Abstract:
STUDY DESIGN:Retrospective observational study. OBJECTIVE:We investigated whether bone turnover markers could be a useful indicator for prediction of nonunion. SUMMARY OF BACKGROUND DATA:Nonunion is a major complication of lumbar spinal fusion surgery. The involvement of bone turnover in the process of bony union in spinal fusion surgery is, however, poorly understood. METHODS:Of the 74 patients analyzed, 13 were diagnosed with nonunion. We evaluated the significance of the following risk factors: age, sex, number of fused segments, serum levels of total alkaline phosphatase, procollagen type 1 amino-terminal propeptide (P1NP), tartrate-resistant acid phosphatase 5b (TRACP-5b), and albumin, and history of diabetes mellitus, cigarette smoking, or alcohol use. We also defined the bone turnover ratio (BTR) as a value that equals serum TRACP-5b concentration divided by serum P1NP concentration to evaluate patients' individual bone turnover balance and investigated the significance of BTR as a risk factor. RESULTS:Univariate analysis showed that older age, malnutrition, and lower P1NP are risk factors for nonunion. Stepwise logistic regression analysis revealed that in the presence of lower P1NP, higher TRACP-5b becomes a risk factor. Furthermore, we identified BTR as the most significant risk factor for nonunion. The optimum cut-off value of BTR by receiver-operating characteristic curve was 11.74. CONCLUSION:These findings show a relation between bone turnover and nonunion after spinal fusion surgery. The measurement of bone turnover markers could potentially be used to predict nonunion after spinal fusion surgery. LEVEL OF EVIDENCE:4.
journal_name
Spine (Phila Pa 1976)journal_title
Spineauthors
Inose H,Yamada T,Mulati M,Hirai T,Ushio S,Yoshii T,Kato T,Kawabata S,Okawa Adoi
10.1097/BRS.0000000000001995subject
Has Abstractpub_date
2018-01-01 00:00:00pages
E29-E34issue
1eissn
0362-2436issn
1528-1159pii
00007632-201801010-00008journal_volume
43pub_type
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