Survey of spine surgeons on attitudes regarding osteoporosis and osteomalacia screening and treatment for fractures, fusion surgery, and pseudoarthrosis
Survey of spine surgeons on attitudes regarding osteoporosis and osteomalacia screening and treatment for fractures, fusion surgery, and pseudoarthrosis
复制标题
DOI：
10.1016/j.spinee.2009.02.005
复制
发表时间：
2009-07-01
期刊：
影响因子：
4.5
通讯作者：
Rechtine, Glenn R.
中科院分区：
文献类型：
--
作者：
Dipaola, Christian P.;Bible, Jesse E.;Rechtine, Glenn R.
背景：骨质疏松和骨软化是骨折和脊柱内固定失败的重要危险因素。由于预期寿命和人口年龄的增加，低能量骨折变得越来越普遍。骨密度降低是脊柱融合手术中器械失效的独立风险因素。目的：评估脊柱外科医生对代谢性骨病和骨质疏松症的认识和实践模式，重点是骨折护理和关节固定术。研究设计/设置：问卷研究。患者样本：参加“脊柱疾病”会议的脊柱外科医生（2007年1月，加拿大不列颠哥伦比亚省惠斯勒）。受访者报告了低能量脊柱骨折、假关节和接受脊柱关节融合术患者的诊断、筛查和治疗方法的频率。对在实践中治疗脊柱骨折和退行性脊柱疾病的骨科医生和神经外科医生进行了一项10个问题的调查。这项调查是针对那些参加继续医学教育脊柱疾病会议的人进行的。调查询问治疗模式，骨质疏松症和骨软化症的检查和治疗的患者低能量脊柱骨折，假关节，和那些接受脊柱arthrodesis.RESULTS：在133名外科医生的调查问卷是在这次会议上分发，114份问卷被退回，相当于86%的响应率。有21项调查因履历资料不完整而被排除在外，因此共有93份填写完毕的问卷可供分析。在治疗低能量脊柱骨折患者时，60%的患者检查了双能X线吸收测定法（DEXA），39%的患者检查了代谢实验室（在那些没有订购实验室和DEXA的患者中，约63%的患者参考治疗）。在器械融合前，44%的患者检查了DEXA，12%的患者检查了代谢实验室（维生素D、甲状旁腺激素[PTH]和钙[Ca]）。在非仪器融合之前，22%的人检查了DEXA，11%的人检查了代谢实验室。在解决假关节，19%的检查DEXA和20%的检查代谢laborators.CONCLUSIONS：尽管大量的老年患者接受脊柱护理和骨质疏松症和/或骨软化症的发病率高，在这一人群中，很大一部分的脊柱外科医生谁回答调查报告说，他们不执行常规的骨质疏松症/骨软化症检查。在那些进行检查的患者中，一些人评论说这会改变他们的手术计划或术前治疗。似乎有必要提高脊柱专家对骨质疏松症筛查和治疗的认识。骨质疏松症的实践模式也可能受到新制定的政府质量报告法规的影响。(c)2009 Elsevier Inc. All rights reserved.
BACKGROUND CONTEXT: Osteoporosis and osteomalacia are significant risk factors for fracture and spine instrumentation failure. Low-energy fractures are becoming increasingly more common because of an increase in life expectancy and age of the population. Decreased bone density is an independent risk factor for instrumentation failure in spinal fusion operations.PURPOSE: To assess the awareness and practice patterns of spine surgeons regarding metabolic bone disorders and osteoporosis with emphasis on fracture care and arthrodesis.STUDY DESIGN/SETTING: Questionnaire study.PATIENT SAMPLE: Spine surgeons attending the "Disorders of the Spine" conference (January 2007, Whistler, British Columbia, Canada).OUTCOME MEASURES: Respondent reported frequencies of diagnostics, screening, and treatment methods for patients with low-energy spine fractures, pseudoarthrosis, and those undergoing spinal arthrodesis.METHODS: A ten-question survey was administered to orthopedic surgeons and neurosurgeons who treated spine fractures and degenerative spine conditions in their practice. The survey was given to those who were attending a continuing medical education spinal disorders conference. The survey asked about treatment patterns with respect to osteoporosis and osteomalacia workup and treatment for patients with low-energy spine fractures, pseudoarthrosis, and those undergoing spinal arthrodesis.RESULTS: Of the 133 surgeons to whom the questionnaire was distributed at this meeting, 114 questionnaires were returned that corresponds to a response rate of 86%. Twenty-one surveys were excluded because of incomplete biographical information, resulting in a total of 93 completed questionnaires that were available for analysis. When treating patients with low-energy spine fractures, 60% checked dual-energy X-ray absorptiometry (DEXA) and 39% checked metabolic laboratories (of those who did not order laboratories and DEXA about 63% refer for treatment). Before instrumented fusion, 44% of those queried checked DEXA and 12% checked metabolic laboratories (vitamin D, parathyroid hormone [PTH], and calcium [Ca]). Before noninstrumented fusion, 22% checked DEXA and 11% checked metabolic laboratories. Before addressing pseudoarthrosis, 19% checked DEXA and 20% checked metabolic laboratories.CONCLUSIONS: Despite of the large number of elderly patients undergoing spine care and the high incidence of osteoporosis and/or osteomalacia in this population, a large portion of the spine surgeons who responded to the survey reported that they do not perform routine osteoporosis/osteomalacia workups. Of those who do perform workups, some commented that it will change their surgical plan or preoperative treatment. It appears that there is a need for increased awareness among spine specialists regarding osteoporosis screening and treatment. Osteoporosis practice patterns may also be affected with newly evolving government quality reporting regulations. (c) 2009 Elsevier Inc. All rights reserved.