Primary Hyperparathyroidism and Lumbar Spinal Fusion Outcomes: A Propensity-Matched Cohort Study.
Preoperative primary hyperparathyroidism was associated with higher 90-day emergency department use after lumbar fusion, but not more mechanical failures.
Primary Hyperparathyroidism and Lumbar Spinal Fusion Outcomes: A Propensity-Matched Cohort Study.
Hyperparathyroidism (hyperparathyroidism) is associated with deterioration of bone microarchitecture, but its impact on lumbar fusion outcomes is poorly characterized, and existing spine data largely reflect dialysis-driven secondary hyperparathyroidism.
Using the TriNetX Research Network, we identified adults undergoing lumbar fusion with and without preoperative primary hyperparathyroidism; propensity score matching (1:1) yielded 775 patients per group.
Higher risk of emergency department visits within 90 days of lumbar fusion with primary hyperparathyroidism (15.7% vs 11.1%).
No mechanical outcome differed significantly between groups.
At 5 y, instrumentation failure was 3.29% versus 2.48% (risk ratio [RR] 1.33, 95% confidence interval 0.74-2.39; P = 0.34), revision 2.51% versus 2.92% (RR 0.86, 0.47-1.58; P = 0.63), and pseudoarthrosis 7.79% versus 6.73% (RR 1.16, 0.80-1.67; P = 0.43).
The parathyroidectomy subgroup was underpowered, with mechanical events below reporting thresholds.
Preoperative primary hyperparathyroidism was not associated with increased instrumentation failure, revision, or pseudoarthrosis through 5 y, though confidence intervals do not exclude smaller effects.
The principal difference was higher early emergency department utilization. The underpowered subgroup permitted no conclusion regarding the effect of preoperative parathyroidectomy.