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The Role of Bone Mineral Density in a Successful Lumbar Interbody Fusion: A Narrative Review – Lumbar Fusion

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The article discusses the challenges of achieving successful lumbar interbody fusion (LIF) in patients with osteoporosis due to their reduced bone mineral density (BMD) and increased risk of cage subsidence. The review highlights the importance of adequate bone quality for successful fusion and explores various techniques to improve fusion success in patients with weakened bone density. While there is an acknowledgment of a correlation between BMD and fusion rate in LIF procedures, the exact BMD threshold for a successful outcome remains elusive. Surgeons are advised to exercise caution in surgical planning and follow-up for patients with lower BMD, and future research initiatives are encouraged to address gaps in the literature regarding the impact of BMD on LIF outcomes

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : top spinal centre in the world

Published article

: While an apparent correlation between BMD and fusion rate in LIF procedures is acknowledged, conclusive evidence regarding the precise BMD threshold indicative of an increased risk of unfavorable outcomes remains elusive. Surgeons are advised to exercise caution in surgical planning and follow-up for patients with lower BMD. Furthermore, future research initiatives, particularly longitudinal studies, are encouraged to prioritize the examination of BMD as a fundamental risk factor,…

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Cureus. 2024 Feb 22;16(2):e54727. doi: 10.7759/cureus.54727. eCollection 2024 Feb.ABSTRACTBACKGROUND: The incidence of osteoporosis is a prime concern, especially in parts of the world where the population is aging, such as Europe or the US. Many new therapy strategies have been described to enhance bone healing. Lumbar interbody fusion (LIF) is a surgical procedure that aims,

Cureus. 2024 Feb 22;16(2):e54727. doi: 10.7759/cureus.54727. eCollection 2024 Feb.

ABSTRACT

BACKGROUND: The incidence of osteoporosis is a prime concern, especially in parts of the world where the population is aging, such as Europe or the US. Many new therapy strategies have been described to enhance bone healing. Lumbar interbody fusion (LIF) is a surgical procedure that aims to stabilize the lumbar spine by fusing two or more vertebrae using an interbody cage. LIF is a standard treatment for various spinal conditions, such as degenerative disc disease, spinal stenosis, and spondylolisthesis. However, successful fusion is challenging for patients with osteoporosis due to their reduced bone mineral density (BMD) and increased risk of cage subsidence, which can lead to implant failure and poor clinical outcomes.

METHODS: A comprehensive literature search yielded 220 articles, with 16 ultimately included. Keywords included BMD, cage subsidence, osteoporosis, teriparatide, and lumbar interbody fusion.

RESULTS: This review examines the relationship between BMD and LIF success, emphasizing the importance of adequate bone quality for successful fusion. Preoperative assessment methods for BMD and the impact of low BMD on fusion rates and patient outcomes are discussed. Additionally, techniques to improve fusion success in patients with weakened bone density, such as biological enhancement and BMD-matched interbody cages, are explored. However, consensus on the exact BMD threshold for a successful outcome remains elusive.

: While an apparent correlation between BMD and fusion rate in LIF procedures is acknowledged, conclusive evidence regarding the precise BMD threshold indicative of an increased risk of unfavorable outcomes remains elusive. Surgeons are advised to exercise caution in surgical planning and follow-up for patients with lower BMD. Furthermore, future research initiatives, particularly longitudinal studies, are encouraged to prioritize the examination of BMD as a fundamental risk factor, addressing gaps in the literature.

PMID:38524011 | PMC:PMC10960932 | DOI:10.7759/cureus.54727

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The Role of Bone Mineral Density in a Successful Lumbar Interbody Fusion: A Narrative Review

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Cureus. 2024 Feb 22;16(2):e54727. doi: 10.7759/cureus.54727. eCollection 2024 Feb.ABSTRACTBACKGROUND: The incidence of osteoporosis is a prime concern, especially in parts of the world where the population is aging, such as Europe or the US. Many new therapy strategies have been described to enhance bone healing. Lumbar interbody fusion (LIF) is a surgical procedure that aims

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