Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Clin Neurol Neurosurg. 2020 Nov;198:106244. doi: 10.1016/j.clineuro.2020.106244. Epub 2020 Sep 21.
Poor bone health can create challenges in management which are amplified for patients undergoing spinal fusion. Although previously shown to improve outcomes postoperatively, the impact of preoperative teriparatide use on long-term complications remains unclear. In this study, we investigated the complication rates within two years of surgery for osteoporotic and osteopenic patients using teriparatide prior to lumbar fusion procedures.
Patients with poor bone health undergoing any lumbar fusion surgery at a single institution between 2008 and 2018 were identified and subsequently divided into two groups as teriparatide and non-teriparatide group. Baseline demographics, patient and surgery related factors, and two-year complications were collected through a retrospective chart review. Multivariable logistic regression was performed to evaluate the association between teriparatide usage and development of any related postoperative complication.
A total of 42 and 114 patients were identified for the teriparatide and non-teriparatide groups, respectively. The median age (IQR) for the teriparatide group was 62 years (55.8-68.8), while the non-teriparatide group had a median (IQR) age of 70 years (64-75.8). Overall, there were no statistically significant differences in terms of individual complications between the groups. However, on adjusted regression analysis, teriparatide use was associated with significantly lower odds of related complications for lumbar fusion patients (p = 0.049).
Teriparatide use prior to lumbar fusion procedures resulted in reduced rate of osteoporosis-related complications within two years postoperatively. Results suggest improved outcomes might be seen in patients with osteopenia and osteoporosis when pre-treating with teriparatide.
骨骼健康状况不佳会给管理带来挑战，对于接受脊柱融合术的患者来说，这些挑战会被放大。虽然先前的研究表明术前使用特立帕肽可以改善术后结果，但术前使用特立帕肽对长期并发症的影响尚不清楚。在这项研究中，我们调查了在单一机构接受任何腰椎融合手术的骨质疏松和低骨量患者在手术前使用特立帕肽的情况下，术后两年内的并发症发生率。
通过回顾性图表审查，确定了 2008 年至 2018 年期间在一家机构接受任何腰椎融合手术且骨骼健康状况不佳的患者，并将其分为特立帕肽组和非特立帕肽组。收集了基线人口统计学资料、患者和手术相关因素以及两年内的并发症。通过多变量逻辑回归来评估特立帕肽使用与任何相关术后并发症的发生之间的关系。
共确定了特立帕肽组和非特立帕肽组的 42 例和 114 例患者。特立帕肽组的中位年龄（IQR）为 62 岁（55.8-68.8），而非特立帕肽组的中位年龄（IQR）为 70 岁（64-75.8）。总体而言，两组之间在各个并发症方面没有统计学上的显著差异。然而，在调整后的回归分析中，特立帕肽的使用与腰椎融合患者相关并发症的几率显著降低相关（p=0.049）。
在腰椎融合术前使用特立帕肽可降低术后两年内与骨质疏松相关的并发症发生率。结果表明，在骨质疏松症和低骨量患者中使用特立帕肽进行预处理可能会看到更好的治疗效果。
