Abstract

BACKGROUND

Osteoporosis is a metabolic bone disease that commonly affects the elderly. Degenerative spinal disease that may require surgical intervention is also prevalent in this susceptible population. If undiagnosed or untreated before spine surgery, osteoporosis may result in an increased risk of postoperative adverse events. Nontreatment of osteoporosis preoperatively may be related to a poor understanding of bone physiology, a lack of standardized treatment algorithms, limited cost-effective interventions, and reluctance by spine surgeons to be the primary provider of osteoporosis management.

OBJECTIVE

The objective of this evidence-based review is to develop guidelines for the preoperative assessment and treatment of osteoporosis in patients undergoing spine surgery.

METHODS

A systematic review of the literature was performed using the National Library of Medicine/PubMed database and Embase for studies relevant to preoperative diagnostic studies that predict increased risk of osteoporosis-related postoperative adverse events and whether the preoperative treatment of low bone mineral density (BMD) in patients with osteoporosis improves outcome.

RESULTS

Out of 281 studies, 17 met the inclusion criteria and were included for systematic review. The task force affirmed a Grade B recommendation that preoperative osteoporosis testing with a dual-energy X-ray absorptiometry scan (T-score < −2.5), a computed tomography scan (Hounsfield units <97.9), and serum vitamin D3 level (<20 ng/mL) predict an increased risk of osteoporosis-related adverse events after spine surgery. The task force determined a Grade B recommendation that preoperative osteoporosis treatment with teriparatide increases BMD, induces earlier and more robust fusion, and may improve select patient outcomes. There is insufficient evidence regarding preoperative treatment with bisphosphonates alone and postoperative outcome.

CONCLUSION

This evidence-based clinical guideline provides a recommendation that patients with suspected osteoporosis undergo preoperative assessment and be appropriately counseled about the risk of postoperative adverse events if osteoporosis is confirmed. In addition, preoperative optimization of BMD with select treatments improves certain patient outcomes.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/3-preoperative-osteoporosis-assessment

中文翻译：

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神经外科医生大会系统回顾和循证指南围手术期脊柱：术前骨质疏松症评估

摘要

背景

骨质疏松症是一种代谢性骨病，通常影响老年人。可能需要手术干预的退行性脊柱疾病在这一易感人群中也很普遍。如果在脊柱手术前未经诊断或未经治疗，骨质疏松症可能会导致术后不良事件的风险增加。术前不治疗骨质疏松症可能与对骨生理学的了解不足、缺乏标准化的治疗算法、具有成本效益的干预措施有限以及脊柱外科医生不愿成为骨质疏松症管理的主要提供者有关。

客观的

本次循证审查的目的是为接受脊柱手术的患者的骨质疏松症的术前评估和治疗制定指南。

方法

使用美国国家医学图书馆/PubMed 数据库和 Embase 对文献进行系统回顾，研究与术前诊断研究相关的研究，这些研究预测骨质疏松症相关术后不良事件的风险增加，以及术前治疗是否低骨密度 (BMD)骨质疏松症患者改善预后。

结果

在 281 项研究中，有 17 项符合纳入标准并被纳入系统评价。工作组确认了 B 级建议，即术前骨质疏松症检测采用双能 X 线骨密度仪扫描（T 分数 < -2.5）、计算机断层扫描（Hounsfield 单位 <97.9）和血清维生素 D3 水平（<20 ng/mL) 预测脊柱手术后骨质疏松症相关不良事件的风险增加。工作组确定了 B 级建议，即术前使用特立帕肽治疗骨质疏松症可增加 BMD，诱导更早和更稳健的融合，并可能改善特定患者的预后。关于单用双膦酸盐的术前治疗和术后结果的证据不足。

结论

该循证临床指南建议疑似骨质疏松症患者进行术前评估，并在确诊骨质疏松症后适当告知术后不良事件的风险。此外，通过选择治疗对 BMD 进行术前优化可改善某些患者的预后。完整指南可在 https://www.cns.org/guidelines/browse-guidelines-detail/3-preoperative-osteoporosis-assessment 访问