111. Is osteoporosis screening routinely needed to evaluate cervical total disc replacement patients?

Abstract

BACKGROUND CONTEXT Osteoporosis/osteopenia is identified as a contraindication for total disc replacement (TDR). However, investigation into the utility of DEXA scanning for screening cervical TDR candidates has been limited. PURPOSE The purpose of this study was to determine if DEXA scanning to screen for osteoporosis/osteopenia is needed routinely to evaluate cervical TDR candidates. STUDY DESIGN/SETTING This study was based on a retrospective review of a consecutive series of patients during a 5-year period. PATIENT SAMPLE During the 5-year period, 365 patients received a cervical TDR and/or underwent DEXA screening during the evaluation for cervical TDR. OUTCOME MEASURES The outcome measures were: (1) whether a DEXA scan was performed prior to TDR; and (2) whether the scan results change the treatment plan. METHODS Clinic records were reviewed to identify the consecutive series of all patients undergoing cervical TDR or ACDF performed by one of three surgeons to identify patients who were considered cervical TDR candidates. Charts were reviewed to determine how many of these patients did not undergo cervical TDR due to poor bone quality as determined by DEXA scan. General demographic data were also recorded and factors possibly related to the surgeon's decision to order a DEXA scan were investigated. RESULTS Among the 229 patients who had a DEXA scan, 2 patients (0.87%) were ruled out of having TDR due to poor bone quality (7 other patients who had a DEXA scan did not receive TDR for other reasons). One patient disqualified from TDR due to poor bone quality was a 56-year-old female smoker. The other was a 55-year-old female former smoker, for whom there was a comment in an office note that radiographs suggested osteopenia. Among the 136 patients who did not undergo DEXA scanning and received a TDR, there were no complications related to poor bone quality such as fracture. There appeared to be some selection process among the surgeons prescribing DEXA scanning. The mean age of patients receiving a DEXA scan were older than those not scanned (mean age 48.8 vs 43.7 yrs; p CONCLUSIONS While avoiding patients with poor bone quality is important to reduce complication risks, routinely scanning cervical TDR candidates may not be necessary. In the United States, the cost of a DEXA scan and its reading is approximately $100-$150. Reducing the number of patients scanned could represent a cost savings without increasing the risk of complications in cervical TDR candidates. There would also be other savings related to scheduling the evaluation and charting the results. While low, there is radiation exposure to patients during scanning as well as the inconvenience of scheduling and undergoing the evaluation. The results of this study suggest that routine DEXA scanning in all patients considered cervical TDR candidates may not be necessary. Certainly, if a patient has risk factors for osteoporosis or indications of poor bone quality on routine radiographs or CT, then the evaluation should be undertaken. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.