Prior Fragility Fractures are Associated With a Higher Risk of Bone Health-Related Complications Within Eight Years Following Lumbar Fusion.

Autor:	Zhao AY; Department of Orthopaedic Surgery, George Washington Hospital, Washington, DC., Agarwal AR; Department of Orthopaedic Surgery, George Washington Hospital, Washington, DC., Durand WM; Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD., Raad M; Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD., Seibold BT; Department of Orthopaedic Surgery, George Washington Hospital, Washington, DC., Thakkar SC; Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD., Jain A; Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD.
Jazyk:	angličtina
Zdroj:	Spine [Spine (Phila Pa 1976)] 2024 Aug 01; Vol. 49 (15), pp. 1046-1051. Date of Electronic Publication: 2023 Nov 06.
DOI:	10.1097/BRS.0000000000004867
Abstrakt:	Study Design: Retrospective study. Objective: To determine the 8-year risk of revision lumbar fusion, pseudoarthrosis, mechanical failure, fragility fracture, and vertebral compression fracture in patients with a prior fragility fracture compared with those without. Summary of Background Data: Osteoporosis is a known modifiable risk factor for revision following lumbar fusion due to inadequate fixation. Patients with prior fragility fractures have been shown to have increased bone health-related complications following various orthopedic surgeries; however, there is a paucity of literature that identifies these complications in patients undergoing lumbar fusion. Patients and Methods: Patients aged 50 years and older who underwent elective lumbar fusion were identified in a large national database and stratified based on whether they sustained a fragility fracture within three years prior to fusion. These patients were propensity-score matched to a control based on age, gender, and Charlson the comorbidity index using a 1:1 ratio. Kaplan-Meier and Cox proportional hazards analyses were used to observe the cumulative incidences and risk of complications within eight years of index surgery. Results: After matching, 8805 patients were included in both cohorts. Patients who sustained a prior fragility fracture had a higher risk of revision [hazard ratio (HR): 1.46; 95% CI: 1.26-1.69; P <0.001), pseudoarthrosis (HR: 1.31; 95% CI: 1.17-1.48; P <0.001), mechanical failure (HR: 2.08; 95% CI: 1.78-2.45; P <0.001), secondary fragility fracture (HR: 6.36; 95% CI: 5.86-6.90; P <0.001), and vertebral compression fracture (HR: 7.47; 95% CI: 7.68-8.21; P <0.001) when compared with the control cohort. Conclusion: Patients who sustain a fragility fracture prior to lumbar fusion have an increased risk of revision, pseudoarthrosis, and mechanical failure within eight years. Surgeons should be aware of this high-risk patient population and consider bone health screening and treatment to reduce these preventable complications. Competing Interests: S.C.T.: Committee member for the American Association of Hip and Knee Surgeons, Editorial or governing board of Arthroplasty Today, Journal of Arthroplasty ; Unpaid consultant for KCI, OrthAlign. A.J.: Paid consultant for DePuy, Globus Medical, Stryker. The remaining authors report no conflicts of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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