title: Vitamin D status in cervical spondylotic myelopathy: comparison of fusion rates and patient outcome measures.
abstract: BACKGROUND
  Patients undergoing elective spinal fusion have an alarming rate of vitamin D deficiency, but its impact on bone fusion and patient outcomes is unclear. We investigated the association of perioperative vitamin D levels, fusion rates, and patient-reported outcome in patients undergoing spinal fusion for cervical spondylotic myelopathy.
  
  
  METHODS
  In this one-year, prospective, single-center observational study, serum 25-OH vitamin D levels were measured perioperatively in adult patients. Serum vitamin D levels <30 ng/mL were considered abnormal. The primary outcome measures were postoperative patient-reported outcomes (Neck Disability Index, Visual Analog Scale, EuroQol EQ-5D-3L, EQ-VAS). Secondary outcome measures were the presence of and time to solid bony fusion, controlling for Body Mass Index (BMI), age, and number of motion segments.
  
  
  RESULTS
  Forty-one of 58 patients (71%) had laboratory-confirmed abnormal vitamin D levels. Patients with low vitamin D were younger (P<0.05) and had a higher BMI (P<0.05) than patients with adequate vitamin D, but the groups were otherwise similar. There were no differences in mean time to fusion between the two groups, but patients with low vitamin D reported more postoperative disability (P<0.05). Multivariate model analysis demonstrated an independent, significant association between normal vitamin D and lower postoperative neck disability index (P=0.05) and EQ-5D-3L (P=0.03).
  
  
  CONCLUSIONS
  Vitamin D deficiency (<30 ng/mL) is highly prevalent in patients undergoing elective spinal fusion for cervical myelopathy. Low vitamin D levels were associated with worse patient-reported outcomes and were an independent predictor of greater disability, which suggests vitamin D supplementation may offer some benefit in these patients.
authors: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
authors: Vijay M
authors: VM
authors: Ravindra
authors: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
authors: Jian
authors: J
authors: Guan
authors: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
authors: Christopher M
authors: CM
authors: Holland
authors: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
authors: Andrew T
authors: AT
authors: Dailey
authors: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
authors: Meic H
authors: MH
authors: Schmidt
authors: Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA.
authors: Jakub
authors: J
authors: Godzik
authors: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
authors: Robert S
authors: RS
authors: Hood
authors: Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA.
authors: Wilson Z
authors: WZ
authors: Ray
authors: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA - neuropub@hsc.utah.edu.
authors: Erica F
authors: EF
authors: Bisson
mesh_terms: D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000097:blood*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000097:blood / Q000503:physiopathology; D013118:Spinal Cord Diseases / Q000097:blood* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D055009:Spondylosis / Q000097:blood* / Q000601:surgery*; D014808:Vitamin D Deficiency / Q000097:blood*
chemical_list: D006887:Hydroxycholecalciferols