The Association of Preoperative Bone Mineral Density and Outcomes After Anterior Cervical Discectomy and Fusion: A Systematic Review.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2025-03-01 Epub Date: 2024-07-23 DOI:10.1097/BSD.0000000000001656

Davin C Gong, Anthony N Baumann, Aditya Muralidharan, Joshua D Piche, Paul A Anderson, Ilyas Aleem

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引用次数: 0

Abstract

Study design: This is a systematic review.

Objective: To evaluate anterior cervical discectomy and fusion (ACDF) outcomes and complications as a function of preoperative bone mineral density (BMD).

Summary of background data: Preoperative BMD optimization is commonly initiated before lumbar spinal fusion, but the effects of BMD on ACDF are less known. Consequently, it remains unclear whether preoperative BMD optimization is recommended before ACDF.

Methods: This systematic review included relevant clinical articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, Web of Science, SCOPUS, and MEDLINE from database inception until October 1, 2023. Eligible studies included those evaluating low BMD and outcomes after ACDF. All articles were graded using the Methodological Index for Non-Randomized Studies (MINORS) scale and Critical Appraisal Skills Programme (CASP) assessment tools.

Results: The initial retrieval yielded 4271 articles for which 4 articles with 671 patients were included in the final analysis. The mean patient age was 56.4 ± 3.9 years, and 331 patients (49.3%) were female. A total of 265 (39.5%) patients had low BMD (T score<-1.0) before ACDF. Preoperative low BMD was associated with cage subsidence in single-level ACDF (odds ratio (OR) 2.57; P =0.063; 95% Confidence Interval (CI): 0.95-6.95), but this result did not reach statistical significance. Osteoporosis (T score<-2.5) was associated with the development of adjacent segment disease following ACDF (OR 4.41; P <0.01; 95% CI: 1.98-9.83). Low pre-operative BMD was associated with reoperation within 2 years ( P <.05) and strongly associated with pseudarthrosis (OR: 11.01; P =0.002; 95% CI 2.4-49.9).

Conclusions: Patients with low BMD who undergo ACDF have higher rates of subsidence, adjacent segment disease, and pseudarthrosis than those with normal BMD. Given the individual and system-wide burdens associated with these complications, some patients may benefit from preoperative BMD screening and optimization before undergoing ACDF.

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术前骨矿密度与颈椎前路椎间盘切除及融合术后疗效的关系：系统回顾

研究设计这是一篇系统性综述：评估颈椎前路椎间盘切除融合术（ACDF）的疗效和并发症与术前骨质密度（BMD）的关系：腰椎融合术前通常会进行术前 BMD 优化，但 BMD 对 ACDF 的影响却鲜为人知。因此，ACDF术前是否建议进行术前BMD优化仍不清楚：本系统性综述采用系统性综述和荟萃分析首选报告项目 (PRISMA) 指南纳入了相关临床文章。我们检索了从数据库开始到 2023 年 10 月 1 日的 PubMed、Web of Science、SCOPUS 和 MEDLINE。符合条件的研究包括评估低 BMD 和 ACDF 后疗效的研究。所有文章均采用非随机研究方法指数（MINORS）量表和批判性评估技能计划（CASP）评估工具进行评分：结果：最初检索到 4271 篇文章，其中 4 篇文章的 671 名患者被纳入最终分析。患者平均年龄为（56.4 ± 3.9）岁，331 名患者（49.3%）为女性。共有 265 名（39.5%）患者的 BMD 较低（T 评分）：与 BMD 正常的患者相比，接受 ACDF 的低 BMD 患者发生下沉、邻近节段疾病和假关节的比例更高。鉴于这些并发症给个人和整个系统带来的负担，一些患者在接受 ACDF 之前可能会受益于术前 BMD 筛查和优化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.