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Review
. 2024 Nov 26;13(23):7173.
doi: 10.3390/jcm13237173.

Surgical Management of Adult Spinal Deformity Patients with Osteoporosis

Makeen Baroudi  1 , Mohammad Daher  1 , Krish Maheshwari  1 , Manjot Singh  1 , Joseph E Nassar  1 , Christopher L McDonald  1 , Bassel G Diebo  1 , Alan H Daniels  1
Affiliations
Review

Surgical Management of Adult Spinal Deformity Patients with Osteoporosis

Makeen Baroudi et al. J Clin Med. .

Abstract

Adult spinal deformity (ASD) commonly affects older adults, with up to 68% prevalence in those over 60, and is often complicated by osteoporosis, which reduces bone mineral density (BMD) and increases surgical risks. Osteoporotic patients undergoing ASD surgery face higher risks of complications like hardware failure, pseudoarthrosis, and proximal junctional kyphosis (PJK). Medical management with antiresorptive medications (e.g., bisphosphonates, SERMs, and denosumab) and anabolic agents (e.g., teriparatide, abaloparatide, and romosozumab) can improve BMD and reduce complications. While bisphosphonates reduce fracture risk, teriparatide and newer agents like romosozumab show promise in increasing bone density and improving fusion rates. Surgical adaptations such as consideration of age-adjusted alignment, fusion level selection, cement augmentation, and the use of expandable screws or tethers enhance surgical outcomes in osteoporotic patients. Specifically, expandable screws and cement augmentation have been shown to improve fixation stability. However, further research is needed to evaluate the effectiveness of these treatments, specifically in osteoporotic ASD patients.

Keywords: adult spinal deformity; osteoporosis; proximal junctional kyphosis.

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Conflict of interest statement

M.B., M.D., K.M., M.S., J.E.N., and C.L.M. have nothing to disclose. B.G.D. discloses the following: receives consulting fees from Medtronic and Spineart, and is a CEO and a shareholder at Spinal Alignment Solutions. A.H.D. discloses the following: receives royalties from Spineart, Stryker, and Medicrea; receives consulting fees from Medtronic; receives research support from Alphatec, Medtronic, and Orthofix; receives grants from Medtronic; and receives fellowship support from Medtronic.

Figures

Figure 1
Figure 1
(A) Baseline anteroposterior and lateral standing radiographs. (B) Hounsfield units at the UIV on sagittal CT scan, mean HU 219.8 (top), and axial plane vertebral translation (bottom). (C) Anteroposterior and lateral standing radiographs 2 years post-operatively.
Figure 2
Figure 2
(A) Baseline anteroposterior and lateral standing radiographs. (B) Hounsfield units at the UIV on sagittal CT scan, mean HU 175.2. (C) Anteroposterior and lateral standing radiographs 2 years post-operatively.
Figure 3
Figure 3
(A) Baseline anteroposterior and lateral standing radiographs. (B) Hounsfield units at the UIV on sagittal CT scan, mean HU 89.7. (C) Anteroposterior and lateral standing radiographs 2 years post-operatively showing proximal junctional kyphosis (PJK).
See this image and copyright information in PMC

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