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. 2024 Jan;14(1):153-158.
doi: 10.1177/21925682221097912. Epub 2022 May 24.

Bone Mineral Density T-Score is an Independent Predictor of Major Blood Loss in Adult Spinal Deformity Surgery

Andrew B Harris  1 , Kevin Y Wang  1 , Kevin Mo  1 , Floreana Kebaish  1 , Michael Raad  1 , Varun Puvanesarajah  1 , Farah Musharbash  1 , Brian Neuman  1 , Akhil Jay Khanna  1 , Khaled M Kebaish  1
Affiliations

Bone Mineral Density T-Score is an Independent Predictor of Major Blood Loss in Adult Spinal Deformity Surgery

Andrew B Harris et al. Global Spine J. 2024 Jan.

Abstract

Study design: Retrospective Cohort Study.

Objective: The purpose of this study was to determine the effect of low bone mineral density (BMD), as assessed by preoperative Dual-energy X-ray Absorptiometry (DEXA) scans, on intraoperative blood loss following adult spinal deformity (ASD) surgery.

Methods: Patients who received spinal fusion for ASD (>5 levels fused) at a single academic center from 2010-2018 were included in this study. The lowest preoperative T-score was recorded for patients who had preoperative DEXA scans within a year of surgery. Patients with liver/kidney disease or on prescription anticoagulant medication were excluded. Major blood loss was a binary variable defined as above or below the 90th percentile of our cohort. Binomial regression was performed controlling for age, number of vertebrae fused, 3-column osteotomy, primary vs. revision surgery, preoperative platelet count, and if the patient was taking medication for osteoporosis.

Results: 91 patients were identified in the cohort. Mean age was 63 ± 11.6 years, 81% female. 56 (62%) of cases included revision of previous instrumentation. Patients had a mean SVA of 9.6 ± 8.6 cm and median of 9 vertebrae fused (range 5-22). The average T-score was -1.2 ± 1.0. Each point lower T-score was associated with significantly higher odds of major blood loss (OR 2.5, 95% CI 1.0 - 5.9) when controlling for age, number of vertebrae fused, 3-column osteotomy, preoperative platelet count and primary vs. revision surgery.

Conclusions: Preoperative T-score is independently associated with increased odds of major blood loss in ASD surgery.

Keywords: adult spinal deformity; blood loss; bone mineral density; dual-energy x-ray absorptiometr scan; osteoporosis.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Estimated Blood Loss During Adult Spinal Deformity Surgery Stratified by Preoperative Bone Mineral Density
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