The next speaker is Dr. Khan. This is a late-breaking abstract, Metabolic and Endocrine Disorders in Pseudoarthrosis. Good afternoon, everyone. My name is Inam, and I am a research fellow at the Vanderbilt Spine Center. Today, I'll be talking about Metabolic Endocrine Disorders in Pseudoarthrosis. The topic in specific is important at this age of ever-increasing number of spinal fusion that we come across. I don't have any disclosures. I would like to thank my mentors, Dr. Devin and Dr. Parker at the Vanderbilt Spine Center. The rate and complexity of spinal fusion surgery has increased incredibly in the last several decades. Advances in surgical technique, use of instrumentation and interbody grafts and CAGs have advanced the rates of successful fusion. However, there exists a non-trivial number of failed fusion that is pseudoarthrosis, accounting for an estimated 23% of revision surgery all across the U.S. Hence, a better understanding of the risk factors and treatment of pseudoarthrosis in the need of time. Factors contributing to non-union can broadly be classified under surgical, that is technique-related or device-related, and that is worse as patient-related or biological factors. In the spinal literature specifically, when we looked at studies, they have been limited to small cohorts and mostly focused on specific conditions such as vitamin D deficiency or smoking. However, the complex interplay between the bone metabolism, vitamin D deficiency, metabolic syndrome and osteoporosis, there are multiple interactions which contributes to the pseudoarthrosis. At our institute, we enroll patients undergoing electrospine surgery for degenerative diseases in a longitudinal registry and the inclusion criteria we have is like a patient age greater than 18 presenting with any of the diagnosis for degenerative spine disease like disc herniations, stenosis, spondylolisthesis or pseudoarthrosis and had failed a minimum of three months of non-operative care or had a progressive neurologic deficit. When we looked at the patient, around 2,721 patients underwent surgery for degenerative spine disease and out of those 169 were the ones that underwent surgery for pseudoarthrosis. Specifically, these patients were younger, they had a higher use of preoperative opioid use, lesser symptoms of neurogenic claudication or myelopathy, a higher ASA grade and we look at the number of levels, they were significantly higher for those undergoing surgery for pseudoarthrosis. At baseline, these patients presented with significantly worse ODI, that is, Osteoporosis Disability Index, NDI Neck Disability Index and PAN scores compared to the non-pseudoarthritic population. All the PROs in the pseudoarthrosis looking at one year follow-up improved significantly and we noticed a 78.7% satisfaction, which is pretty high for the pseudoarthrosis population than previously reported in the literature. Some of these pseudoarthritic patients were referred to an endocrine bone specialist and we looked at the metabolic diseases that were previously identified and some of the endocrine diseases that were identified by the endocrine referral and endocrine-related disorder was identified in 82% of the pseudoarthritic patients on chart review. And of the 59 patients who were referred to endocrinology, of these around 58 patients had new diagnosis or treatment to an existing disorder modified. The most common disorder identified or intervened upon was osteoporosis in this population, which was followed by vitamin D deficiency, diabetes, hyperlipidemia, six hormone deficiency, and hypothyroidism. Through endocrine evaluation, anabolic agents, that is, teriparatide or avilaparatide was started and calcium was recommended to 46 and 37 patients with osteoporosis, respectively. Vitamin D was initiated, modified in around 39 patients out of those who were referred to the endocrine evaluator. We were unable Can we go back? Let's go. Okay. Okay, thanks. We were unable to make any conclusion on the efficacy of the intervention that this patient had, those that were referred to the endocrinologist or make any evidence-based recommendation for endocrine referral because the patients that were referred to a bone metabolic specialist had similar reported outcomes compared to those that were not referred. In addition, a limitation for any predictive analytics in this population was the limited number that we had and also the lack of surgical details for the index procedure among these patients. In conclusion, we came to this conclusion that multitude of endocrine and metabolic disorders were identified in the cohort and that warrants a thoughtful approach of workup and optimization for these patients. And the burden for endocrine disorder in these patients warrant a future establishment of protocols for workup and indications for referral to bone metabolic specialist. Thank you. Thanks, Dr. Kahn.

metabolic disorders

endocrine disorders

pseudoarthrosis

spinal fusion surgery

risk factors