Table 2.
Summarized Results of Studies Focusing on Radiographic Outcomes.
| Study | Type of Study | Patient population/Indications | Outcome of Interest | Results |
|---|---|---|---|---|
| Yagi et al 2012* | Retrospective case series (n = 76) | Patients undergoing long instrumented (>5 levels) spine fusion for adult idiopathic scoliosis | PJK┼ | T-score of PJK group: −1.32 ± .34 T-score of non-PJK group: −1.08 ± .32 |
| Park et al 2017 | Retrospective case review (n = 160) | Patients undergoing long spinal fusion to the sacrum for ASD | PJK PJF┼ |
(+) or (−) osteoporosis: PJK P-value = .55 (+) or (−) osteoporosis: PJF P-value <.001 |
| Yagi et al al 2011* | Retrospective case series (n = 157) | Patients undergoing long instrumented (>5 levels) spine fusion for adult idiopathic scoliosis | PJK | BMD of PJK group: .69 ± .19 g/cm2 BMD of non-PJK group: .79 ± .18 g/cm2 |
| Wang et al 2016* | Prospective cohort study (n = 98) | Patients undergoing instrumented segmental posterior spinal fusion (>4 levels) for degenerative lumbar scoliosis | PJK┼ | BMD of PJK group: −1.4 ± .8 g/cm2 BMD of non-PJK group: −.7 ± .3 g/cm2 Multivariate OR: 3.27 (95% CI: 9.85-91.13, P < .001) |
| Lee et al 2014* | Retrospective comparative study (n = 47) | Patients undergoing lumbar fusion for sagittal imbalance due to lumbar degenerative kyphosis | PJK | BMD of PJK group: −2.19 ± 1.27 g/cm2 BMD of non-PJK group: −1.98 ± 1.58 g/cm2 |
| Kyrölä et al 2019* | Retrospective cohort study (n = 79) | Patients undergoing corrective surgery of coronal or sagittal deformity of the spine | PJF┼ Rod breakage |
PJF group: 50.0% with osteoporosis Non-PJF group: 15.5% with osteoporosis Rod breakage group: 40.0% with osteoporosis Non-rod breakage group: 15.9% with osteoporosis |
| Yagi et al 2018 | Retrospective propensity-matched cohort study (n = 113) | Patients undergoing long instrumented (>5 levels) spine fusion for adult idiopathic scoliosis | PJF┼ PI-LL SVA PT |
T-score < −1.5: 33% with PJF T-score ≥ −1.5: 8% with PJF Univariate OR: 6.4 (95% CI: 1.2-32.3, P < .01) PI-LL of T-score < −1.5: 36.8 ± 23.5° PI-LL of T-score ≥ −1.5: 34.6 ± 23.3° SVA of T-score < −1.5: 81.8 ± 59.1 mm SVA of T-score ≥ −1.5: 80.6 ± 59.2 mm PT of T-score < −1.5: 30.8 ± 11.6° PT of T-score ≥1.5: 30.7 ± 11.7° |
| Hyun et al 2016* | Retrospective database review (n = 44) | Patients undergoing multilevel (>5 levels) spinal instrumented fusion stopping at the thoracolumbar junction (from T9 to L2) for ASD | PJK┼ | T-score of PJK group: −2.5 ± 1.2 T-score of non-PJK group: −1.3 ± 1.3 |
| Rodriguez-Fontan et al 2020* | Retrospective matched cohort study (n = 80) | Patients undergoing posterior instrumented fusion for correction of ASD | PJK + PJF | Multivariate OR: 2.6 (95% CI: .9-6.8, P = .08) |
| Park et al 2020* | Retrospective case series (n = 63) | Patients undergoing all-pedicle-screw instrumentation and fusion for ASD with the upper instrumented level at the thoracolumbar junction | PJF┼ | Multivariate OR: 4.46 (95% CI: 1.13-17.62, P = .03) |
| Kim et al 2017* | Retrospective case series (n = 49) | Patients undergoing multilevel (>4 levels) posterior fusion with instrumentation for ASD | PJK┼ | T-score of PJK group: −2.30 ± .85 T-score of non-PJK group: −1.01 ± .67 |
| Kim et al 2020* | Retrospective case series (n = 68) | Patients undergoing long fusion surgery with pelvic fixation using bilateral iliac screws for ASD | PJK Screw loosening |
T-score of PJK group: −2.9 ± 1.1 T-score of non-PJK group: −2.6 ± 1.3 T-score of screw loosening group: −2.9 ± 1.2 T-score of non-screw loosening group: −2.5 ± 1.3 |
| Bridwell et al 2013* | Retrospective case series (n = 90) | Patients undergoing primary instrumented multilevel posterior spinal fusion (≥5 levels) for adult idiopathic/degenerative scoliosis | PJK | PJK group: 33.3% with osteoporosis Non-PJK group: 32.8% with osteoporosis |
| Maruo et al 2013* | Retrospective case series (n = 90) | Patients undergoing long instrumented spinal fusion (≥6 levels) to the sacrum for ASD | PJK | PJK group: 55% with osteoporosis Non-PJK group: 37% with osteoporosis |
| Yagi et al 2011* | Retrospective database review (n = 176) | Women treated surgically for scoliosis with preoperative BMD assessment of the lumbar spine and femoral neck determined by DXA | Fusion rate | Fusion rate by spine T-score: 88.9% with osteoporosis; 94.1% with osteopenia; 93.5% normal fusion rate by hip T-score: 89.5% with osteoporosis; 93.1% with osteopenia; 94.3% normal |
| Ploumis et al 2015 | Retrospective case series (n = 54) | Patients undergoing multilevel (≥4 levels) fusions ending at L5 or S1 for ASD | C7PL distance from the midsacrum in the coronal plane┼ | F = 4.99 on repeated measures regression analysis (P = .032) |
| Yuan et al 2021* | Retrospective study (n = 130) | Patients undergoing long spinal fusion (≥5 levels) for degenerative lumbar scoliosis | Screw loosening┼ | T-score of screw loosening group: −2.1 ± 1.0 T-score of non-screw loosening group: −1.4 ± 1.5 Multivariate OR: 2.40 (95% CI: 2.40-27.97, P = .001) |
| Banno et al 2019* | Retrospective study (n = 106) | Patients undergoing fusion surgery with bilateral iliac screws for ASD with 2 groups: Conventional two-rod or multi-rod constructs | Screw loosening┼ | T-score of screw loosening group: −1.9 ± 0.9 T-score of non-screw loosening group: −1.0 ± 0.8 Multivariate OR: 2.63 (95% CI: 1.17-5.90, P = .019) |
| Nakazawa et al 2018* | Retrospective case series (n = 23) | Patients undergoing surgery for ASD using S2 alar screws as anchors in the lower vertebrae | Screw loosening PI-LL PI-LL┼ SVA |
T-score of screw loosening group: −2.0 ± 1.16 T-score of non-screw loosening group: −.96 ± .68 T-score of PI-LL <10°: −1.5 ± 1.3 T-score of PI-LL ≥10°: −1.6 ± 1.0 BMD of PI-LL <10°: 1.04 ± .31 BMD of PI-LL ≥10°: .74 ± .17 T-score of SVA <40 mm: −1.6 ± 1.1 T-score of SVA ≥40 mm: −1.5 ± 1.2 |
| O'Leary et al | Retrospective matched cohort analysis (n = 44) | Patients undergoing spinal fusion (≥4 segments) with long segmental pedicle screw constructs for ASD | Pedicle screw fracture | T-score of fracture group: −1.73 ± .76 T-score of non-fracture group: −.58 ± 1.12 |
| Lertudomphonwanit et al 2018* | Retrospective cohort study (n = 526) | Patients undergoing long posterior fusion (≥5 levels) to the sacrum for ASD | Rod fracture┼ | Rod fracture group: 23.5% with osteoporosis Non-rod fracture group: 22.1% with osteoporosis |
| Kim et al 2015* | Retrospective study (n = 40) | Patients undergoing surgery involving posterior column release with segmental pedicle screw insertion for lumbar degenerative kyphosis | Pseudarthrosis SVA LL PT TK SL Sagittal decompensation (SD) Cage subsidence Proximal adjacent fractures |
Rate of pseudarthrosis: 6.3% with osteoporosis, 13.3% with osteopenia, 33.3% with severe osteoporosis SVA of osteopenia: 74.4 ± 58.1 SVA of osteoporosis: 92.8 ± 72.9 SVA of severe osteoporosis: 110.1 ± 92.8 LL of osteopenia: 33.0 ± 2.4 LL of osteoporosis: 33.0 ± 9.3 LL of severe osteoporosis: −33.0 ± 22.1 PT of osteopenia: −37.5 ± 14.7 PT of osteoporosis: −33.1 ± 13.1 PT of severe osteoporosis: 34.6 ± 11.3 TK of osteopenia: 30.6 ± 9.1 TK of osteoporosis: 32.1 ± 16.5 TK of severe osteoporosis: 34.6 ± 11.3 SL of osteopenia: 26.2 ± 8.5 SL of osteoporosis: 24.6 ± 7.5 SL of severe osteoporosis: 26.7 ± 9.9 Osteopenic group: 33.3% with SD Osteoporotic group: 43.8% with SD Severely osteoporotic group: 22.2% with SD Osteopenic group: 6.7% with CS Osteoporotic group: 31.2% with CS Severely osteoporotic group: 22.2% with CS Osteopenic group: 20.0% with fractures Osteoporotic group: 6.3% with fractures Severely osteoporotic group: 33.3% with fractures |
| Xu et al 2022* | Retrospective study (n = 78) | Patients undergoing lumbosacral instrumentation for degenerative lumbar scoliosis | Screw loosening┼ | Screw loosening group: 75.0% with osteoporosis Non-screw loosening group: 20.6% with osteoporosis |
* = included in meta-analysis.
┼ = statistically significant relationship between outcome and osteoporosis (P < .05).
PJK/PJF, proximal junctional kyphosis/failure; SVA, sagittal vertical axis; PI-LL, pelvic incidence-lumbar lordosis; LL, lumbar lordosis; TK, thoracic kyphosis; PT, pelvic tilt; C7PL, C7 plumbline; SL, sacral slope.