A Systematic Review of the Effect of Osteoporosis on Radiographic Outcomes, Complications, and Reoperation Rate in...

Background/Objectives: The purpose of this review was to determine the impact of osteoporosis on outcomes after surgery for cervical deformity. Cervical deformity involves abnormal curvature or misalignment of the cervical spine, often resulting in a significant loss of quality of life and requiring surgical correction. While osteoporosis has been associated with hardware failure including screw loosening and cage migration in spine surgery, its role in cervical deformity remains unclear. Existing studies report mixed findings with regard to postoperative sequelae in patients with osteoporosis undergoing surgical correction of cervical deformity. Methods: A systematic review using PRISMA guidelines and MeSH terms involving spine surgery for cervical deformity and osteoporosis was performed. The Medline (PubMed) database was searched from 1990 to August 2022 using the following terms: "osteoporosis" AND "cervical" AND ("outcomes" OR "revision" OR "reoperation" OR "complication"). This review focused on radiographic outcomes, as well as post-operative complications. Results: Eight studies were included in the final analysis. Three papers assessed risk factors for the development of post-operative distal junctional kyphosis (DJK), but only one found osteoporosis as a predictor for DJK. Although three studies found that osteoporosis was not significantly associated with the incidence of surgical complications, one highlights osteoporosis as a predictor of complications at 90 days postoperatively (p < 0.001) and another associates osteoporosis with overall poor outcomes (p = 0.021). Furthermore, one study assessing the relationship between osteoporosis and reoperation found no association. Conclusions: Overall, our systematic review suggests that in patients undergoing surgery for cervical deformity, osteoporosis is not predictive of the need for reoperation or the development of postoperative complications, such as DJK, dysphagia, superficial infection, and others. These findings highlight the need for further study regarding the role of osteoporosis in surgical correction of cervical deformity.