Osteoporosis is not associated with reoperation or pseudarthrosis after anterior cervical discectomy and fusion through 4-years’ follow-up: a retrospective cohort study of US academic health centers

Oct 6, 2024The spine journal : official journal of the North American Spine Society

Osteoporosis is not linked to repeat surgery or failed bone healing after front-neck spine fusion over 4 years

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Abstract

Patients with osteoporosis had a reoperation risk of 17.3% after anterior cervical discectomy and fusion, compared to 16.5% for those without osteoporosis.

No statistically significant difference was found in the risk of reoperation between patients with osteoporosis and those without over a 4-year follow-up.
The risk of pseudoarthrosis was also similar between both groups, with rates of 26.5% for osteoporosis patients and 29.1% for nonosteoporotic patients.
Oral opioid prescription rates and counts did not differ significantly between the two cohorts, with 75.0% of osteoporosis patients receiving prescriptions compared to 76.0% of nonosteoporotic patients.
Overall, osteoporosis was not associated with increased risks of reoperation, pseudoarthrosis, or opioid prescriptions after ACDF.

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BACKGROUND CONTEXT: Osteoporosis has been proposed as a risk factor for reoperation after anterior cervical discectomy and fusion (ACDF), yet this potential association has been understudied, with conflicting results to date.

PURPOSE: This study examines the hypothesis that adults with osteoporosis would have an increased risk of reoperation after ACDF compared to matched adults without osteoporosis.

STUDY DESIGN/SETTING: Retrospective cohort study.

PATIENT SAMPLE: Two matched cohorts (mean age: 62 years; 75% female), each with 1,019 patients, who underwent primary ACDF. Cohorts were determined by the presence or absence of a diagnosis of osteoporosis.

OUTCOME MEASURES: Incidence of reoperation occurring over 4 years postoperatively, with our primary outcome being the risk ratio (RR) of reoperation with 95% confidence intervals (CI). Secondary outcomes included risk and mean count of oral opioid prescriptions and risk of pseudoarthrosis.

METHODS: We utilized the TriNetX network to identify adults undergoing their first ACDF from 2004 to 2020, excluding those with serious pathology, and divided patients into 2 cohorts: osteoporosis and nonosteoporosis. Patients were propensity matched according to key risk factors for reoperation.

RESULTS: Patients with osteoporosis had no statistically significant or meaningful difference in risk of reoperation compared to nonosteoporotic patients over 4-years' follow-up [95% CI] (17.3% vs 16.5%; RR: 1.05 [0.86, 1.27]; p=.6361). Similarly, there were no significant differences in the risk of pseudoarthrosis (26.5% vs 29.1%; RR: 0.91 [0.79, 1.05]; p=.1820), oral opioid prescription (75.0% vs 76.0%; RR: 0.99 [0.94, 1.04]; p=.6067), or mean oral opioid prescription count (11.5 vs 11.8; p=.7040).

CONCLUSIONS: Compared to matched nonosteoporosis controls, osteoporosis was not associated with a statistically significant or clinically meaningful increase in risk of reoperation in adults over 4 years after ACDF. Furthermore, osteoporosis was not associated with a significant or meaningful risk of pseudoarthrosis or oral opioid prescription after ACDF, although more research is needed for corroboration. Additional research is needed to clarify whether those with osteoporosis have meaningful differences in pain and function compared to those without osteoporosis following ACDF.

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Osteoporosis is not associated with reoperation or pseudarthrosis after anterior cervical discectomy and fusion through 4-years’ follow-up: a retrospective cohort study of US academic health centers

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