Bone Mineral Density T-Score is an Independent Predictor of Major Blood Loss in Adult Spinal Deformity Surgery

Andrew B. Harris, Kevin Y. Wang, Kevin Mo, Floreana Kebaish, Michael Raad, Varun Puvanesarajah, Farah Musharbash, Brian Neuman, Akhil Jay Khanna, Khaled M. Kebaish

Research output: Contribution to journalArticlepeer-review

Abstract

Study Design: Retrospective Cohort Study. Objective: The purpose of this study was to determine the effect of low bone mineral density (BMD), as assessed by preoperative Dual-energy X-ray Absorptiometry (DEXA) scans, on intraoperative blood loss following adult spinal deformity (ASD) surgery. Methods: Patients who received spinal fusion for ASD (>5 levels fused) at a single academic center from 2010-2018 were included in this study. The lowest preoperative T-score was recorded for patients who had preoperative DEXA scans within a year of surgery. Patients with liver/kidney disease or on prescription anticoagulant medication were excluded. Major blood loss was a binary variable defined as above or below the 90th percentile of our cohort. Binomial regression was performed controlling for age, number of vertebrae fused, 3-column osteotomy, primary vs. revision surgery, preoperative platelet count, and if the patient was taking medication for osteoporosis. Results: 91 patients were identified in the cohort. Mean age was 63 ± 11.6 years, 81% female. 56 (62%) of cases included revision of previous instrumentation. Patients had a mean SVA of 9.6 ± 8.6 cm and median of 9 vertebrae fused (range 5-22). The average T-score was -1.2 ± 1.0. Each point lower T-score was associated with significantly higher odds of major blood loss (OR 2.5, 95% CI 1.0 – 5.9) when controlling for age, number of vertebrae fused, 3-column osteotomy, preoperative platelet count and primary vs. revision surgery. Conclusions: Preoperative T-score is independently associated with increased odds of major blood loss in ASD surgery.

Original languageEnglish
Pages (from-to)153-158
Number of pages6
JournalGlobal Spine Journal
Volume14
Issue number1
DOIs
StatePublished - Jan 2024

Keywords

  • adult spinal deformity
  • blood loss
  • bone mineral density
  • dual-energy x-ray absorptiometr scan
  • osteoporosis

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