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Low levels of vitamin D prior to spine surgery – March 2013

Preoperative Vitamin D Status of Adults Undergoing Surgical Spinal Fusion

Spine: 15 March 2013 - Volume 38 - Issue 6 - p 507–515
Stoker, Geoffrey E. BS; Buchowski, Jacob M. MD, MS; Bridwell, Keith H. MD; Lenke, Lawrence G. MD; Riew, K. Daniel MD; Zebala, Lukas P. MD

Study Design. Retrospective investigation of cross-sectional data.

Objective. To define the prevalence and determinants of preoperative vitamin D deficiency among adults undergoing spinal fusion.

Summary of Background Data. Vitamin D plays a critical role in establishing optimal bone health, which, in turn, is vital to the success of spinal arthrodesis. Recently, hypovitaminosis D was documented in 43% of adults undergoing any orthopedic surgery.

Methods. Serum 25-hydroxyvitamin D levels were routinely measured in adults undergoing spinal fusion at a single institution. Between January 2010 and March 2011, 313 patients were retrospectively identified for inclusion. Risk factors for vitamin D deficiency (<20 ng/mL) were analyzed using univariate analysis and multivariate logistic regression.

Results. The rates of inadequacy (<30 ng/mL) and deficiency were 57% and 27%, respectively.
Although 260 patients were diagnosed with degenerative disease (spondylosis), 99 had deformity, and there were 73 revision cases.
There was a

  • higher rate of smoking (P = 0.03) and
  • lower age (P < 0.01) in the vitamin D–deficient subset.

There was no sex difference. Increasing body mass index (P < 0.01), increasing Neck and Oswestry Disability Index scores (P = 0.03), and lack of vitamin D and/or multivitamin supplementation (P < 0.01) remained predictors of deficiency after multivariate analysis. Those with previous supplementation were older (P < 0.01) and more likely to be at least 50 years old than those without repletion (P < 0.01).

Conclusion. Our investigation revealed a substantially high prevalence of vitamin D abnormality in the analyzed population. Although advanced age is a well-established risk factor for hypovitaminosis, young adults undergoing fusion should not be overlooked with regard to vitamin D screening; this age bracket is less likely to have been previously supplemented. In the absence of better-recognized determinants, spinal disability indices may also be useful in identifying those with deficiency.

© 2013 Lippincott Williams & Wilkins, Inc.

See also VitaminDWiki