Sawakami Kimihiko, Watanabe Kei, Hasegawa Kazuhiro, Yamamoto Noriaki, Shimakura Taketoshi, Ohashi Masayuki, Shoji Hirokazu, Mizouchi Tatsuki, Tanaka Yuki, Segawa Hiroyuki, Ishikawa Seiichi, Hirano Toru, Kawashima Hiroyuki, Endo Naoto, Takahashi Hideaki E
1Department of Orthopaedic Surgery, Niigata City General Hospital, Niigata, Japan.
2Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan.
J Neurosurg Spine. 2021 Oct 15;36(3):429-439. doi: 10.3171/2021.5.SPINE202003. Print 2022 Mar 1.
Teriparatide (TPTD) is a potent promoter of early-stage osteogenesis and may be a useful adjuvant therapy to reduce complications related to bone fragility in spinal surgery patients with osteoporosis. However, effective neoadjuvant TPTD therapy regimens remain poorly understood. This study aimed to examine the effect of preoperative TPTD administration on cancellous bone with bone histomorphometry and to clarify the timing of preoperative TPTD administration for patients with spinal fusion and osteoporosis.
In this longitudinal multicenter study, 57 patients with spinal fusion and osteoporosis, who consented to undergo iliac biopsy, were allocated to the following treatment groups: neoadjuvant TPTD therapy group (n = 42) and no neoadjuvant therapy (NTC) group (n = 15). Patients in the TPTD group were categorized into subgroups on the basis of duration of preoperative TPTD administration, as follows: 1 month (n = 9), 2 months (n = 8), 3 months (n = 9), 4 months (n = 7), and 6 months (n = 9). All patient samples were preoperatively double labeled with tetracycline, and iliac biopsies were performed during spinal fusion surgery. Histomorphometric analyses were performed on nondecalcified, thin-sliced specimens. Specimens were classified on the basis of TPTD administration duration and subsequently compared with those of the NTC group. Postoperative complications and Oswestry Disability Index scores were evaluated at 1 and 2 years after surgery.
There were no demographic differences between groups. Mineralizing surface/bone surface, a key parameter of dynamic bone formation, started to increase after 1 month of TPTD administration; this increase became significant after 3 months of administration and peaked at 4 months, with a 6-fold increase relative to that of the NTC group. The patients who received preoperative TPTD for 3 months or more had superior clinical results in terms of the osteoporotic complication rate and Oswestry Disability Index scores, except for bisphosphonate-pretreated patients.
When considering neoadjuvant TPTD therapy, the authors recommend at least 3 months of preoperative administration to provide a more substantial anabolic effect from the early postoperative stage.
特立帕肽（TPTD）是早期骨生成的有效促进剂，可能是一种有用的辅助治疗方法，可减少骨质疏松性脊柱手术患者与骨脆性相关的并发症。然而，有效的新辅助TPTD治疗方案仍知之甚少。本研究旨在通过骨组织形态计量学研究术前给予TPTD对松质骨的影响，并明确脊柱融合和骨质疏松患者术前TPTD给药的时机。
在这项纵向多中心研究中，57例同意接受髂骨活检的脊柱融合和骨质疏松患者被分配到以下治疗组：新辅助TPTD治疗组（n = 42）和无新辅助治疗（NTC）组（n = 15）。TPTD组患者根据术前TPTD给药持续时间分为亚组，如下：1个月（n = 9）、2个月（n = 8）、3个月（n = 9）、4个月（n = 7）和6个月（n = 9）。所有患者样本术前均用四环素进行双重标记，并在脊柱融合手术期间进行髂骨活检。对未脱钙的薄片标本进行组织形态计量学分析。标本根据TPTD给药持续时间进行分类，随后与NTC组的标本进行比较。在术后1年和2年评估术后并发症和Oswestry功能障碍指数评分。
各组之间在人口统计学上无差异。动态骨形成的关键参数矿化表面/骨表面在TPTD给药1个月后开始增加；给药3个月后这种增加变得显著，并在4个月时达到峰值，相对于NTC组增加了6倍。除接受双膦酸盐预处理的患者外，术前接受TPTD治疗3个月或更长时间的患者在骨质疏松并发症发生率和Oswestry功能障碍指数评分方面具有更好的临床结果。
在考虑新辅助TPTD治疗时，作者建议术前至少给药3个月，以便从术后早期阶段获得更显著的合成代谢效果。
