Jul 2026· Asian Journal of Medicine and Health· Vol 24, pp. 1-10· 0 citations
TL;DR
Improved diagnostic capacity and access to appropriate augmentation strategies may support surgical planning in resource-limited Nigerian settings and the absence of DEXA screening, cement augmentation, and pharmacological treatment indicates a gap in care.
Abstract
Background: Osteoporosis poses a significant challenge to spinal instrumentation because compromised bone quality may predispose patients to screw loosening, implant failure, and reoperation. However, in resource-limited settings where dual-energy X-ray absorptiometry (DEXA) is unavailable, clinicians must rely on clinical and radiographic indicators of poor bone quality.
Aim: This study evaluated the outcomes of pedicle screw fixation in patients with clinically suspected osteoporosis at a Nigerian tertiary hospital and identified factors associated with adverse outcomes.
Methods: A retrospective cohort study was conducted among 61 patients older than 55 years who underwent pedicle screw fixation at the National Orthopaedic Hospital Dala, Kano, from January 2018 to December 2024. Clinically suspected osteoporosis was identified using age, sex, low body mass index (BMI), fragility fractures, and radiographic osteopenia. DEXA was unavailable. Outcomes included screw loosening at one year, reoperation, pain (VAS), neurological status (ASIA grade), disability (ODI), fusion status, quality of life (EQ-5D), and complications. Univariate analysis was used to examine factors associated with adverse outcomes.
Results: Of the 61 patients (47 women and 14 men), screw loosening at one year occurred in 14 (22.9%): 11 women (23.4% of women) and 3 men (21.4% of men). Reoperation was required in 5 patients (8.2%): 4 women (8.5%) and 1 man (7.1%). Univariate analysis showed no statistically significant association between sex and screw loosening (p = 1.00) or reoperation (p = 1.00). Patients older than 75 years had a higher loosening rate (44.4% vs 14.3–25.0%), although the difference was not statistically significant (p = 0.17). Multilevel fusion (≥3 levels) was associated with a higher loosening rate (50.0% vs 9.1–20.0%; p = 0.02). VAS improved from 7.2 ± 1.5 to 3.1 ± 1.8 (p < 0.001), and ODI improved from 58.4 ± 14.2 to 32.5 ± 16.5 (p < 0.001). Complications occurred in 18 patients (29.5%).
Conclusions: Pedicle screw fixation in patients with clinically suspected osteoporosis was accompanied by screw loosening in 22.9% and reoperation in 8.2%. Multilevel fusion was associated with screw loosening. The absence of DEXA screening, cement augmentation, and pharmacological treatment indicates a gap in care. Improved diagnostic capacity and access to appropriate augmentation strategies may support surgical planning in resource-limited Nigerian settings.
Background: The relationship between radiographic success and functional improvement following lumbar spine surgery remains a subject of ongoing debate. While plain radiographs are routinely used to assess fusion and alignment in clinical practice, their correlation with patient-reported functional outcomes is not well established, particularly in resource-limited settings. Methods: A retrospective cohort study of 302 consecutive patients who underwent lumbar surgery (discectomy, fusion with or without instrumentation) at the National Orthopaedic Hospital Dala, Kano, from January 2019 to December 2025 was conducted. Radiographic parameters assessed included fusion status (presence of continuous bridging trabecular bone, absence of lucency, and <3° motion on flexion-extension views), lumbar lordosis, segmental lordosis, and sagittal balance. Functional outcomes were measured using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and leg pain at 12-month follow-up. Correlation between radiographic parameters and functional outcomes was assessed using Spearman's correlation coefficient. Results: Radiographic fusion was achieved in 268 patients (88.7%). A positive but weak correlation was observed between radiographic fusion and improvement in VAS for back pain (r=0.255, p=0.02), while no significant correlation was found with ODI improvement (r=0.112, p=0.18). Restoration of lumbar lordosis correlated weakly with ODI improvement (r=0.218, p=0.04). Notably, 18 patients (6.0%) with radiographic non-union reported satisfactory functional outcomes (ODI improvement ≥15 points), while 22 patients (7.3%) with solid radiographic fusion reported poor functional outcomes (ODI improvement <5 points). Conclusions: Good clinical radiographs show only a weak to moderate correlation with functional outcomes after lumbar spine surgery. Radiographic fusion does not guarantee functional success, nor does non-union uniformly predict failure. Functional outcomes are influenced by multiple factors beyond radiographic parameters, including patient expectations, psychosocial factors, and residual pain. Surgeons should therefore avoid over-reliance on plain radiographs as the sole measure of surgical success.
Ahidjo Abdulkadiri Kawu, Haruna Ahmad Misbahu, B. Ahmed et al.· International Journal Of Med...· 0 citations
Background: Traumatic cervical spine injuries are associated with significant morbidity and mortality, often requiring surgical stabilization to prevent neurological deterioration and maintain alignment. Lateral mass screw fixation has emerged as a reliable technique for posterior cervical stabilization. This study evaluates the clinical and radiological outcomes of lateral mass screw fixation in patients with traumatic subaxial cervical spine injuries at the National Orthopaedic Hospital (NOH), Dala, Kano, Nigeria.
Methods: A retrospective cohort study was conducted on patients who underwent posterior lateral mass screw fixation for traumatic cervical spine injuries (C3-C7) between January 2019 and December 2024 at NOH, Dala. Data extracted included demographics, mechanism of injury, levels instrumented, neurological status using Frankel grading, operative details, complications and fusion rates. Outcomes were assessed preoperatively and at 6 and 12 months postoperatively.
Results: A total of 48 patients (38 males, 10 females) with a mean age of 41.2 ± 12.8 years (range: 19-68 years) underwent lateral mass screw fixation. Road traffic accidents were the predominant mechanism (81.3%). The most common level of injury was C5-C6 (47.9%). Mean operative time was 168 ± 42 minutes and mean blood loss was 320 ± 140 mL. At 12 months, 32 of 48 patients (66.7%) showed neurological improvement by at least one Frankel grade, with 12 patients (25.0%) achieving complete neurological recovery (Grade E). Fusion was achieved in 44 patients (91.7%). Complications occurred in 8 patients (16.7%), including superficial wound infection (6.3%), transient C5 radiculopathy (4.2%), screw malposition requiring revision (2.1%) and implant failure (2.1%). There was no vertebral artery injury or perioperative mortality.
Conclusion: Lateral mass screw fixation for traumatic cervical spine injuries at NOH, Dala, demonstrates favourable neurological recovery, high fusion rates and acceptable complication rates, comparable to international series. These findings support the continued use of this technique in Nigerian tertiary centres for managing unstable subaxial cervical trauma.
Kawu Ahidjo Abdulkadiri, A. Kabir, Nurudeen Aminu Muhammad et al.· Journal of Orthopaedic Scien...· 0 citations
Cementless CTTS demonstrated reliable early fixation with no femoral failures in a rigorously defined osteoporotic cohort, suggesting that cementless CTTS may be a viable option for femoral fixation in osteoporotic patients undergoing elective THA.
Ahmad M. Zedan, Jessica L. Abrolat, Maithily Diaz et al.· Arthroplasty Today· 0 citations
Introduction
Osteoporosis may adversely affect implant fixation and bone integrity following total elbow arthroplasty (TEA), yet its impact on postoperative complications remains incompletely defined. This study compared outcomes following TEA in patients with and without osteoporosis.
Methods
A retrospective analysis was performed including 1,410 adult patients who underwent total elbow arthroplasty (TEA) with a minimum follow-up of two years. Patients with osteoporosis were matched to an equal number of patients without osteoporosis based on demographics, comorbidities, surgical indication, and preoperative inflammatory laboratory markers. Outcome measures included two-year rates of revision, periprosthetic fracture, implant loosening, prosthetic joint infection (PJI), ulnar nerve injury, and instability. A secondary analysis of 520 patients with osteoporosis compared those who received anti-osteoporosis medication to those who did not. Complication rates were compared between groups using chi-squared testing.
Results
Patients with osteoporosis had higher two-year rates of periprosthetic fracture (4.4% vs. 1.4%, p<0.001) and implant loosening (5.0% vs. 2.3%, p=0.007). There were no differences in revision (p=0.144), PJI (p=0.479), ulnar nerve injury (p=0.228), or instability (p=0.692). Among patients with osteoporosis, medication use was not associated with differences in revision, implant loosening, PJI, or ulnar nerve injury. Patients on medication had a lower rate of periprosthetic fracture that did not reach significance (p=0.061).
Conclusion
Osteoporosis is associated with increased risk of periprosthetic fracture and implant loosening following TEA. These findings suggest that impaired bone quality may contribute to structural modes of failure, highlighting the importance of preoperative bone health optimization in patients undergoing TEA.
Akinkunmi Adio, M. Daher, J. Alsamhori et al.· Geriatric Orthopaedic Surger...· 0 citations
PURPOSE
Cement-augmented pedicle screws (CPSCA) and cortical bone trajectory (CBT) screws are used to enhance the fixation strength in osteoporotic bone, but direct comparative clinical evidence remains limited. This study compared 24-month patient-reported outcomes, hospital stay, and complication profiles after CBT versus CPSCA instrumentation in osteoporotic patients undergoing lumbar fixation with interbody fusion.
METHODS
This retrospective cohort study included 134 patients with a bone mineral density T-score < - 2.5 who underwent one- to four-level lumbar fixation with interbody fusion between 2015 and 2021 (CPSCA, n = 63; CBT, n = 71). Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were assessed preoperatively and at a standardized 24-month clinical assessment, conducted in outpatient clinics or by structured telephone follow-up. Primary multivariable models adjusted for age and number of fusion levels. Expanded sensitivity models additionally incorporated sex, bone mineral density, baseline outcome severity, surgical year, and radiographic follow-up duration where applicable. Complications, reoperations, and minimal clinically important difference (MCID) responder rates were also compared.
RESULTS
At 24 months, CBT was associated with comparative VAS improvement than CPSCA (adjusted β = 13.39% points, p < 0.001), comparative ODI improvement (adjusted β = 8.53% points, p = 0.003), and shorter hospital stay (adjusted β = -3.00 days, p = 0.020). These associations remained statistically significant in expanded sensitivity analyses. All CBT patients met the predefined MCID thresholds for VAS and ODI, compared with 90.5% and 87.3% of CPSCA patients, respectively; the exact 95% confidence interval for each 100% CBT responder rate was 94.9-100.0%. Recorded perioperative complications occurred in 5 of 63 CPSCA patients (7.9%) and 4 of 71 CBT patients (5.6%; p = 0.734), while reoperation rates were 7.9% and 5.6%, respectively (p = 0.734). Cement leakage occurred only after CPSCA, whereas screw loosening occurred only after CBT. No individual complication differed significantly between groups.
CONCLUSION
In this retrospective cohort, CBT instrumentation was associated with comparative 24-month improvement in pain and disability and shorter hospitalization than CPSCA after adjustment for measured covariates. Complication and reoperation rates did not differ statistically, although complication patterns varied between techniques. Because treatment allocation was non-randomised, surgeon and instrumentation effects could not be separated, and the study was underpowered for uncommon adverse events, these findings require cautious interpretation and prospective validation.
Chao-Hsuan Chen, Chun-Jen Chang, Hsiang-ming Huang et al.· European spine journal· 0 citations
Objective: To identify independent clinical and inflammatory risk factors associated with asymptomatic vertebral compression fractures in ankylosing spondylitis patients undergoing routine spinal evaluation. Study Design: Analytical Cross-sectional. Period: January to December 2025. Setting: Department of Neurosurgery, Nishtar Hospital II, Multan. Methods: A total of 289 adults meeting ASAS criteria who underwent spinal imaging. Patients with acute symptomatic fractures, recent trauma, prior spinal surgery, or metabolic bone disorders were excluded. Asymptomatic vertebral compression fractures were defined radiographically using Genant semiquantitative grading without acute pain or neurological deficits. Demographic, clinical, and laboratory parameters were evaluated using SPSS version 24.0, with statistical significance considered at p<0.05. Results: Asymptomatic fractures were identified in 74 participants (25.6%). Affected individuals were significantly older (46.3±9.8 versus 36.1±10.4 years; p<0.001) and exhibited longer disease duration (14.2±7.1 versus 9.8±6.3 years; p<0.001). Prior falls within twelve months (27.0% versus 14.9%; p=0.018) and elevated C-reactive protein levels >6 mg/L (48.6% versus 35.3%; p=0.041) were independently associated with fracture presence. The thoracolumbar junction harbored 47.3% of lesions, with mild grade one deformities comprising 62.2% of cases. Conclusion: Occult vertebral compression fractures represent a frequent complication in ankylosing spondylitis, driven by disease chronicity, mechanical trauma, and persistent inflammation. Targeted imaging protocols and proactive fall prevention strategies should be prioritized for high-risk patients.
M. Rizwan, S. H. Shah, M. Irshad et al.· The Professional Medical Jou...· 0 citations
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