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Prior Fragility Fractures are Associated With Higher Risk of Bone Health-Related Complications Within 8-Years Following Lumbar Fusion – Lumbar Fusion

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This article presents a retrospective study that aimed to determine the 8-year risk of complications in patients who underwent lumbar fusion and had a prior fragility fracture compared to those without. The study included patients aged 50 years and older from a large national database. After matching, a total of 8,805 patients were included. The results showed that patients with a prior fragility fracture had a higher risk of revision lumbar fusion, pseudoarthrosis, mechanical failure, fragility fracture, and vertebral compression fracture compared to the control cohort. The study suggests that surgeons should consider bone health screening and treatment to reduce these preventable complications in high-risk patients

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

: Patients who sustain a fragility fracture prior to lumbar fusion have an increased risk of revision, pseudoarthrosis, and mechanical failure within 8 years. Surgeons should be aware of this high-risk patient population and consider bone health screening and treatment to reduce these preventable complications.

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Spine (Phila Pa 1976). 2023 Nov 6. doi: 10.1097/BRS.0000000000004867. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective study.OBJECTIVE: To determine the 8-year risk of revision lumbar fusion, pseudoarthrosis, mechanical failure, fragility fracture, and vertebral compression fracture in patients with a prior fragility fracture compared to those without.SUMMARY OF BACKGROUND DATA: Osteoporosis is a known modifiable risk factor,

Spine (Phila Pa 1976). 2023 Nov 6. doi: 10.1097/BRS.0000000000004867. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective study.

OBJECTIVE: To determine the 8-year risk of revision lumbar fusion, pseudoarthrosis, mechanical failure, fragility fracture, and vertebral compression fracture in patients with a prior fragility fracture compared to those without.

SUMMARY OF BACKGROUND DATA: Osteoporosis is a known modifiable risk factor for revision following lumbar fusion due to inadequate fixation. Patients with prior fragility fractures have been shown to have increased bone health-related complications following various orthopedic surgeries, however there is a paucity of literature that identifies these complications in patients undergoing lumbar fusion.

METHODS: Patients aged 50 years and older who underwent elective lumbar fusion were identified in a large national database and stratified based on whether they sustained a fragility fracture within 3 years prior to fusion. These patients were propensity-score matched to a control based on age, gender, and Charlson Comorbidity Index (CCI) using a 1:1 ratio. Kaplan-Meier and Cox Proportional Hazards analyses were used to observe the cumulative incidences and risk of complications within 8-years of index surgery.

RESULTS: After matching, 8,805 patients were included in both cohorts. Patients who sustained a prior fragility fracture had a higher risk of revision (Hazard Ratio [HR]: 1.46; 95% Confidence Interval [CI]: 1.26-1.69; P<0.001), pseudoarthrosis (HR: 1.31; 95% CI: 1.17-1.48; P<0.001), mechanical failure (HR: 2.08; 95% CI: 1.78-2.45; P<0.001), secondary fragility fracture (HR: 6.36; 95% CI: 5.86-6.90; P<0.001), and vertebral compression fracture (HR: 7.47; 95% CI: 7.68-8.21; P<0.001) when compared to the control cohort.

: Patients who sustain a fragility fracture prior to lumbar fusion have an increased risk of revision, pseudoarthrosis, and mechanical failure within 8 years. Surgeons should be aware of this high-risk patient population and consider bone health screening and treatment to reduce these preventable complications.

PMID:37937392 | DOI:10.1097/BRS.0000000000004867

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Prior Fragility Fractures are Associated With Higher Risk of Bone Health-Related Complications Within 8-Years Following Lumbar Fusion

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Spine (Phila Pa 1976). 2023 Nov 6. doi: 10.1097/BRS.0000000000004867. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective study.OBJECTIVE: To determine the 8-year risk of revision lumbar fusion, pseudoarthrosis, mechanical failure, fragility fracture, and vertebral compression fracture in patients with a prior fragility fracture compared to those without.SUMMARY OF BACKGROUND DATA: Osteoporosis is a known modifiable risk factor

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