Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
Clin Spine Surg. 2023 Jul 1;36(6):E234-E238. doi: 10.1097/BSD.0000000000001434. Epub 2023 Feb 9.
Retrospective single-center study.
This study aimed to assess the effects of pre and postoperative teriparatide (TPTD) treatment on Hounsfield units (HU) after surgery for adult spinal deformity (ASD).
The most commonly used method for assessing bone mineral density is dual-energy x-ray absorptiometry. HU values at the upper instrumented vertebra (UIV) have been proposed as a surrogate method for assessing bone quality, particularly in patients with ASD. However, the effect of TPTD treatment on vertebral HU values remains unclear.
We identified 57 consecutive patients with ASD who underwent long-instrumented fusion surgery (>5 vertebrae) between 2014 and 2020. Patients were retrospectively divided into a non-TPTD group (n = 31) and a TPTD group (n = 26). HU measurements were obtained at a level above the UIV (UIV + 1). Changes in the HU value at 1-year postoperatively were compared between the TPTD and non-TPTD groups. The duration of preoperative TPTD was compared between the proximal junctional proximal junctional failure (PJF) and non-PJF groups.
Preoperative HU values were significantly lower in the TPTD group than in the non-TPTD group, despite no significant difference in preoperative bone mineral density of the proximal femur between the two groups. Changes in HU values were significantly higher in the TPTD group than in the non-TPTD group (20.8 ± 15.7% vs -2 ± 10.2%, P < 0.001). In the subanalysis of the TPTD group, the duration of preoperative TPTD treatment was significantly shorter in the PJF group than in the non-PJF group (34.7 ± 16.8 days vs 86.9 ± 34.7 days, P = 0.004).
Pre and post-operative TPTD treatment increased the average HU value at UIV + 1 by 20.8%. Therefore, more prolonged preoperative TPTD treatment improves bone quality and may help prevent osteoporosis-related complications.
回顾性单中心研究。
本研究旨在评估特立帕肽（TPTD）术前和术后治疗对成人脊柱畸形（ASD）术后的 Hounsfield 单位（HU）的影响。
评估骨密度最常用的方法是双能 X 射线吸收法。在上位器械椎（UIV）处的 HU 值已被提议作为评估骨质量的替代方法，特别是在 ASD 患者中。然而，TPTD 治疗对椎体 HU 值的影响尚不清楚。
我们确定了 2014 年至 2020 年间接受长节段器械融合手术（>5 个椎体）的 57 例连续 ASD 患者。患者回顾性地分为非 TPTD 组（n=31）和 TPTD 组（n=26）。在 UIV 上方（UIV+1）进行 HU 测量。比较 TPTD 和非 TPTD 组之间术后 1 年 HU 值的变化。比较近端交界区近端交界区失败（PJF）和非 PJF 组之间术前 TPTD 持续时间。
尽管两组患者的股骨近端骨密度无显著差异，但 TPTD 组的术前 HU 值明显低于非 TPTD 组。TPTD 组的 HU 值变化明显高于非 TPTD 组（20.8%±15.7%对-2%±10.2%，P<0.001）。在 TPTD 组的亚分析中，PJF 组的术前 TPTD 治疗持续时间明显短于非 PJF 组（34.7±16.8 天对 86.9±34.7 天，P=0.004）。
术前和术后 TPTD 治疗使 UIV+1 的平均 HU 值增加了 20.8%。因此，更长期的术前 TPTD 治疗可改善骨质量，有助于预防与骨质疏松相关的并发症。
