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Katiyar P, Reyes J, Coury J, Lombardi J, Sardar Z. Preoperative Optimization for Adult Spinal Deformity Surgery: A Systematic Review. Spine (Phila Pa 1976) 2024; 49:304-312. [PMID: 37678375 DOI: 10.1097/brs.0000000000004823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The purpose of this review is to identify modifiable risk factors in patients undergoing adult spinal deformity surgery and compile literature recommendations for the preoperative optimization of these risk factors. SUMMARY OF BACKGROUND DATA Optimization of modifiable risk factors not only benefits the patient but also lessens resource and cost burdens on the health care system, allowing for better quality and value-based care. There is limited but applicable literature discussing preoperative optimization in adult spinal deformity surgery patients specifically. METHODS We searched PubMed for studies that looked at one of the variables of interest (eg, osteoporosis, prehabilitation and functional status, multidisciplinary preoperative screening, infection, obesity, nutrition, smoking, diabetes, blood loss, chronic opioid use, and psychosocial factors) in adult patients with spinal deformity according to Preferred Reporting Items for Systematic Reviews and Meta-Analyse guidelines. RESULTS Seventy studies were included in the final review and synthesis of information. Guidelines and recommendations from these studies were compared and compiled into evidence-based action items for preoperative optimization of modifiable risk factors before adult spinal deformity surgery. CONCLUSIONS While the approach of preoperative optimization of modifiable risk factors may incur additional planning efforts and patient care time, it has the potential to significantly reduce perioperative complications and reduce morbidity and mortality during surgery, thus allowing for improved outcomes, increased quality of life, and satisfaction from this patient population. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Prerana Katiyar
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Justin Reyes
- Och Spine Hospital at Columbia New York Presbyterian Hospital, New York, NY
| | - Josephine Coury
- Och Spine Hospital at Columbia New York Presbyterian Hospital, New York, NY
| | - Joseph Lombardi
- Och Spine Hospital at Columbia New York Presbyterian Hospital, New York, NY
| | - Zeeshan Sardar
- Och Spine Hospital at Columbia New York Presbyterian Hospital, New York, NY
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Singh M, Balmaceno-Criss M, Knebel A, Kuharski M, Sakr I, Daher M, McDonald CL, Diebo BG, Czerwein JK, Daniels AH. Sacroplasty for Sacral Insufficiency Fractures: Narrative Literature Review on Patient Selection, Technical Approaches, and Outcomes. J Clin Med 2024; 13:1101. [PMID: 38398413 PMCID: PMC10889545 DOI: 10.3390/jcm13041101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Sacral insufficiency fractures commonly affect elderly women with osteoporosis and can cause debilitating lower back pain. First line management is often with conservative measures such as early mobilization, multimodal pain management, and osteoporosis management. If non-operative management fails, sacroplasty is a minimally invasive intervention that may be pursued. Candidates for sacroplasty are patients with persistent pain, inability to tolerate immobilization, or patients with low bone mineral density. Before undergoing sacroplasty, patients' bone health should be optimized with pharmacotherapy. Anabolic agents prior to or in conjunction with sacroplasty have been shown to improve patient outcomes. Sacroplasty can be safely performed through a number of techniques: short-axis, long-axis, coaxial, transiliac, interpedicular, and balloon-assisted. The procedure has been demonstrated to rapidly and durably reduce pain and improve mobility, with little risk of complications. This article aims to provide a narrative literature review of sacroplasty including, patient selection and optimization, the various technical approaches, and short and long-term outcomes.
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Affiliation(s)
- Manjot Singh
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Ashley Knebel
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Michael Kuharski
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Itala Sakr
- Department of Orthopedic Surgery, Hotel Dieu de France, Beirut 166830, Lebanon
| | - Mohammad Daher
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Christopher L. McDonald
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Bassel G. Diebo
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - John K. Czerwein
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Alan H. Daniels
- Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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Patel D, Roy G, Endres N, Ziino C. Preoperative vitamin D supplementation is a cost-effective intervention in arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2023; 32:2473-2482. [PMID: 37308074 DOI: 10.1016/j.jse.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/16/2023] [Accepted: 05/06/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study investigates the potential role of preoperative 25(OH)D supplementation as a cost-effective strategy to decrease revision rotator cuff repair (RCR) rates and lower the total health care burden from patients undergoing primary arthroscopic RCR. Previous literature has emphasized the importance of vitamin D on bone health maintenance, soft tissue healing, and outcomes in RCR. Inadequate preoperative vitamin D levels may increase revision RCR rates following primary arthroscopic RCR. Although 25(OH)D deficiency is common in RCR patients, serum screening is not routinely performed. METHODS A cost-estimation model was developed to determine the cost-effectiveness of both preoperative selective and nonselective 25(OH)D supplementation in RCR patients in order to reduce revision RCR rates. Prevalence and surgical cost data were obtained from published literature through systematic reviews. Cost of serum 25(OH)D assay and supplementation were obtained from public-use data. Mean and lower and upper bounds of 1-year cost savings were calculated for both the selective and nonselective supplementation scenarios. RESULTS Preoperative 25(OH)D screening and subsequent selective 25(OH)D supplementation was calculated to result in a mean cost savings of $6,099,341 (range: -$2,993,000 to $15,191,683) per 250,000 primary arthroscopic RCR cases. Nonselective 25(OH)D supplementation of all arthroscopic RCR patients was calculated to result in a mean cost savings of $11,584,742 (range: $2,492,401-$20,677,085) per 250,000 primary arthroscopic RCR cases. Univariate adjustment projects that selective supplementation is a cost-effective strategy in clinical contexts where the cost of revision RCR exceeds $14,824.69 and prevalence of 25(OH)D deficiency exceeds 6.67%. Additionally, nonselective supplementation is a cost-effective strategy in clinical scenarios where revision RCR cost is ≥$4216.06 and prevalence of 25(OH)D deficiency is ≥1.93%. CONCLUSIONS This cost-predictive model promotes the role of preoperative 25(OH)D supplementation as a cost-effective mechanism to reduce revision RCR rates and lower the overall health care burden from arthroscopic RCR. Nonselective supplementation appears to be more cost-effective than selective supplementation, likely due to the lower cost of 25(OH)D supplementation compared to serum assays.
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Affiliation(s)
- Dhiraj Patel
- Department of Orthopedic Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Gregory Roy
- Department of Orthopedic Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Nathan Endres
- Department of Orthopedic Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Chason Ziino
- Department of Orthopedic Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA.
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Diebo BG, Kovoor M, Alsoof D, Beyer GA, Rompala A, Balmaceno-Criss M, Mai DH, Segreto FA, Shah NV, Lafage R, Passias PG, Aaron RK, Daniels AH, Paulino CB, Schwab FJ, Lafage V. Metabolic Bone Disorders Are Predictors for 2-year Adverse Outcomes in Patients Undergoing 2-3 Level Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy or Myelopathy. Clin Spine Surg 2023; 36:120-126. [PMID: 36864582 DOI: 10.1097/bsd.0000000000001452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/25/2023] [Indexed: 03/04/2023]
Abstract
STUDY DESIGN Retrospective cohort study utilizing the New York statewide planning and research cooperative system. STUDY OBJECTIVE To investigate postoperative complications of patients with metabolic bone disorders (MBDs) who undergo 2-3 levels of anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA MBDs and cervical degenerative pathologies, including cervical radiculopathy (CR) and cervical myelopathy (CM), are prevalent in the aging population. Complications with ACDF procedures can lead to increased hospitalization times, more expensive overhead, and worse patient outcomes. METHOD Patients with CM/CR who underwent an ACDF of 2-3 vertebrae from 2009 to 2011 with a minimum 2-year follow-up were identified. Patients diagnosed with 1 or more MBD at baseline were compared with a control cohort without any MBD diagnosis. Cohorts were compared for demographics, hospital-related parameters, and 2-year medical, surgical, and overall complications. Binary multivariate logistic regression was used to identify independent predictors. RESULTS A total of 22,276 patients were identified (MBD: 214; no-MBD: 22,062). Among MBD patients, the majority had vitamin D deficiency (n = 194, 90.7%). MBD patients were older (53.0 vs 49.7 y, P < 0.001), and with higher Deyo index (1.0 vs 0.5, P < 0.001). MBD patients had higher rates of medical complications, including anemia (6.1% vs 2.3%), pneumonia (4.7% vs 2.1%), hematoma (3.3% vs 0.7%), infection (2.8% vs 0.9%), and sepsis (3.7% vs 0.9%), as well as overall medical complications (23.8% vs 9.6%) (all, P ≤0.033). MBD patients also experienced higher surgical complications, including implant-related (5.7% vs 1.9%), wound infection (4.2% vs 1.2%), and wound disruption (0.9% vs 0.2%), and overall surgical complications (9.8% vs 3.2%) (all, P ≤0.039). Regression analysis revealed that a baseline diagnosis of MBD was independently associated with an increased risk of 2-year surgical complications (odds ratio = 2.10, P < 0.001) and medical complications (odds ratio = 1.84, P = 0.001). CONCLUSIONS MBD as a comorbidity was associated with an increased risk of 2-year postoperative complications after 2-3 level ACDF for CR or CM.
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Affiliation(s)
- Bassel G Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island
| | - Matthew Kovoor
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island
| | | | | | - Mariah Balmaceno-Criss
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island
| | - David H Mai
- Department of Orthopedics, SUNY Downstate, Brooklyn
| | | | - Neil V Shah
- Department of Orthopedics, SUNY Downstate, Brooklyn
| | | | | | - Roy K Aaron
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, East Providence, Rhode Island
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Bajaj A, Shah RM, Goodwin AM, Kurapaty S, Patel AA, Divi SN. The Role of Preoperative Vitamin D in Spine Surgery. Curr Rev Musculoskelet Med 2022; 16:48-54. [PMID: 36538281 PMCID: PMC9889582 DOI: 10.1007/s12178-022-09813-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Vitamin D is an essential micronutrient for human bone health and maintenance. Patients undergoing orthopaedic surgery with hypovitaminosis D may be at greater risk for worsened clinical outcomes. This narrative review aims to compile the current literature studying the effects of low preoperative vitamin D on spine surgery outcomes, creating a resource that clinicians can use to inform their practice. RECENT FINDINGS Vitamin D deficiency predisposes to worse outcomes following spine surgery. Vitamin D supplementation may be beneficial in reducing the risk for adverse postoperative events; however, the literature is inconclusive regarding its efficacy in improving bone density and fracture risk. Spine clinicians should be aware of the increased risk for poor outcomes in patients with preoperative vitamin D deficiency. Future investigations are needed to better evaluate the benefits of preoperative vitamin D screening and supplementation on improving surgical outcomes in spine patients. These studies must also consider the effects on perioperative healthcare costs.
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Affiliation(s)
- Anitesh Bajaj
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Rohan M. Shah
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Alyssa M. Goodwin
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Steven Kurapaty
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Alpesh A. Patel
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Srikanth N. Divi
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
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Vitamin D supplementation is a cost-effective intervention after posterolateral lumbar fusion: a systematic review. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Hu MH, Tseng YK, Chung YH, Wu NY, Li CH, Lee PY. The efficacy of oral vitamin D supplements on fusion outcome in patients receiving elective lumbar spinal fusion—a randomized control trial. BMC Musculoskelet Disord 2022; 23:996. [PMID: 36401234 PMCID: PMC9673414 DOI: 10.1186/s12891-022-05948-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background Previous studies have reported that vitamin D supplement could improve fracture healing, but evidence regarding the role of vitamin D supplements in spinal fusion was limited. Thus, this study aimed to evaluate the effectiveness of oral vitamin D supplements on fusion outcomes in patients undergoing lumbar spinal fusion. Methods This randomized, double-blind, parallel-designed, active-control trial included the patients who planned for elective lumbar spinal fusion. Eligible patients were randomly assigned to receive either daily vitamin D3 (cholecalciferol) 800 IU and daily calcium citrate 600 mg (experimental group) or only daily calcium citrate 600 mg (control group). All supplements were given from postoperative day 1 and lasted for 3 months. Primary outcome was postoperative 1-year fusion rate, and secondary outcomes included time to fusion, Oswestry Disability Index (ODI), and visual analogue scale (VAS) for pain. Results Among the included 34 patients (21 in the experimental group and 13 in the control group), baseline 25-hydroxyvitamin D (25[OHVitD) level was 26.7 (10.4) ng/ml. Preoperative prevalence of vitamin D deficiency and insufficiency were 23.5% and 47.1%, respectively. Postoperative 1-year fusion rate was not significantly different between the two groups (95.2% vs. 84.6%, P = 0.544). The experimental group had significantly shorter time to fusion (Kaplan–Meier estimated: 169 days vs. 185 days [interquartile range: 88–182 days vs. 176–324 days], log-rank test: P = 0.028), lower postoperative 6-month ODI (P < 0.001), and lower postoperative 6-month VAS (P < 0.001) than the control group. Time to fusion was significantly and negatively correlated with preoperative, postoperative 3-month, and 6-month 25(OH)VitD levels (all P < 0.01). Conclusion The patient with vitamin D supplements had shorter time to fusion, better spinal function and less pain after elective spinal fusion. Further research is warranted to identify the patients who can benefit the most from vitamin D supplements and the appropriate dose of vitamin D supplements. Trial registration ClinicalTrials.gov, NCT05023122. Registered 20 August 2021. Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT03793530. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05948-9.
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