Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States of America.
Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, VA, United States of America.
Clin Neurol Neurosurg. 2020 Sep;196:106030. doi: 10.1016/j.clineuro.2020.106030. Epub 2020 Jun 25.
As the ageing population continues to grow, the incidence of osteoporosis continues to rise. Patients with osteoporosis are often managed pharmacologically. It is unclear the impact of these medications on osteoporotic patients requiring lumbar interbody fusion, and whether differences exist with respect to patient outcomes among the different medication classes that are often employed. In this systematic review, the authors examine studies evaluating the impact of pharmacologic therapy on osteoporotic patients undergoing lumbar interbody fusion.
Using PubMed and MEDLINE databases, the authors conducted a systematic literature review for studies published between 1986 and 2020 following PRISMA guidelines.
A total of 12 articles were ultimately selected. Studies assessing bisphosphonate usage, parathyroid hormone analogues, vitamin D, or combination therapies and their impact on lumbar interbody fusion were included.
The evidence regarding bisphosphonate therapy and improved fusion rates with reduced incidence of complications is inconsistent. While some studies suggest bisphosphonates to confer added benefit, other studies suggest no such improvements despite reduction in bone turnover biomarkers. Teriparatide, on the other hand, consistently demonstrated improved fusion rates and may reduce screw loosening events. In comparison studies against bisphosphonates, teriparatide demonstrates greater potential. A single study reported vitamin D3 to increase fusion rates, although more studies are needed to validate this finding. It is important to note that these benefits are only demonstrated in single-level fusion, with multi-level fusions not being significantly enhanced by teriparatide therapy. Combination therapy with denosumab further augment fusion rates. Further prospective randomized controlled trials are necessary before standardized recommendations regarding pharmacological intervention in patients undergoing LIF can be made.
随着人口老龄化的持续增长，骨质疏松症的发病率不断上升。骨质疏松症患者通常需要进行药物治疗。目前尚不清楚这些药物对需要腰椎体间融合的骨质疏松症患者的影响，以及在经常使用的不同药物类别中，患者结局是否存在差异。在这项系统评价中，作者研究了评估药物治疗对接受腰椎体间融合的骨质疏松症患者影响的研究。
作者按照 PRISMA 指南，使用 PubMed 和 MEDLINE 数据库对 1986 年至 2020 年间发表的研究进行了系统的文献回顾。
最终共选择了 12 篇文章。评估双膦酸盐、甲状旁腺激素类似物、维生素 D 或联合治疗及其对腰椎体间融合影响的研究被纳入。
关于双膦酸盐治疗和改善融合率、减少并发症发生率的证据并不一致。虽然一些研究表明双膦酸盐具有额外的益处，但其他研究表明，尽管骨转换生物标志物减少，但并没有改善。另一方面，特立帕肽始终显示出更高的融合率，并可能减少螺钉松动事件。与双膦酸盐相比，比较研究表明特立帕肽具有更大的潜力。仅有一项研究报告维生素 D3 可增加融合率，但需要更多的研究来验证这一发现。需要注意的是，这些益处仅在单节段融合中得到证实，特立帕肽治疗并不能显著提高多节段融合的效果。与地舒单抗联合治疗可进一步提高融合率。在对接受 LIF 的患者进行药物干预的标准化建议之前，需要进行更多的前瞻性随机对照试验。
