Comparative Outcomes of Adult Spinal Deformity Surgery in Patients with and Without Osteoporosis: A Systematic Review and Meta-analysis

Introduction: Adult Spinal Deformity (ASD) surgery is complex and carries a high risk of complications, especially in patients with osteoporosis, a common condition among the elderly that compromises bone density and strength. Osteoporosis is associated with an increased risk of fractures and other adverse outcomes, potentially impacting the success and safety of ASD surgery. Despite the relevance of osteoporosis in this context, there is limited evidence on how it affects surgical outcomes in ASD patients. This study aim to compare postoperative outcomes of ASD surgery in patients with and without osteoporosis.

Methods: Based on the PRISMA guideline, a systematic search was conducted across Embase, Scopus, Web of Science, and PubMed up until September 15th, 2024, using the relevant key terms. Records were screened according to the eligibility criteria, and data from the included studies were extracted. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) checklist.

Results: Among 602 recruited records, five studies met the inclusion criteria. This systematic review includes 4101 patients (74.45% females) aged 20 to 79 with post-op follow-ups between one month and 7.6 years. 37.6% of patients were diagnosed with osteoporosis using bone densitometry scans or clinical measures. The pooled surgery time for osteoporotic patients was reported as 188.17 minutes, and the pooled length of hospitalization was reported as 14.53 days. In addition, the pooled blood loss for osteoporotic patients was 740.83 ml. Comparative analysis indicated no significant differences between osteoporotic, osteopenic, and control groups regarding complication (P = 0.08) and revision surgery rates (P = 0.27).

Conclusion : This study indicates that while ASD patients with osteoporosis may have extended surgery times and hospital stays, the rates of complications and revision surgeries are comparable to those of non-osteoporotic patients. These findings suggest that with careful preoperative planning and management, ASD surgery may be feasible in patients with osteoporosis without a significant increase in adverse outcomes. Further high-quality research is needed to refine surgical strategies and optimize outcomes for this high-risk patient population.