Skeletal risk factors for postoperative complications in older men undergoing spinal fusion surgery

Older men may be at particular risk for skeletal complications following orthopaedic procedures but seldom have bone health evaluated. This prospective study investigated bone quality and risk of complications in men undergoing spine fusion. Older age, revisions, procedures involving > 5 vertebrae, and abnormal microarchitecture increased the risk of postoperative skeletal complications.

Perioperative bone health is seldom evaluated in male patients. Older men, in particular, may be at elevated risk for skeletal complications following orthopaedic procedures such as spine fusion; however, few studies have evaluated preoperative skeletal health or risk factors for postoperative complications in this population. This prospective cohort study investigated relationships between preoperative bone health and postoperative outcomes in older men having spine fusion. We hypothesized that men with preoperative skeletal deficits would have higher rates of postoperative complications.

Preoperative skeletal evaluation included DXA, lumbar spine QCT, and high-resolution peripheral CT (HR-pQCT). Postoperative complications were assessed by radiographs and CTs.

Among 63 men enrolled (mean age 66 ± 8 years), only one had osteoporosis based upon the lowest DXA T-score (spine, hip, or wrist) and 15% by lumbar QCT. Skeletal complications occurred in twenty (32%) patients over approximately one year of follow-up. Older age (odds ratio [OR] 2.26, 95% confidence interval 1.09-4.69), revision surgery (OR 3.30, 1.07-10.18), and procedures involving > 5 surgical levels (OR 1.30, 1.12-1.51) were significant predictors of skeletal complications. We did not find that DXA or QCT significantly predicted complications in this cohort. Complication risk was associated with lower cortical vBMD (OR 1.71, 1.13-2.61) and higher cortical porosity (OR 1.83, 1.01-3.30) at the tibia and lower trabecular number (OR 2.45, 1.19-5.05) and greater trabecular separation (OR 3.28, 1.11-9.72) at the radius by HR-pQCT.

Among men undergoing spinal fusion, older age, procedures involving a greater number of vertebrae, revision surgery, and abnormal microarchitecture were risk factors for postoperative skeletal complications.