Ide Manabu, Yamada Katsutaka, Kaneko Kanichirou, Sekiya Tatsuhiro, Kanai Kenzo, Higashi Takayuki, Saito Tomoyuki
Department of Orthopedic Surgery, Yokohama City University, Fukuura 3-9, Kanazawa-ku, Yokohama-shi, 236-0004 Kanagawa, Japan.
Department of Orthopedic Surgery, Yokohama City University, Fukuura 3-9, Kanazawa-ku, Yokohama-shi, 236-0004 Kanagawa, Japan.
Orthop Traumatol Surg Res. 2018 Nov;104(7):1043-1048. doi: 10.1016/j.otsr.2018.07.015. Epub 2018 Sep 1.
Previous studies reported that teriparatide (recombinant human parathyroid hormone) accelerated spinal fusion following posterior lumbar inter-body fusion surgery, and combination therapy using teriparatide and denosumab increased bone marrow density more than teriparatide alone. The purpose of this study is to evaluate the influence of combination therapy with teriparaide and denosumab on spinal fusion after posterior lumbar interbody fusion.
Sixteen osteoporotic patients with lumbar canal stenosis were randomly divided into two treatment groups, a teriparatide group (n=8; 20μg of teriparatide daily alone, administered from a month before surgery to 12 months after surgery) and a combination group (n=8; 20μg of teriparatide administered daily from a month before surgery to 12 months after surgery with 60mg denosumab every 6 months, administered at 2 and 8 months following surgery). All patients underwent posterior lumbar interbody fusion with local bone grafts. At 3, 6, 9, and 12 months following surgery, bone mineral density at the femoral neck was measured, and biochemical markers were obtained for bone turnover for all cases. Clinical findings were quantified using the Japanese Orthopedic Association scores before surgery, and at 6 and 12 months following surgery. Fusion rates were measured using computed tomography images before surgery, and 6 and 12 months following surgery.
Alkaline phosphatase in the teriparatide group increased more than in the combination group at 3 months following surgery (p<0.05). Femoral neck BMD increased more in the combination group than in the teriparatide group at 12 months following surgery. The combination group achieved higher fusion rates than the teriparatide group at 6 months following surgery.
Combination therapy with teriparatide and denosumab increased bone mineral density more than teriparatide alone, and accelerated spinal fusion following posterior lumbar interbody fusion.
先前的研究报道，特立帕肽（重组人甲状旁腺激素）可加速腰椎后路椎间融合术后的脊柱融合，且特立帕肽与地诺单抗联合治疗比单独使用特立帕肽能更有效地增加骨髓密度。本研究旨在评估特立帕肽与地诺单抗联合治疗对腰椎后路椎间融合术后脊柱融合的影响。
16例患有腰椎管狭窄症的骨质疏松患者被随机分为两个治疗组，特立帕肽组（n = 8；每天单独使用20μg特立帕肽，从手术前1个月至手术后12个月给药）和联合治疗组（n = 8；从手术前1个月至手术后12个月每天使用20μg特立帕肽，术后2个月和8个月每隔6个月给予60mg地诺单抗）。所有患者均接受了后路腰椎椎间融合术并进行了局部植骨。在术后3、6、9和12个月，测量股骨颈的骨密度，并获取所有病例的骨转换生化指标。使用日本骨科协会评分在手术前、术后6个月和12个月对临床结果进行量化。使用计算机断层扫描图像在手术前、术后6个月和12个月测量融合率。
术后3个月时，特立帕肽组的碱性磷酸酶升高幅度大于联合治疗组（p < 0.05）。术后12个月时，联合治疗组的股骨颈骨密度增加幅度大于特立帕肽组。术后6个月时，联合治疗组的融合率高于特立帕肽组。
特立帕肽与地诺单抗联合治疗比单独使用特立帕肽能更有效地增加骨密度，并加速腰椎后路椎间融合术后的脊柱融合。
