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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Do we underdiagnose osteoporosis in patients with pyogenic spondylodiscitis?

Wird Osteoporose unterdiagnostiziert in Patienten mit Spondylodiszitis?

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  • presenting/speaker Christoph Bettag - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Tammam Abboud - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Christian von der Brelie - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Patrick Melich - Universitätsklinikum Köln, Neurochirurgie, Köln, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Bawarjan Schatlo - Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV079

doi: 10.3205/20dgnc084, urn:nbn:de:0183-20dgnc0840

Published: June 26, 2020

© 2020 Bettag et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Pyogenic spondylodiscitis (PS) affects a fragile patient population. Surgical treatment frequently entails instrumentation. Loosening of the implanted construct has been reported in patients with PS. As it usually occurs in the elderly, a poor bone quality might be one reason leading to subsequent construct loosening. We hypothesized that osteoporosis is underdiagnosed in patients undergoing surgery for PS.

Methods: We undertook an opportunistic estimation of bone density based on computed tomography (CT) scans of the thoracolumbar spine obtained prior to surgery. Based on a validated axial normative CT-scan we assessed the average Hounsfield units (HU) in vertebral bodies of L1 and L4 in patients with spondylodiscitis. We defined a conservative cut off value of ≤ 110 HU as a limit for a diagnosis of osteoporosis. Baseline and outcome variables including construct loosening were entered into a multivariate logistic model for statistical analysis.

Results: Out of 200 consecutive patients who underwent fusion surgery for PS, 64% were male (n=127). N=132 (66%) were older than 65 years. A total of 14 out of 200 patients (7%) had a known past medical history of osteoporosis. L1 and L4 measurements revealed a mean attenuation value of 120.6±47.3 and 118.4±54.6, respectively. With the threshold of 110 HU, the correlation between the two measured levels was excellent (Pearson correlation coefficient of 0.820, p-value less than 0.001). Our attenuation analysis revealed values compatible with osteoporosis in 95 patients (49%). Binary logistic regression showed that age greater than 65 years was the most reliable predictor for osteoporosis (OR 3.09; CI95% 1.91-7.96; p-value less than 0.001). The need for subsequent revision surgery due to construct failure showed a trend towards an association with osteoporosis (OR 2.11; CI95% 0.95-4.68; p=0.067).

Conclusion: Relying on past medical history of osteoporosis is insufficient in the management of patients with pyogenic spondylodiscitis. Half of the patients presenting with spondylodiscitis also had severely reduced bone mass compatible with a diagnosis of osteoporosis. We advocate routine opportunistic CT evaluation to better guide the type of surgery and potentially reduce the risk of construct failure.