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Incidence and risk factors of vertebral body collapse after posterior instrumented spinal fusion in elderly patients: An observational study.

ABSTRACT: This study investigates the incidence and risk factors of new vertebral body collapse (VC) after posterior instrumented spinal fusion in patients older than 70 years. This retrospective study analyzed the data of elderly patients who underwent posterior instrumented spinal fusion in the thoracolumbar spine between January 2013 and December 2017. The 2 subsamples comprised of patients who had experienced vertebral compression fracture (VCF) before the index spinal surgery (group 1, n = 324) and those who had not (group 2, n = 1040). We recorded and analyzed their baseline characteristics, their underlying comorbidities, and the details of their current instrumented spinal fusion. The incidences of new VC and screw loosening were recorded. In groups 1 and 2, the incidences of new VC were 31.8% and 22.7%, respectively, and those of new VC with screw loosening were 25.6% and 33%, respectively. The risk factor was upper screw level at the thoracolumbar junction (hazard ratio [HR] = 2.181, 95% confidence interval [CI]: 1.135-4.190) with previous VCF. The risk factors were age ≥ 80 years (HR = 1.782, 95% CI: 1.132-2.805), instrumented levels > 4 (HR = 1.774, 95% CI: 1.292-2.437), and peptic ulcer (HR = 20.219, 95% CI: 2.262-180.731) without previous VCF. Clinicians should closely monitor new VC after posterior instrumented spinal fusion in elderly patients with previous VCF with upper screw level at the thoracolumbar junction and in patients without previous VCF aged ≥ 80 years, with instrumented levels > 4 and peptic ulcer.

SUBMITTER: Kao FC

PROVIDER: S-EPMC9646654 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Incidence and risk factors of vertebral body collapse after posterior instrumented spinal fusion in elderly patients: An observational study.

Kao Feng-Chen FC Hsu Yao-Chun YC Chen Tzu-Shan TS Tu Yuan-Kun YK Liu Pao-Hsin PH

Medicine 20221101 44

This study investigates the incidence and risk factors of new vertebral body collapse (VC) after posterior instrumented spinal fusion in patients older than 70 years. This retrospective study analyzed the data of elderly patients who underwent posterior instrumented spinal fusion in the thoracolumbar spine between January 2013 and December 2017. The 2 subsamples comprised of patients who had experienced vertebral compression fracture (VCF) before the index spinal surgery (group 1, n = 324) and t ...[more]

PMID: 36343049

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Project description:BackgroundAcute kidney injury (AKI) after spinal fusion is a significant morbidity that can lead to poor post-surgical outcomes. Identifying AKI risk factors and developing a risk model can raise surgeons' awareness and allow them to take actions to mitigate the risks. The objective of the current study is to develop machine learning (ML) models to assess patient risk factors predisposing to AKI after posterior spinal instrumented fusion.MethodsData was collected from the IBM MarketScan Database (2009-2021) for patients >18 years old who underwent spinal fusion with posterior instrumentation (3-6 levels). AKI incidence (defined by the International Classification of Diseases codes) was recorded 90-day post-surgery. Risk factors for AKI were investigated and compared through several ML models including logistic regression, linear support vector machine (LSVM), random forest, extreme gradient boosting (XGBoost), and neural networks.ResultsAmong the 141,697 patients who underwent fusion with posterior instrumentation (3-6 levels), the overall rate of 90-day AKI was 2.96%. We discovered that the logistic regression model and LSVM demonstrated the best predictions with area under the curve (AUC) values of 0.75. The most important AKI prediction features included chronic renal disease, hypertension, diabetes mellitus ± complications, older age (>50 years old), and congestive heart failure. Patients who did not have these five key risk factors had a 90-day AKI rate of 0.29%. Patients who had an increasing number of key risk factors subsequently had higher risks of postoperative AKI.ConclusionsThe analysis of the data with different ML models identified 5 key variables that are most closely associated with AKI: chronic renal disease, hypertension, diabetes mellitus ± complications, older age (>50 years old), and congestive heart failure. These variables constitute a simple risk calculator with additive odds ratio ranging from 3.38 (1 risk factor) to 91.10 (5 risk factors) over 90 days after posterior spinal fusion surgery. These findings can help surgeons risk-stratify their patients for AKI risk, and potentially guide post-operative monitoring and medical management.

Project description:BackgroundThe optimal treatment of osteoporosis after reconstruction surgery for osteoporotic vertebral fractures (OVF) remains unclear. In this multicentre retrospective study, we investigated the effects of typically used agents for osteoporosis, namely, bisphosphonates (BP) and teriparatide (TP), on surgical results in patients with osteoporotic vertebral fractures.MethodsRetrospectively registered data were collected from 27 universities and affiliated hospitals in Japan. We compared the effects of BP vs TP on postoperative mechanical complication rates, implant-related reoperation rates, and clinical outcomes in patients who underwent posterior instrumented fusion for OVF. Data were analysed according to whether the osteoporosis was primary or glucocorticoid-induced.ResultsA total of 159 patients who underwent posterior instrumented fusion for OVF were included. The overall mechanical complication rate was significantly lower in the TP group than in the BP group (BP vs TP: 73.1% vs 58.2%, p = 0.045). The screw backout rate was significantly lower and the rates of new vertebral fractures and pseudoarthrosis tended to be lower in the TP group than in the BP group. However, there were no significant differences in lumbar functional scores and visual analogue scale pain scores or in implant-related reoperation rates between the two groups. The incidence of pseudoarthrosis was significantly higher in patients with glucocorticoid-induced osteoporosis (GIOP) than in those with primary osteoporosis; however, the pseudoarthrosis rate was reduced by using TP. The use of TP also tended to reduce the overall mechanical complication rate in both primary osteoporosis and GIOP.ConclusionsThe overall mechanical complication rate was lower in patients who received TP than in those who received a BP postoperatively, regardless of type of osteoporosis. The incidence of pseudoarthrosis was significantly higher in patients with GIOP, but the use of TP reduced the rate of pseudoarthrosis in GIOP patients. The use of TP was effective to reduce postoperative complications for OVF patients treated with posterior fusion.

Dataset Information

Incidence and risk factors of vertebral body collapse after posterior instrumented spinal fusion in elderly patients: An observational study.

Publications

Incidence and risk factors of vertebral body collapse after posterior instrumented spinal fusion in elderly patients: An observational study.

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