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I have osteoporosis and I am considering a spinal fusion. What are some things to consider?
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A recent article by Chroma et al discusses some of the challenges faced by spinal surgeons when dealing with the older patent, and changes in bone health is a primary concern. Successful fixation for a spinal fusion in the osteoporotic client is a very important consideration. Due to a tendency for fixation failures in brittle bone some surgeons will recommend against surgical options for this population. Other options may include using more points of fixation, a larger diameter screw, and addition of cement to improve fixation success. All of these options have some drawbacks and more research is certainly needed. There is evidence that routinely recommending vitamin D preoperatively for spinal surgeries can improve bone healing and decrease infection risk. Calcium supplements are also important to reduce surgical complications. This article notes that for patients with osteoporosis there is some concern about prescribing diphosphonates following spinal fusion or fracture based on some models that show a poor outcome of healing. Other drug options include Denosumab or Teriparatide. One study cited by Chroma et al found that following spinal fixation with use of Teriparatide vs diphosphonates the risk of the screws loosening was significantly lower in the Teriparatide group, and the fusion rate was higher. It is important to discuss with your surgeon the options for fixation and recommendations for supplements, because the outcome of a spinal fusion is better with successful fixation. If there is concern about bone health the other option is conservative care, which your surgeon may be able to recommend options for as well.
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