Mohanty Sarthak, Sardar Zeeshan M, Hassan Fthimnir M, Lombardi Joseph M, Lehman Ronald A, Lenke Lawrence G
Department of Orthopaedic Surgery, Och Spine Hospital, Columbia University Irving Medical Center, New York, NY.
J Bone Joint Surg Am. 2024 Feb 7;106(3):206-217. doi: 10.2106/JBJS.23.00272. Epub 2023 Nov 16.
Surgery for adult spinal deformity (ASD) poses substantial risks, including the development of symptomatic pseudarthrosis, which is twice as prevalent among patients with osteoporosis compared with those with normal bone mineral density (BMD). Limited data exist on the impact of teriparatide, an osteoanabolic compound, in limiting the rates of reoperation and pseudarthrosis after treatment of spinal deformity in patients with osteoporosis.
Osteoporotic patients on teriparatide (OP-T group) were compared with patients with osteopenia (OPE group) and those with normal BMD. OP-T patients were matched with OPE patients and patients with normal BMD at a 1:2:2 ratio. All patients had a minimum 2-year follow-up and underwent posterior spinal fusion (PSF) involving >7 instrumented levels. The primary outcome was the 2-year reoperation rate. Secondary outcomes included pseudarthrosis with or without implant failure, proximal junctional kyphosis (PJK), and changes in patient-reported outcomes (PROs). Clinical outcomes were analyzed using conditional logistic regression. Changes in PROs were analyzed using a mixed-effects model.
Five hundred and forty patients (52.6% normal BMD, 32.9% OPE, 14.4% OP-T) were included. In the unmatched cohort, 2-year reoperation rates (odds ratio [OR] = 0.45 [95% confidence interval (CI): 0.20 to 0.91]) and pseudarthrosis rates (OR = 0.25 [95% CI: 0.08 to 0.61]) were significantly lower in the OP-T group than the OPE group. Seventy-eight patients in the OP-T group were matched to 156 patients in the OPE group. Among these matched patients, at 2 years, 23.1% (36) in the OPE group versus 11.5% (9) in the OP-T group had a reoperation (OR = 0.45, p = 0.0188), 21.8% (34) versus 6.4% (5) had pseudarthrosis with or without implant failure (OR = 0.25, p = 0.0048), and 6.4% (10) versus 7.7% (6) had PJK (OR = 1.18, p = 0.7547), respectively. At 2 years postoperatively, PROs were better among OP-T patients than OPE patients. Subsequently, 78 patients in the OP-T group were matched to 156 patients in the normal BMD group. Among these matched patients, there was no significant difference in 2-year reoperation (OR = 0.85 [95% CI: 0.37 to 1.98]), pseudarthrosis (OR = 0.51 [95% CI: 0.181 to 1.44]), and PJK rates (OR = 0.77 [95% CI: 0.28 to 2.06).
Osteoporotic patients on teriparatide demonstrated lower reoperation and symptomatic pseudarthrosis rates 2 years postoperatively compared with osteopenic patients. Moreover, patient-reported and clinical outcomes for osteoporotic patients on teriparatide were not different from those for patients with normal BMD.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
成人脊柱畸形（ASD）手术存在重大风险，包括症状性假关节形成，骨质疏松患者中症状性假关节的发生率是骨密度正常患者的两倍。关于特立帕肽（一种骨合成代谢化合物）对限制骨质疏松患者脊柱畸形治疗后再次手术率和假关节形成率的影响，现有数据有限。
将使用特立帕肽的骨质疏松患者（OP-T组）与骨质减少患者（OPE组）和骨密度正常的患者进行比较。OP-T组患者与OPE组患者及骨密度正常的患者按1:2:2的比例进行匹配。所有患者均接受至少2年的随访，并接受涉及>7个器械固定节段的后路脊柱融合术（PSF）。主要结局是2年再次手术率。次要结局包括有无植入物失败的假关节形成、近端交界性后凸（PJK）以及患者报告结局（PRO）的变化。使用条件逻辑回归分析临床结局。使用混合效应模型分析PRO的变化。
共纳入540例患者（52.6%骨密度正常，32.9%OPE，14.4%OP-T）。在未匹配队列中，OP-T组的2年再次手术率（优势比[OR]=0.45[95%置信区间（CI）：0.20至0.91]）和假关节形成率（OR=0.25[95%CI：0.08至0.61]）显著低于OPE组。OP-T组的78例患者与OPE组的156例患者进行匹配。在这些匹配患者中，2年时，OPE组有23.1%（36例）进行了再次手术，而OP-T组为11.5%（9例）（OR=0.45，p=0.0188）；有21.8%（34例）出现有无植入物失败的假关节形成，而OP-T组为6.4%（5例）（OR=0.25，p=0.0048）；有6.4%（10例）出现PJK，而OP-T组为7.7%（6例）（OR=1.18，p=0.7547）。术后2年，OP-T组患者的PRO优于OPE组患者。随后，OP-T组的78例患者与骨密度正常组的156例患者进行匹配。在这些匹配患者中，2年再次手术率（OR=0.85[95%CI：0.37至1.98]）、假关节形成率（OR=0.51[95%CI：0.181至1.44]）和PJK率（OR=0.77[95%CI：0.28至2.06]）无显著差异。
与骨质减少患者相比，使用特立帕肽的骨质疏松患者术后2年的再次手术率和症状性假关节形成率较低。此外，使用特立帕肽的骨质疏松患者的患者报告结局和临床结局与骨密度正常的患者无异。
治疗性三级。有关证据级别的完整描述，请参阅作者须知。
