Changes in Vitamin D Status After Surgery in Female Patients With Lumbar Spinal Stenosis and its Clinical Significance.
Kim TH, Yoon JY, Lee BH, Jung HS, Park MS, Park JO, Moon ES, Kim HS, Lee HM, Moon SH.
1 Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul,
2 Department of Orthopedic Surgery, Medical College of Hallym University, Anyang, Korea.
Spine (Phila Pa 1976). 2012 Jul 14.
ABSTRACT: Study Design. Prospective cohort study
Objective. To demonstrate the changes in vitamin D status after surgery in female patients with lumbar spinal stenosis (LSS), and its correlation with surgical outcomes.
Summary of Background Data. In LSS, patients' general health including walking ability and nutritional status can be markedly improved by decompressive surgery. It can be hypothesized that such an improvement may have a positive effect on their vitamin D status.
Methods. In total, 31 female patients who underwent decompression and instrumented posterolateral fusion for LSS were enrolled. Serum 25-hydroxyvitamin D (25-OHD) level was measured before the surgery and at 1-year postoperative visit. According to serum 25-OHD level, patients were classified into three groups: deficient group, when 25-OHD level was less than 20 ng/ml (<50 nmol/L); insufficient group, when 25-OHD level was between 20 to 30 ng/ml (50 nmol/L? 25-OHD<75 nmol/L); and normal group, when 25-OHD level was greater than or equal to 30 ng/ml (?75 nmol/L).
The Oswestry disability index (ODI) score and health related quality of life (EQ-5D) were compared according to the level of 25-OHD at 1 year postoperatively.
Results. Preoperatively, there were 20 patients in the deficient group, 11 patients in the insufficient group and no patient in the normal group. There were no differences in age, body mass index, preoperative ODI scores, preoperative EQ-5D index scores and EQ-5D VAS scores between the two groups.
Mean preoperative 25-OHD level was 15.8 ng/ml (range, 5.2?29.4 ng/ml) and increased to 19.5 ng/ml (range, 6.3?47.7 ng/ml) at 1 year after surgery (p = 0.075).
Significant increase of 25-OHD was noted only in the deficient group (p = 0.017).
Postoperatively, there were 18 patients in the deficient group, 8 patients in the insufficient group and 5 patients in the normal group. In the postoperative deficient group, postoperative ODI scores and EQ-5D index scores showed significantly worse outcomes than those in the other groups. The changes in serum 25-OHD level were significantly correlated with the changes in ODI scores (r = -0.580, p = 0.001) and with the changes in EQ-5D index scores (r = 0.379, p = 0.035).
In all the groups, postoperative ODI scores (r = -0.665, p<0.001) and EQ-5D index scores (r = 0.601, p<0.001) were significantly correlated with postoperative 25-OHD level.
Conclusion. Vitamin D deficiency was common in patients with LSS.
However, vitamin D status was improved after decompressive surgery, and postoperative 25-OHD level was significantly correlated with surgical outcomes.
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|When||Avg vitamin D||Deficient||Insufficient||Normal|
|Before surgery||16 ng||20||11||0|
|1 year after surgery||20 ng||18||8||5|
The women having the largest increase in vitamin D had the best improvement in disability and best quality of life.