For patients contemplating spinal fusion surgery to alleviate pain, bone health is an important consideration.
If a patient is found to have low bone density prior to surgery, it could affect the treatment plan before, during and after the procedure. A study at Hospital for Special Surgery (HSS) in New York City found that a CT scan of the lumbar spine prior to surgery indicated that a significant number of patients had low bone density that was previously undiagnosed.
And I assume they then had the surgery in spite of it.
Once the “medical machine” for a surgical procedure is started, it involves close to a dozen individuals and time slots, and the patient’s progress within the hospital is so carefully orchestrated and choreographed that it might be simpler to just go ahead as planned.
Almost half of the nearly 300 patients tested were diagnosed with osteoporosis or its precursor, osteopenia for the first time.
Spinal fusion is a very common surgery, with 400,000 to 500,000 such procedures performed in the United States each year. Two-thirds are fusions in the lumbar, or lower, spine.
“The purpose was to measure lumbar spine bone density using QCT and determine the prevalence of osteopenia or osteoporosis in patients undergoing lumbar spine fusions. We believe that QCT is more effective in screening patients because the DXA scan can overestimate bone density in the spine due to certain bone changes, a patient’s weight or physique, and other factors.”
If a patient is found to have osteoporosis or osteopenia prior to spinal fusion, the treatment plan may be modified, including the type of implants used.
The study enrolled 296 patients undergoing lumbar spine fusion for a degenerative condition or spinal instability.
Fifty-five percent were female, and the mean age was 63 years old, with patients ranging in age from 21 to 89 years old.
Almost 90 years old and they still want to do a spinal fusion surgery? Well, without opioids to ease the pain of spinal nerves being pinched, I don’t suppose these patients don’t have much choice.
It seems that interventional (invasive) pain specialists are making out like bandits now that patients aren’t able to get effective pain relief with medication anymore.
Pain from compressed nerves in the spine can be severe enough to make a patient consent to dangerous surgeries, tissue-destroying epidural injections, long courses of ineffective therapies like acupuncture, or any quackery that promises relief.
Using American College of Radiology criteria,
- 44 percent of patients were diagnosed with osteopenia;
- 15 percent had osteoporosis; and
- 41 percent were diagnosed with normal bone density.
There were no differences in prevalence between gender or race, but patients over age 50 were much more likely to be diagnosed with low bone density.
Of these patients,
- 49 percent were diagnosed with osteopenia and
- 18 percent had osteoporosis.
In patients under age 50,
- no individuals were found to have osteoporosis, but
- 17 percent had osteopenia.
Within a subgroup of 212 patients with no prior history of low bone density,
- 39 percent were diagnosed with osteopenia and
- 10 percent had osteoporosis.
“Spine surgeons should be aware of the high prevalence of abnormal bone mineral density in lumbar spine patients and the possibility that those without a previous diagnosis may have osteopenia or osteoporosis,” Dr. Hughes said.
“Diagnosing this prior to spine fusion could lead to a change in surgical planning and treatment, and we believe this would improve outcomes.”
I wonder if this is what causes so many of the failed back surgery syndrome cases. Trying to do spinal fusions when the bones are already deteriorating does not seem a good recipe for success.