Cargando…

Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review

STUDY DESIGN: Narrative review. OBJECTIVES: With an aging population, the prevalence of osteoporosis is continuously rising. As osseous integrity is crucial for bony fusion and implant stability, previous studies have shown osteoporosis to be associated with an increased risk for implant failure and...

Descripción completa

Detalles Bibliográficos
Autores principales: Schömig, Friederike, Becker, Luis, Schönnagel, Lukas, Völker, Anna, Disch, Alexander C., Schnake, Klaus John, Pumberger, Matthias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10177307/
https://www.ncbi.nlm.nih.gov/pubmed/37084355
http://dx.doi.org/10.1177/21925682231159066
_version_ 1785040607872286720
author Schömig, Friederike
Becker, Luis
Schönnagel, Lukas
Völker, Anna
Disch, Alexander C.
Schnake, Klaus John
Pumberger, Matthias
author_facet Schömig, Friederike
Becker, Luis
Schönnagel, Lukas
Völker, Anna
Disch, Alexander C.
Schnake, Klaus John
Pumberger, Matthias
author_sort Schömig, Friederike
collection PubMed
description STUDY DESIGN: Narrative review. OBJECTIVES: With an aging population, the prevalence of osteoporosis is continuously rising. As osseous integrity is crucial for bony fusion and implant stability, previous studies have shown osteoporosis to be associated with an increased risk for implant failure and higher reoperation rates after spine surgery. Thus, our review’s purpose was to provide an update of evidence-based solutions in the surgical treatment of osteoporosis patients. METHODS: We summarize the existing literature regarding changes associated with decreased bone mineral density (BMD) and resulting biomechanical implications for the spine as well as multidisciplinary treatment strategies to avoid implant failures in osteoporotic patients. RESULTS: Osteoporosis is caused by an uncoupling of the bone remodeling cycle based on an unbalancing of bone resorption and formation and resulting reduced BMD. The reduction in trabecular structure, increased porosity of cancellous bone and decreased cross-linking between trabeculae cause a higher risk of complications after spinal implant-based surgeries. Thus, patients with osteoporosis require special planning considerations, including adequate preoperative evaluation and optimization. Surgical strategies aim towards maximizing screw pull-out strength, toggle resistance, as well as primary and secondary construct stability. CONCLUSIONS: As osteoporosis plays a crucial role in the fate of patients undergoing spine surgery, surgeons need to be aware of the specific implications of low BMD. While there still is no consensus on the best course of treatment, multidisciplinary preoperative assessment and adherence to specific surgical principles help reduce the rate of implant-related complications.
format Online
Article
Text
id pubmed-10177307
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-101773072023-05-13 Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review Schömig, Friederike Becker, Luis Schönnagel, Lukas Völker, Anna Disch, Alexander C. Schnake, Klaus John Pumberger, Matthias Global Spine J Special Issue Articles STUDY DESIGN: Narrative review. OBJECTIVES: With an aging population, the prevalence of osteoporosis is continuously rising. As osseous integrity is crucial for bony fusion and implant stability, previous studies have shown osteoporosis to be associated with an increased risk for implant failure and higher reoperation rates after spine surgery. Thus, our review’s purpose was to provide an update of evidence-based solutions in the surgical treatment of osteoporosis patients. METHODS: We summarize the existing literature regarding changes associated with decreased bone mineral density (BMD) and resulting biomechanical implications for the spine as well as multidisciplinary treatment strategies to avoid implant failures in osteoporotic patients. RESULTS: Osteoporosis is caused by an uncoupling of the bone remodeling cycle based on an unbalancing of bone resorption and formation and resulting reduced BMD. The reduction in trabecular structure, increased porosity of cancellous bone and decreased cross-linking between trabeculae cause a higher risk of complications after spinal implant-based surgeries. Thus, patients with osteoporosis require special planning considerations, including adequate preoperative evaluation and optimization. Surgical strategies aim towards maximizing screw pull-out strength, toggle resistance, as well as primary and secondary construct stability. CONCLUSIONS: As osteoporosis plays a crucial role in the fate of patients undergoing spine surgery, surgeons need to be aware of the specific implications of low BMD. While there still is no consensus on the best course of treatment, multidisciplinary preoperative assessment and adherence to specific surgical principles help reduce the rate of implant-related complications. SAGE Publications 2023-04-21 2023-04 /pmc/articles/PMC10177307/ /pubmed/37084355 http://dx.doi.org/10.1177/21925682231159066 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Special Issue Articles
Schömig, Friederike
Becker, Luis
Schönnagel, Lukas
Völker, Anna
Disch, Alexander C.
Schnake, Klaus John
Pumberger, Matthias
Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review
title Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review
title_full Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review
title_fullStr Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review
title_full_unstemmed Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review
title_short Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review
title_sort avoiding spinal implant failures in osteoporotic patients: a narrative review
topic Special Issue Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10177307/
https://www.ncbi.nlm.nih.gov/pubmed/37084355
http://dx.doi.org/10.1177/21925682231159066
work_keys_str_mv AT schomigfriederike avoidingspinalimplantfailuresinosteoporoticpatientsanarrativereview
AT beckerluis avoidingspinalimplantfailuresinosteoporoticpatientsanarrativereview
AT schonnagellukas avoidingspinalimplantfailuresinosteoporoticpatientsanarrativereview
AT volkeranna avoidingspinalimplantfailuresinosteoporoticpatientsanarrativereview
AT dischalexanderc avoidingspinalimplantfailuresinosteoporoticpatientsanarrativereview
AT schnakeklausjohn avoidingspinalimplantfailuresinosteoporoticpatientsanarrativereview
AT pumbergermatthias avoidingspinalimplantfailuresinosteoporoticpatientsanarrativereview