Outcome of Pedicle Screw Fixation in Patients with Clinically Suspected Osteoporosis at the National Orthopaedic Hospital Dala Kano Nigeria

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.