Give Vitamin D before all spinal surgeries – no testing needed

Created July 2020

A Review of Vitamin D in Spinal Surgery: Deficiency Screening, Treatment, and Outcomes

Int J Spine Surg. 2020 Jun 30;14(3):447-454. doi: 10.14444/7059

Benjamin C Mayo 1, Dustin H Massel 1, Alem Yacob 1, Ankur S Narain 1, Fady Y Hijji 1, Nathaniel W Jenkins 1, James M Parrish 1, Krishna D Modi 1, William W Long 1, Nadia M Hrynewycz 1, Thomas S Brundage 1, Kern Singh 1

* Better Surgical outcomes if preceded by Vitamin D loading dose – Oct 2018* Surgery outcome worse if low vitamin D (lumbar spine surgery this time) – Nov 2019* Spinal Surgery patients – almost all have low vitamin D – Nov 2016* Vitamin D needed after most spinal surgeries (and before as well) – 2013* Vitamin D before surgery often helps (Thyroidectomy in this case) – Sept 2019* Pre-operative Vitamin D often helps (thyroidectomy in this case) – June 2021 1. Loading Dose of Vitamin D category has the following{include}

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In this review, we discuss the demonstrated value of vitamin D in bone maintenance, fracture resistance, spinal health, and spine surgery outcomes. Despite this, the effect of vitamin D levels in spine surgery has not been well described. Through this review of literature, several conclusions were drawn.

  • First, despite the fact that a high number of spine surgery patients are vitamin D deficient, screening is not commonly performed.

  • Second, adequate vitamin D levels will not be achieved in a majority of these patients without supplementation.

  • Last, inadequate vitamin D levels may increase the risk of pseudarthrosis.

Given these findings, we suggest that many patients undergoing spinal surgery could be treated with vitamin D supplementation prior to surgery without the need for confirmatory testing for vitamin D deficiency . This is a more cost-effective method than screening all patients. However, future randomized trials and cost-effectiveness analyses are needed to determine the ultimate effects of vitamin D supplementation on clinical morbidity and surgical outcomes.

Tags: Trauma and surgery