The Role of Osteoporosis in Spine Surgery and Current Management Strategies: A Review.

IF 5.3 2区 医学
Jordan Bauer, Bryan Heard, Hardeep Singh, Scott Mallozzi, Isaac Moss
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引用次数: 0

Abstract

Purpose of review: Osteoporosis is a systemic skeletal disease that presents unique challenges in spine surgery due to decreased bone mass, poor bone quality, and increased risk of fractures. This review aims to synthesize current understanding of osteoporosis in the context of spinal procedures, emphasizing the pathophysiology, diagnostic challenges, perioperative considerations, and evolving management strategies.

Recent findings: Despite high prevalence, osteoporosis remains underdiagnosed and undertreated in surgical candidates, with preoperative bone mineral density (BMD) screening often overlooked. Recent evidence underscores the importance of optimizing bone health preoperatively through pharmacologic therapies, which includes bisphosphonates, denosumab, and anabolic agents like teriparatide and romosozumab. Furthermore, surgical innovations such as cement augmentation and biomechanically optimized pedicle screw techniques are thoroughly discussed. New modalities, such as CT-based Hounsfield unit assessments and finite element analysis, offer improved preoperative evaluation of bone quality. Successful spine surgery outcomes in osteoporotic patients require a multidisciplinary approach that integrates early screening, targeted pharmacologic treatment, lifestyle modifications, and advanced surgical planning. Addressing osteoporosis comprehensively improves implant fixation, reduces complications like pseudoarthrosis and junctional failures, and enhances overall patient quality of life.

骨质疏松症在脊柱外科中的作用和当前的管理策略:综述。
综述目的:骨质疏松症是一种系统性骨骼疾病,由于骨量减少、骨质量差和骨折风险增加,在脊柱外科中提出了独特的挑战。本综述旨在综合目前对脊柱手术背景下骨质疏松症的认识,强调病理生理学、诊断挑战、围手术期注意事项和不断发展的管理策略。最近的研究发现:尽管骨质疏松症的发病率很高,但在手术候选人中,骨质疏松症的诊断和治疗仍然不足,术前骨密度(BMD)筛查经常被忽视。最近的证据强调了术前通过药物治疗优化骨健康的重要性,包括双膦酸盐、地诺单抗和合成代谢药物如特立帕肽和罗莫索单抗。此外,手术创新,如水泥增强和生物力学优化椎弓根螺钉技术进行了深入的讨论。新的模式,如基于ct的Hounsfield单元评估和有限元分析,提供了更好的术前骨质量评估。骨质疏松症患者脊柱手术的成功需要多学科的方法,包括早期筛查、靶向药物治疗、生活方式改变和先进的手术计划。全面解决骨质疏松症可改善种植体固定,减少假关节和关节失效等并发症,提高患者整体生活质量。
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来源期刊
Current Osteoporosis Reports
Current Osteoporosis Reports ENDOCRINOLOGY & METABOLISM-
CiteScore
8.40
自引率
2.30%
发文量
44
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of osteoporosis. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as current and future therapeutics, epidemiology and pathophysiology, and evaluation and management. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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