For people with bone problems such as osteopenia or osteoporosis, improving bone health before complex spine surgery is important. Improving bone density before spinal fusion or surgery to repair a deformity lowers the rate of complications, according to Mayo Clinic studies published in Spine and the Journal of Neurosurgery.
Osteopenia is when bones become less dense. Osteoporosis is when bones become even more brittle and can break easily. Both problems increase the risk of broken bones and are common among spinal surgery patients ages 50 and older and among people under 50 at risk of bone health problems because of other factors, such as chronic steroid use or early menopause.
"One of the biggest challenges in adult spinal surgery — in addition to achieving proper alignment — is ensuring correct healing," says Dr. Benjamin Elder, a Mayo Clinic neurosurgeon. "Our goal is to get patients' bones as healthy as possible before they go into surgery."
Neurosurgeons and endocrinologists, who specialize in bone metabolism, work together to help patients determine the cause of their poor bone health — whether it's because of aging, smoking, steroid use, vitamin D deficiency or some other cause. One possible cause is hyperparathyroidism, when the body creates high amounts of parathyroid hormone in the bloodstream. The parathyroid hormone, which helps maintain calcium balance, is important for bone health.
To improve bone mineral density, treatment may include medications. Other strategies to improve spine healing may include:
Treatment may range from two months to two years before complex spinal surgery. Continued maintenance therapy after surgery is essential.
"If the surgery is done on weak bone and fails, additional repair might be impossible," Dr. Elder says. "These are 12-hour surgeries that require a week in the hospital and a year for complete recovery. They have a high complication rate. That's why we try to do everything possible to maximize results."
Beyond giving shape to a body's skeleton, bones are busy. Healthy bones help you move. They anchor muscles and protect your brain, heart and other organs from injury. Bones store minerals that get released into the body for multiple uses.Dr. Elder stresses that everyone should take care of their bone health by following these tips:
Dr. Elder also is studying the use of stem cells and biomaterials to repair spinal bone and cartilage, with the ultimate goal of avoiding major fusion surgeries. Another project is developing an injectable polymer that promotes bone growth. The polymer could be used to perform minimally invasive spinal fusions or as a bone cement that could regrow the bone.