Yu Dongwoo, Kim Sungho, Jeon Ikchan
Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.
Department of Neurosurgery, Bogang Hospital, Daegu, Korea.
J Korean Neurosurg Soc. 2020 Nov;63(6):794-805. doi: 10.3340/jkns.2020.0110. Epub 2020 Oct 27.
Teriparatide is known as an effective anabolic agent not only for severe osteoporosis but also for bone healing and union. We explored the possibility of teriparatide as an alternative treatment option for osteoporotic thoracolumbar (TL) burst fracture.
This retrospective study enrolled 35 female patients with mean age of 73.77±6.71 years (61-88) diagnosed as osteoporotic TL burst fracture with ≥4 of thoracolumbar injury classification and severity (TLICS) score and no neurological deficits. All patients were treated by teriparatide only (12 of group A), teriparatide plus vertebroplasty (12 of group B), or surgical fixation with fusion (11 of group C), and followed up for 12 months. Radiological outcomes were evaluated using radiological parameters including kyphotic angle (KA), segmental vertebral kyphotic angle (SVKA), compression ratio (CR), and vertebral body height (anterior [AH], middle [MH], posterior [PH]). Functional outcomes were evaluated using visual analog scale (VAS) and Macnab classification (MC).
There were no statistical significant differences in age, bone mineral density (-3.36±0.73), and TLICS score (4.34±0.48) among the three groups (p>0.05). Teriparatide was administered during 8.63±2.32 months in group A and B. In 12-month radiological outcomes, there were significant restoration in SVKA, CR, AH, and MH of group B and KA, SVKA, CR, AH, and MH of group C compared to group A with no radiological changes (p<0.05). All groups showed similar significant improvements in 12-month functional outcomes, although group B and C showed a better 1-month VAS, 1-month MC, 3-month MC compared to group A (p<0.05).
Non-surgical treatment with teriparatide showed similar 12-month functional outcomes compared to surgical fixation with fusion. The additional vertebroplasty to teriparatide and surgical fixation with fusion were more helpful to improve short-term functional outcomes with structural restoration compared to teriparatide only.
特立帕肽不仅被认为是治疗严重骨质疏松症的有效促合成药物，还对骨愈合和骨结合有效。我们探讨了特立帕肽作为骨质疏松性胸腰椎爆裂骨折替代治疗方案的可能性。
这项回顾性研究纳入了35例平均年龄为73.77±6.71岁（61 - 88岁）的女性患者，她们被诊断为骨质疏松性胸腰椎爆裂骨折，胸腰椎损伤分类及严重程度（TLICS）评分≥4分且无神经功能缺损。所有患者分别接受单纯特立帕肽治疗（A组12例）、特立帕肽联合椎体成形术治疗（B组12例）或手术固定融合治疗（C组11例），并随访12个月。使用包括后凸角（KA）、节段性椎体后凸角（SVKA）、压缩率（CR）和椎体高度（前缘[AH]、中部[MH]、后缘[PH]）等放射学参数评估放射学结果。使用视觉模拟量表（VAS）和Macnab分类（MC）评估功能结果。
三组患者在年龄、骨密度（-3.36±0.73）和TLICS评分（4.34±0.48）方面无统计学显著差异（p>0.05）。A组和B组特立帕肽给药时间为8.63±2.32个月。在12个月的放射学结果中，与无放射学变化的A组相比，B组的SVKA、CR、AH和MH以及C组的KA、SVKA、CR、AH和MH均有显著恢复（p<0.05）。所有组在12个月的功能结果方面均有相似的显著改善，尽管B组和C组在1个月VAS、1个月MC、3个月MC方面比A组表现更好（p<0.05）。
与手术固定融合治疗相比，特立帕肽非手术治疗在12个月时功能结果相似。与单纯特立帕肽相比，特立帕肽联合椎体成形术和手术固定融合治疗在改善短期功能结果和结构恢复方面更有帮助。
