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Vitamin D before surgery improves outcome (spinal in this case) – Dec 2022

The Role of Preoperative Vitamin D in Spine Surgery

A Curr Rev Musculoskelet Med . 2022 Dec 20. doi: 10.1007/s12178-022-09813-z
nitesh Bajaj 1, Rohan M Shah 2, Alyssa M Goodwin 2, Steven Kurapaty 2, Alpesh A Patel 2, Srikanth N Divi 2

Purpose of review: Vitamin D is an essential micronutrient for human bone health and maintenance. Patients undergoing orthopaedic surgery with hypovitaminosis D may be at greater risk for worsened clinical outcomes. This narrative review aims to compile the current literature studying the effects of low preoperative vitamin D on spine surgery outcomes, creating a resource that clinicians can use to inform their practice.

Recent findings: Vitamin D deficiency predisposes to worse outcomes following spine surgery. Vitamin D supplementation may be beneficial in reducing the risk for adverse postoperative events; however, the literature is inconclusive regarding its efficacy in improving bone density and fracture risk.
Spine clinicians should be aware of the increased risk for poor outcomes in patients with preoperative vitamin D deficiency. Future investigations are needed to better evaluate the benefits of preoperative vitamin D screening and supplementation on improving surgical outcomes in spine patients. These studies must also consider the effects on perioperative healthcare costs.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Xu HW, Shen B, Hu T, Zhao WD, Wu DS, Wang SJ. Preoperative vitamin D status and its effects on short-term clinical outcomes in lumbar spine surgery. J Orthop Sci. 2020;25(5):787–92. https://doi.org/10.1016/j.jos.2019.10.011 . Results show vitamin D deficiency is associated with worsened patient-reported outcomes at 3 months postoperatively. - DOI
  2. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–81. https://doi.org/10.1056/NEJMra070553
  3. Gaugris S, Heaney RP, Boonen S, Kurth H, Bentkover JD, Sen SS. Vitamin D inadequacy among post-menopausal women: a systematic review. QJM: An International Journal of Medicine. 2005;98(9):667–76. https://doi.org/10.1093/qjmed/hci096
  4. Patton CM, Powell AP, Patel AA. Vitamin D in orthopaedics. J Am Acad Orthop Surg. 2012;20(3):123–9. https://doi.org/10.5435/jaaos-20-03-123
  5. Maier GS, Jakob P, Horas K, Roth KE, Kurth AA, Maus U. Vitamin D deficiency in orthopaedic patients: a single center analysis. Acta Orthop Belg. 2013;79(5):587–91.
  6. Kalb S, Mahan MA, Elhadi AM, Dru A, Eales J, Lemos M, Theodore N. Pharmacophysiology of bone and spinal fusion. Spine J. 2013;13(10):1359–69. https://doi.org/10.1016/j.spinee.2013.06.005
  7. Okuyama K, Abe E, Suzuki T, Tamura Y, Chiba M, Sato K. Influence of bone mineral density on pedicle screw fixation: a study of pedicle screw fixation augmenting posterior lumbar interbody fusion in elderly patients. Spine J. 2001;1(6):402–7. https://doi.org/10.1016/s1529-9430(01)00078-x
  8. Dvorak MF, Pitzen T, Zhu Q, Gordon JD, Fisher CG, Oxland TR. Anterior cervical plate fixation: a biomechanical study to evaluate the effects of plate design, endplate preparation, and bone mineral density. Spine (Phila Pa 1976). 2005;30(3):294–301. https://doi.org/10.1097/01.brs.0000152154.57171.92
  9. Reitman CA, Nguyen L, Fogel GR. Biomechanical evaluation of relationship of screw pullout strength, insertional torque, and bone mineral density in the cervical spine. J Spinal Disord Tech. 2004;17(4):306–11. https://doi.org/10.1097/01.bsd.0000090575.08296.9d
  10. LeBoff MS, Hawkes WG, Glowacki J, Yu-Yahiro J, Hurwitz S, Magaziner J. Vitamin D-deficiency and post-fracture changes in lower extremity function and falls in women with hip fractures. Osteoporos Int. 2008;19(9):1283–90. https://doi.org/10.1007/s00198-008-0582-6
  11. Rodriguez WJ, Gromelski J. Vitamin d status and spine surgery outcomes. ISRN Orthop. 2013;2013:471695. https://doi.org/10.1155/2013/471695
  12. Schmidt T, Ebert K, Rolvien T, Oehler N, Lohmann J, Papavero L, Kothe R, Amling M, Barvencik F, Mussawy H. A retrospective analysis of bone mineral status in patients requiring spinal surgery. BMC Musculoskelet Disord. 2018;19(1):53. https://doi.org/10.1186/s12891-018-1970-5
  13. Galbusera F, Volkheimer D, Reitmaier S, Berger-Roscher N, Kienle A, Wilke HJ. Pedicle screw loosening: a clinically relevant complication? Eur Spine J. 2015;24(5):1005–16. https://doi.org/10.1007/s00586-015-3768-6
  14. Dodwad SM, Khan SN. Surgical stabilization of the spine in the osteoporotic patient. Orthop Clin North Am. 2013;44(2):243–9. https://doi.org/10.1016/j.ocl.2013.01.008
  15. Stoker GE, Buchowski JM, Bridwell KH, Lenke LG, Riew KD, Zebala LP. Preoperative vitamin D status of adults undergoing surgical spinal fusion. Spine. 2013;38(6):507–15. https://doi.org/10.1097/BRS.0b013e3182739ad1
  16. Donnally CJ 3rd, Sheu JI, Bondar KJ, Mouhanna JN, Li DJ, Butler AJ, et al. Is there a correlation between preoperative or postoperative vitamin D levels with pseudarthrosis, hardware failure, and revisions after lumbar spine fusion? World Neurosurg. 2019;130:e431–e7. https://doi.org/10.1016/j.wneu.2019.06.109
  17. Ravindra VM, Godzik J, Dailey AT, Schmidt MH, Bisson EF, Hood RS, Cutler A, Ray WZ. Vitamin D levels and 1-year fusion outcomes in elective spine surgery: a prospective observational study. Spine. 2015;40(19):1536–41. https://doi.org/10.1097/brs.0000000000001041
  18. Kim TH, Yoon JY, Lee BH, Jung HS, Park MS, Park JO, et al. Changes in vitamin D status after surgery in female patients with lumbar spinal stenosis and its clinical significance. Spine (Phila Pa 1976). 2012;37(21):E1326–30. https://doi.org/10.1097/BRS.0b013e318268ff05 . Provides recent meta-analysis that shows worsened ODI in patients with vitamin D deficiency. - DOI
  19. Khalooeifard R, Rahmani J, Tavanaei R, Adebayo O, Keykhaee M, Ahani A, et al. The effect of vitamin D deficiency on outcomes of patients undergoing elective spinal fusion surgery: a systematic review and meta-analysis. Int J Spine Surg. 2022:8177. https://doi.org/10.14444/8177 .
  20. Ko S, Chae S, Choi W, Kwon J, Choi JY. The effectiveness of vitamin D supplementation in functional outcome and quality of life (QoL) of lumbar spinal stenosis (LSS) requiring surgery. J Orthop Surg Res. 2020;15(1):117. https://doi.org/10.1186/s13018-020-01629-2
  21. Xu Y, Zhou M, Liu H, Zhang Q, Hu Z, Zhang N, Ren Y. Effect of 1,25-dihydroxyvitamin D3 on posterior transforaminal lumbar interbody fusion in patients with osteoporosis and lumbar disc degenerative disease. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014;28(8):969–72.
  22. Waikakul S. Serum 25-hydroxy-calciferol level and failed back surgery syndrome. J Orthop Surg (Hong Kong). 2012;20(1):18–22. https://doi.org/10.1177/230949901202000104
  23. Skrobot W, Perzanowska E, Krasowska K, Flis DJ, Dzik KP, Kloc W, et al. Vitamin D supplementation improves the effects of the rehabilitation program on balance and pressure distribution in patients after anterior cervical interbody fusion-randomized control trial. Nutrients. 2020;12(12). https://doi.org/10.3390/nu12123874 .
  24. Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, et al. Calcium plus vitamin D supplementation and the risk of fractures. New England Journal of Medicine. 2006;354(7):669–83. https://doi.org/10.1056/NEJMoa055218
  25. LeBoff MS, Chou SH, Murata EM, Donlon CM, Cook NR, Mora S, et al. Effects of supplemental vitamin D on bone health outcomes in women and men in the VITamin D and OmegA-3 TriaL (VITAL). Journal of Bone and Mineral Research. 2020;35(5):883–93. https://doi.org/10.1002/jbmr.3958
  26. Reid IR, Bolland MJ, Grey A. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. The Lancet. 2014;383(9912):146–55. https://doi.org/10.1016/S0140-6736(13)61647-5
  27. Bischoff-Ferrari HA, Willett WC, Orav EJ, Lips P, Meunier PJ, Lyons RA, Flicker L, Wark J, Jackson RD, Cauley JA, Meyer HE, Pfeifer M, Sanders KM, Stähelin HB, Theiler R, Dawson-Hughes B. A pooled analysis of vitamin D dose requirements for fracture prevention. New England Journal of Medicine. 2012;367(1):40–9. https://doi.org/10.1056/NEJMoa1109617
  28. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005;293(18):2257–64. https://doi.org/10.1001/jama.293.18.2257
  29. Mayo BC, Massel DH, Yacob A, Narain AS, Hijji FY, Jenkins NW, et al. A Review of vitamin D in spinal surgery: deficiency screening, treatment, and outcomes. Int J Spine Surg. 2020;14(3):447–54. https://doi.org/10.14444/7059

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