European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
Baseline history of primary fragility fracture is associated with medical complications and revision through 1 year in adult spinal deformity patients undergoing thoracolumbar spinal fusion.
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Shah Neil V, Baum Rachel, Friedman Alejandro J, Ikwuazom Chibuokem P, Khan Rehan R, Poche Alex La, Manis Stefani, Fucich Dario, Alam Juhayer S, Smith Kyle, Purewal Henna, Saha Prasenjit, Monsef Jad Bou, Tannoury Chadi, Tannoury Tony, Paulino Carl B
Аннотация
PURPOSE: Fragility fractures (FFx) can indicate osteoporosis following posterior spinal fusion (PSF) in adult spinal deformity (ASD) patients. We sought to evaluate the impact of a history of FFx on adverse postoperative outcomes following ≥ 3-level PSFs.
METHODS: This retrospective cohort study queried the Mariner10 PearlDiver database to identify patients aged ≥ 50 years undergoing ≥ 3-level PSF for ASD from 2010 to 2022. All trauma, infection, and tumor indications were excluded. Patients with and without a history of FFx (hip, proximal humerus, distal radius, vertebral body, or pelvis fracture) were stratified. Multivariable logistic regression identified factors associated with adverse outcomes (covariates: age, sex, CCI, obesity, FFx history).
RESULTS: 439 ASD patients were identified, of which 33 (7.5%) had FFx. These patients had higher overall medical complications (38.3% vs. 5.2%), respiratory failure (8.3% vs. 2%), DVT (8.3% vs. 0.6%), and infection (6.7% v 0.9%) at 90-day postoperatively, all p < 0.05. FFx patients had higher surgical complications (20% vs. 2.5%), revision/extension (15% vs. 0.4%), and decompression/laminectomy (6.7% vs. 0.8%) at 1-year, all p < 0.005. FFx history was associated with higher risk of wound disruption (OR = 3.9), respiratory failure (OR = 3.1), pneumonia (OR = 2.4), and PE (OR = 1.1). FFx history was associated with higher odds of revision/extension (OR = 3.5), all p < 0.05.
CONCLUSIONS: FFx history was associated with both medical and surgical complications through 1-year postoperatively, demonstrating how important risk stratification/optimization data can be identified from simple preoperative assessment of FFx history.
LEVEL OF EVIDENCE: III.
METHODS: This retrospective cohort study queried the Mariner10 PearlDiver database to identify patients aged ≥ 50 years undergoing ≥ 3-level PSF for ASD from 2010 to 2022. All trauma, infection, and tumor indications were excluded. Patients with and without a history of FFx (hip, proximal humerus, distal radius, vertebral body, or pelvis fracture) were stratified. Multivariable logistic regression identified factors associated with adverse outcomes (covariates: age, sex, CCI, obesity, FFx history).
RESULTS: 439 ASD patients were identified, of which 33 (7.5%) had FFx. These patients had higher overall medical complications (38.3% vs. 5.2%), respiratory failure (8.3% vs. 2%), DVT (8.3% vs. 0.6%), and infection (6.7% v 0.9%) at 90-day postoperatively, all p < 0.05. FFx patients had higher surgical complications (20% vs. 2.5%), revision/extension (15% vs. 0.4%), and decompression/laminectomy (6.7% vs. 0.8%) at 1-year, all p < 0.005. FFx history was associated with higher risk of wound disruption (OR = 3.9), respiratory failure (OR = 3.1), pneumonia (OR = 2.4), and PE (OR = 1.1). FFx history was associated with higher odds of revision/extension (OR = 3.5), all p < 0.05.
CONCLUSIONS: FFx history was associated with both medical and surgical complications through 1-year postoperatively, demonstrating how important risk stratification/optimization data can be identified from simple preoperative assessment of FFx history.
LEVEL OF EVIDENCE: III.