INTRODUCTION

Osteoporosis is common in elderly patients and could be increased the risk of revision surgery in surgical treatment with spinal instrumentation.

The primary objective of this systematic literature review is to assess the effect of poor bone quality on surgical outcomes in such patients, including clinical and safety performance (both device- and patient-related), and economic outcomes of surgical management of spine fractures caused in patients with concurrent osteoporosis.

METHODS

A systematic review and meta-analysis were conducted to identify the characteristics of patients with compromised bone quality undergoing spinal surgeries. The systematic review was conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies appearing in ProQuest (searched on 29 March 2021) and PubMed (searched on 27 May, 2021) databases up to past five years were queried using key words like spine surgery, osteoporosis, osteopenia or spinal implant.

The results were presented and synthesized qualitatively and quantitatively. Qualitative synthesis included summarization of individual studies and description of their results with respect to the relevant outcomes. For the quantitative synthesis, data on proximal junctional kyphosis (PJK)/proximal junctional failure (PJF) and revision surgery were analyzed using RevMan 5.4 according to PRISMA guidelines.

RESULTS & DISCUSSION

From 2,262 initial matches, a total of 62 studies met the inclusion criteria and were included in this systematic literature review. Overall, 540,289 patients were reported in the included studies. The number of patients varied from 18 to 182,519 and the follow-up period ranged from 1.2 to 51.7 months.

The overall prevalence of patients with compromised bone quality undergoing spinal surgery was found to be 21.79%. It was also reported that the rates of occurrence of the outcomes for the osteoporotic/osteopenic population was found to be higher when compared to those of the normal population. Regarding surgery related clinical and safety outcomes, patients presenting with compromised bone quality reported higher rates (33.44% vs. 29.05%) of PJK and PJF, when compared to normal population. Similarly, patients with compromised bone quality not only reported higher rates of implant-related complications (9.97% vs. 6.24%), but also revision surgeries (5.59% vs. 2.28%), readmissions (38.38% vs. 33.03%), reoperations (20.06% vs. 13.24%), and other adverse events (11.85% vs.7.69%). In addition, the meta-analysis also revealed that the risk of PJK/PJF (RR=1.89; 95%CI=1.22-2.92, p=0.004), but also revision surgeries (RR=1.65; 95%CI=1.13-2.42, p=0.010) was higher in osteoporotic patients when compared to normal patients.  In a sub-analysis, the rates of outcomes were also provided for studies published in Asian countries. Among Asian patients, the prevalence of osteoporotic patients undergoing spinal surgeries, was higher (43.70%) than the overall prevalence (21.79%) in all included studies. Similarly, compared to non-Asian patients, Asian patients exhibited higher rates of PJK and PJF (32.10% vs. 30.30%), higher implant-related complications (42.80% vs. 16.20%), revision surgery (24.00% vs. 17.6%), and readmission (38.60% vs. 33.30%).