I Have Osteoporosis and Need Spine Surgery, What’s Next?

If you have osteoporosis and are a candidate for spine surgery, you likely have several concerns. Will osteoporosis complicate my procedure? How will my weakened bones impact my recovery? To answer these and other questions, SpineUniverse reached out to Benjamin T. Bjerke, MD, an orthopaedic spine surgeon. Dr. Bjerke specializes in treating low bone density and shares key considerations when surgery enters the treatment picture.
Normal bone versus one with osteoporosisOsteoporosis or low bone density is an important consideration when making decisions about spine surgery. Photo Source: 123RF.com.

How common is low bone density (osteopenia) and osteoporosis in people with neck or back pain?

Dr. Bjerke: Osteopenia and back pain are both common conditions. Often, they are both present but unrelated. For some people, compression fractures may develop due to low bone density and cause significant pain.

Knowing that osteoporosis affects many men and women older than 50 years of age, do you routinely test for bone mineral density prior to surgical decision-making?

Dr. Bjerke: Patients with osteoporosis are at increased risk for complications, particularly after a spinal fusion procedure. For this reason, many surgeons will test for osteoporosis before any elective orthopaedic or spine surgery. Bone mineral density is very helpful to understand these risks, and the results may affect the timing or type of surgery I offer to my patients. In severe cases, osteoporosis may be treated for a period of time to increase bone density before surgery is considered.

Will you please explain how you work up a patient with osteopenia or osteoporosis?

Dr. Bjerke: For patients who I suspect may have low bone density, I will record a detailed history of any bone fractures and order a DEXA scan to look at multiple areas of the body. Most cases of osteopenia or osteoporosis are treated by a medical doctor or an endocrinologist. I believe that it is important for surgeons to coordinate medical care with other providers and approach these problems as a team.

Pre-operatively, what roles (if any) does the patient’s primary care physician and/or endocrinologist play?

Dr. Bjerke: It is very important for a patient's medical doctor and endocrinologist (if the patient has one) to know about any upcoming surgery. Certain medications may negatively affect surgery for bone healing/fusion or infection.

What are the risks of spine surgery in people with osteoporosis?

Dr. Bjerke: Many of the spinal implants require strong bones to stay in place and for the spine to remain stable. Patients with osteoporosis may need prolonged time in a spinal brace to achieve the same result. Patients with osteoporosis have also been shown to have lower rates of bone healing (fusion) and have problems at spinal levels next to the surgery levels.

What should patients ask their doctor or be aware of if they suspect or know they have osteoporosis?

Dr. Bjerke: Asking questions prior to surgery and discussing your medical history with your doctor is important. Patients should let their doctor know about osteoporosis if they have it, or to inquire about whether a proper work up may be needed before surgery.

How does osteoporosis affect the type and extent of a surgical treatment you recommend?

Dr. Bjerke: Spinal fixation is significantly more difficult in weak bone. I will often use larger and stronger screws to stay in place. Additional bone grafting may be needed to ensure fusion, and other products to help fusion (such as BMP) may also be helpful for these patients. I may also leave patients in a spinal brace for longer following the surgery.

Do you use PMMA {polymethylmethacrylate) to more securely affix pedicle screws when needed?

Dr. Bjerke: On rare occasions, I will insert surgical "cement" or PMMA through screws and into the patient's vertebral bodies. I believe that this will provide a more secure fixation into the bone for the most severe cases of osteoporosis.

Do the newer interbody devices with coatings to stimulate bony in-growth help?

Dr. Bjerke: Newer materials, such as titanium, have been shown to increase the amount of bone that grows into spinal implants. This has been used for years in orthopaedic implants and shown to be effective. Since these advances are relatively new to the spine world, I feel that we are still waiting to see the final outcome of these coatings.

Updated on: 01/30/20
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Spine Surgery Risks and Potential Complications
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Spine Surgery Risks and Potential Complications

Complications of spine surgery to treat neck or back pain are often similar to other operations, except spinal surgery may involve greater risk depending on how it is performed (open or minimally invasive) and if spinal instrumentation and fusion are involved.
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