Systematic Review and Meta-Analysis of the Effect of Osteoporosis on Fusion Rates and Complications Following Surgery for Degenerative Cervical Spine Pathology

Elizabeth A. Lechtholz-Zey; Mina Ayad; Brandon S. Gettleman; Emily S. Mills; Hannah Shelby; Andy Ton; John J.S. Shin; Jeffrey C. Wang; Raymond J. Hah; Ram K. Alluri

doi:10.14444/8568

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Study selection flowchart.

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Table 1

Characteristics of studies focusing on surgery for cervical degenerative disease.

Study	Type of Study	Patient Population/Indications	Radiographic Outcomes	Surgical Outcomes	Clinical Outcomes	Complications	Level of Evidence	Quality of Evidence (GRADE)
Brenke et al 20156	Randomized controlled trial (n = 88)	Patients undergoing ACDF for 1- or 2-level cervical pathology and absence of concomitant spinal disease	Cage subsidence				I	Moderate
Zhang et al 201916	Retrospective cohort (n = 42)	Osteoporotic patients undergoing ACDF with the Zero-Profile device for symptomatic cervical degenerative disc disease	Cage subsidence; fusion rate; change in cervical lordosis	Operative time; blood loss; hospital LOS; cost of surgery	JOA, NDI, VAS, SF-36 PCS, and SF-36 MCS scores	Cervical soft tissue swelling; dysphagia	III	Very low
Yan et al 201115	Retrospective cohort (n = 75)	Osteoporotic patients undergoing anterior corpectomy and reconstruction for cervical spondylotic myelopathy	Cage subsidence; change in cervical lordosis		JOA score VAS score		III	Very low
Ren at al. 2020^{^a} 13	Retrospective cohort (n = 295)	Patients undergoing ACDF for cervical spondylotic disease	Cage nonunion				III	Low
Bergin et al 2021^{^a} 8	Retrospective cohort (n = 326)	Patients undergoing single-level ACDF utilizing Osteocel	Pseudarthrosis				III	Low
Lee et al 2020^{^a} 11	Retrospective database (n = 85)	Patients undergoing elective primary two-level ACDF for degenerative cervical disease causing radiculopathy or myelopathy	Pseudarthrosis				III	Low
Wang et al 202014	Retrospective cohort (n = 91)	Patients undergoing single-level ACDF with anterior plate fixation for degenerative cervical disease	Cage subsidence				III	Low
Ji et al 20209	Retrospective cohort (n = 73)	Patients undergoing single-level anterior cervical corpectomy and fusion with the use of titanium mesh cage	Cage subsidence				III	Low
Lee et al 202210	Retrospective cohort (n = 40)	Patients undergoing single-level ACDF using a stand-alone PEEK cage	Cage subsidence				III	Low
Opsenak et al 20197	Prospective cohort (n = 61)	Patients undergoing microsurgical 1- or 2-level anterior cervical discectomy for cervical degenerative disc disease	Cage subsidence				II	Very low
Lee et al 201412	Retrospective cohort (n = 78)	Patients undergoing single-level ACDF with neck pain and radiculopathy	Cage subsidence				III	Low
Guzman et al 201620	Retrospective administrative database analysis (n = 1,602,129)	Patients with any cervical degenerative disc disease undergoing cervical spine surgery		Hospital length of stay; cost of hospitalization		Revision surgery; wound complications; postoperative hemorrhage	III	Low
Park et al 201621	Retrospective national database (n = 7948)	Patients with degenerative cervical spondylotic radiculopathy or myelopathy undergoing discectomy with anterior fusion, corpectomy, laminectomy, with/without posterior fusion, or laminoplasty				Revision surgery	III	Low
Park et al 201622	Retrospective national database (n = 9071)	Patients with degenerative cervical spondylotic radiculopathy or myelopathy undergoing discectomy with anterior fusion, corpectomy, laminectomy with/without posterior fusion, or laminoplasty				Revision surgery	III	Low
Veeravagu et al 201323	Retrospective administrative database (n = 28,777)	Patients undergoing single- and multilevel ACDF				Revision surgery Readmission Any perioperative complication	III	Low
Rumalla et al 201724	Retrospective administrative database (n = 29,990)	Patients undergoing elective posterior cervical spine surgery for degenerative conditions				Readmission	III	Very low

Abbreviations: ACDF, anterior cervical discectomy and fusion; GRADE, Grading of Recommendations, Assessment, Development, and Evaluation; JOA, Japanese Orthopedic Association; LOS, length of stay; MCS, mental component score; NDI, Neck Disability Index; PCS, physical component score; PEEK, polyether-ether-ketone; VAS, visual analog score.
↵a Included in the meta-analysis portion of this study.

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Table 2
Results of the meta-analysis comparing outcomes after surgery for cervical degenerative disease between osteoporotic and nonosteoporotic patients.
Outcome Osteoporosis No osteoporosis P value
Fusion rate at 6 mo 85.0% ± 9.0% 89.4% ± 7.4% 0.708
Fusion rate 1 y 68.5% ± 9.4% 91.3% ± 3.3% 0.023