posterior instrumentation were used. Patients younger than 65 years old were excluded. Patients were followed continuously by using the matching denominator file until they withdrew from Medicare or died. The authors identified 15,069 patients with primary fusion procedures and 605 with revision of instrumented lumbar fusion. Infections were identified by the related ICD-9 codes (998.59 or 996.67) after fusion. Kaplan-Meier survival analysis and Cox regression were performed to determine adjusted infection risk for each type of spine procedure (primary vs revision) and surgical approach (anterior, posterior, combined anteroposterior), accounting for patient (for example, age, sex, comorbidities/Charlson Comorbidity Index [CCI], and state buy-in) and hospital (census region) characteristics. Results At 10 years, the overall infection incidence, including superficial and deep infections, was 8.5% in primary procedures and 12.2% in revisions. Among the factors considered, infection risk within 10 years was most influenced by comorbidities: for a CCI of 5 versus 0, the adjusted hazard ratio (AHR) was 2.48 (95% CI 1.93–3.19, p < 0.001); for ≥ 9 versus 2–3 fused vertebrae, the AHR was 2.39 (95% CI 1.20–4.76, p < 0.001); for revision versus primary fusion procedures, the AHR was 1.66 (95% CI 1.28–2.15, p < 0.001). Other significant predictors of 10-year infection risk included diagnosis of obesity (p < 0.001); state buy-in—a proxy for socioeconomic status (p = 0.02); age (p = 0.003); surgical approach (p = 0.03); census region (p = 0.02); and the year of the index procedure (p = 0.03). Conclusions Patient comorbidities were the greatest predictor of infection risk for the Medicare population. The high incidence of infection following instrumented fusion warrants increased focus on infection risk mitigation, especially for patients with comorbid conditions.

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