Study: Routine DEXA scanning likely unnecessary prior to cervical arthroplasty
CHICAGO — The recommendation that patients who are scheduled to undergo cervical total disc replacement be tested with DEXA to screen for osteoporosis — a condition that may be a contraindication for such surgery — may no longer need to be followed based on results of a retrospective review study presented at the North American Spine Society Annual Meeting, here.
“This study suggests that routine DEXA scanning in patients who are going to have cervical arthroplasty may not be necessary,” Jack E. Zigler, MD, a study co-author, said. “Less than 1% of patients really had an issue.”
The study Zigler and his colleagues conducted was named the Section on Motion Technology Best Paper at the meeting.
Investigators conducted a chart review of 365 patients treated in a 5-year period at the Center for Disc Replacement at Texas Back Institute in Plano, Texas, to determine how many patients did not undergo cervical total disc replacement (TDR) due to poor bone quality that was identified from their DEXA scan.
Results showed two patients with a DEXA scan (0.87%) were ruled out from undergoing the surgery due to poor bone quality.
“Of 136 patients who did not have preop DEXA scans, none of those had any complications related to poor bone quality. So, none of them have an endplate fracture, subsidence, loosening [or] expulsion,” Zigler said.
DEXA scans do not cost much and the radiation exposure from these scans is relatively low, he explained.
“What we would suggest is ... I’m going to change my methods now and not get routine DEXA scans for patients unless I medically suspect that there is an issue,” said Zigler, noting that in the past, he ordered DEXA scans regularly in patients who were candidates for cervical arthroplasty as part of FDA investigational device exemption trials. – by Susan M. Rapp
Blumenthal SL, et al. Abstract 111. Presented at: North American Spine Society Annual Meeting; Sept. 25-28, 2019; Chicago.
Disclosure: Zigler reports he is a consultant for Aesculap, Centinel Spine, Flo-Spine, Medtronic Spine, Orthofix and Simplify Medical; receives royalties from Zimmer Spine and is on the scientific advisory board for Safe Orthopedics from which future compensation is expected.