Universität zu Köln

Bettag, Christoph, Abboud, Tammam, von der Brelie, Christian, Melich, Patrick, Rohde, Veit and Schatlo, Bawarjan (2020). Do we underdiagnose osteoporosis in patients with pyogenic spondylodiscitis? Neurosurg. Focus, 49 (2). ROLLING MEADOWS: AMER ASSOC NEUROLOGICAL SURGEONS. ISSN 1092-0684

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Abstract

OBJECTIVE Pyogenic spondylodiscitis affects a fragile patient population. Surgical treatment in cases of instability entails instrumentation, and loosening of this instrumentation is a frequent occurrence in pyogenic spondylodiscitis. The authors therefore attempted to investigate whether low bone mineral density (BMD)-which is compatible with the diagnosis of osteoporosis-is underdiagnosed in patients with pyogenic spondylodiscitis. How osteoporosis was treated and how it affected implant stability were further analyzed. METHODS Charts of patients who underwent operations for pyogenic spondylodiscitis were retrospectively reviewed for clinical data, prior medical history of osteoporosis, and preoperative CT scans of the thoracolumbar spine. In accordance with a previously validated high-fidelity opportunistic CT assessment, average Hounsfield units (HUs) in vertebral bodies of L1 and L4 were measured. Based on the validation study, the authors opted for a conservative cutoff value for low BMD, being compatible with osteoporosis 110 HUs. Baseline and outcome variables, including implant failure and osteoporosis interventions, were entered into a multivariate logistic model for statistical analysis. RESULTS Of 200 consecutive patients who underwent fusion surgery for pyogenic spondylodiscitis, 64% (n = 127) were male and 66% (n = 132) were older than 65 years. Seven percent (n = 14) had previously been diagnosed with osteoporosis. The attenuation analysis revealed HU values compatible with osteoporosis in 48% (95/200). The need for subsequent revision surgery due to implant failure showed a trend toward an association with estimated low BMD (OR 2.11, 95% CI 0.95-4.68, p = 0.067). Estimated low BMD was associated with subsequent implant loosening (p < 0.001). Only 5% of the patients with estimated low BMD received a diagnosis and pharmacological treatment of osteoporosis within 1 year after spinal instrumentation. CONCLUSIONS Relying on past medical history of osteoporosis is insufficient in the management of patients with pyogenic spondylodiscitis. This is the first study to identify a substantially missed opportunity to detect osteoporosis and to start pharmacological treatment after surgery for prevention of implant failure. The authors advocate for routine opportunistic CT evaluation for a better estimation of bone quality to initiate diagnosis and treatment for osteoporosis in these patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bettag, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Abboud, Tammam UNSPECIFIED UNSPECIFIED UNSPECIFIED von der Brelie, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Melich, Patrick UNSPECIFIED UNSPECIFIED UNSPECIFIED Rohde, Veit UNSPECIFIED UNSPECIFIED UNSPECIFIED Schatlo, Bawarjan UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-324278
DOI:	10.3171/2020.5.FOCUS20267
Journal or Publication Title:	Neurosurg. Focus
Volume:	49
Number:	2
Date:	2020
Publisher:	AMER ASSOC NEUROLOGICAL SURGEONS
Place of Publication:	ROLLING MEADOWS
ISSN:	1092-0684
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language COMPUTED-TOMOGRAPHY; POSTMENOPAUSAL WOMEN; SURGICAL-MANAGEMENT; SPINAL INFECTIONS; CLINICAL-USE; SURGERY; FUSION; ATTENUATION; DIAGNOSIS; ANTERIOR Multiple languages Clinical Neurology; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/32427