Clin Orthop Surg.  2013 Dec;5(4):292-297. 10.4055/cios.2013.5.4.292.

The Effect of Zoledronic Acid on the Volume of the Fusion-Mass in Lumbar Spinal Fusion

• Park YS
• Kim HS
• Baek SW
• Kong DY
• Ryu JA

• KMID: 1787032
• DOI: http://doi.org/10.4055/cios.2013.5.4.292

Abstract

BACKGROUND
Few studies have explored the effects of bisphosphonates on bony healing in patients undergoing spinal fusion surgery. Most previous studies used animal models and found that bisphosphonate shows negative effects on spinal fusion consolidation. We intended to evaluate the effect of a single-dose of zoledronic acid on the volume of the fusion-mass in lumbar spinal fusion.
METHODS
A retrospective review was carried out on 44 patients with symptomatic degenerative lumbar spinal stenosis who underwent one or two-level posterolateral fusion from January 2008 and January 2011. They were divided into 4 groups: group 1, autograft and zoledronic acid; group 2, allograft and zoledronic acid; group 3, autograft alone; and group 4, allograft alone. Functional radiography and three-dimensional computed tomography scans were used to evaluate and quantify the volume of the fusion-mass. The visual analog scale (VAS), the Oswestry disability index (ODI), and the short form 36 (SF-36) were used to evaluate the clinical outcomes.
RESULTS
The mean volume of the fusion-mass per level was 8,814 mm3, 8,035 mm3, 8,383 mm3, and 7,550 mm3 in groups 1, 2, 3, and 4, respectively, but there were no significant differences between the groups (p = 0.829). There were no significant decreases in the volume of the fusion-mass (p = 0.533) in the zoledronic acid groups (groups 1 and 2). The VAS, the ODI, and the SF-36 at the 6-month follow-up after surgery were not significantly different (p > 0.05) among the 4 groups. The VAS, the ODI, and the SF-36 were not correlated with the volume of the fusion-mass (p = 0.120, 0.609, 0.642).
CONCLUSIONS
A single dose of zoledronic acid does not decrease the volume of the fusion-mass in patients undergoing spinal fusion with osteoporosis. Therefore, we recommend that zoledronic acid may be used after spinal fusion in osteoporotic patients.

Keyword

Osteoporosis; Spinal fusion; Fusion-mass; Bisphosphonate; Zoledronic acid

MeSH Terms

Aged
Aged, 80 and over
Bone Density Conservation Agents/*therapeutic use
Diphosphonates/*therapeutic use
Female
Humans
Imidazoles/*therapeutic use
Lumbar Vertebrae/drug effects/pathology/radiography/surgery
Male
Middle Aged
Osteoporosis/drug therapy
Pain Measurement
Pain, Postoperative
Quality of Life
Retrospective Studies
Spinal Fusion/adverse effects/*methods
Spinal Stenosis/pathology/radiography/*surgery
Treatment Outcome
Bone Density Conservation Agents
Diphosphonates
Imidazoles

Figure

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  Fig. 1 An 80-year-old woman received posterolateral fusion and pedicle screw fixation at L3-L5 for degenerative spinal stenosis.

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  Fig. 2 Computed tomography reconstruction scan of the lumbosacral spine was checked at 6 months after operation for better identification of successful fusion between the transverse processes.

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  Fig. 3 We used the regions of interest (ROI, dotted frame) that had been rendered around the fusion masses bilaterally to quantify the fusion volume in coronal images at the L3-L4 or L4-L5 level.

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