Surgical stabilization for degenerative lesions of the lumbar spine in patients with reduced bone mineral density: a systematic literature review

Abstract

Objective. To analyze methods contributing to the improvement of clinical and radiological outcomes of surgical stabilization of the lumbar spine in conditions of reduced bone mineral density (BMD).Material and Methods. A search for publications presenting the results of clinical studies of surgical treatment of patients with degenerative lesions of the lumbar spine and reduced BMD was conducted in English and Russian in the MEDLINE and Russian Science Citation Index (RSCI) databases using key words “osteoporosis”, “osteopenia”, “spinal surgery”, “spinal fusion” and related terms in titles and abstracts with a search depth of 20 years. After applying the inclusion and exclusion criteria, 17 clinical studies were selected for analysis.Results. Among the large number of techniques and implant-associated factors affecting the success of surgical intervention for degenerative lesions of the lumbar spine and reduced BMD, high-quality clinical studies have proven the effectiveness of expandable screws, spinal fusion with cortical screw placement and cement augmentation with polymethyl methacrylate.Conclusion. The combination of techniques for cortical pedicle screw placement, cement augmentation and the use of expandable screws makes it possible to achieve results in surgical treatment of patients with degenerative lesions of the lumbar spine with reduced BMD comparable with those in patients with normal BMD. Of particular importance is the preoperative assessment of the regional state of bone tissue, which should be carried out using quantitative CT or MRI studies.