Al-Najjar Yousef A, Quraishi Danyal A, Kumar Neerav, Hussain Ibrahim
Department of Neurological Surgery, Och Spine at New York Presbyterian at the Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA.
J Clin Med. 2024 Aug 19;13(16):4891. doi: 10.3390/jcm13164891.
Osteoporosis and low bone mineral density (BMD) pose significant challenges in adult spinal deformity surgery, increasing the risks of complications such as vertebral compression fractures, hardware failure, proximal junctional kyphosis/failure, and pseudoarthrosis. This narrative review examines the current evidence on bone health optimization strategies for spinal deformity patients. Preoperative screening and medical optimization are crucial, with vitamin D supplementation showing particular benefit. Among the pharmacologic agents, bisphosphonates demonstrate efficacy in improving fusion rates and reducing hardware-related complications, though the effects may be delayed. Teriparatide, a parathyroid hormone analog, shows promise in accelerating fusion and enhancing pedicle screw fixation. Newer anabolic agents like abaloparatide and romosozumab require further study but show potential. Romosozumab, in particular, has demonstrated significant improvements in lumbar spine BMD over a shorter duration compared to other treatments. Surgical techniques like cement augmentation and the use of larger interbody cages can mitigate the risks in osteoporotic patients. Overall, a multifaceted approach incorporating medical optimization, appropriate pharmacologic treatment, and tailored surgical techniques is recommended to improve outcomes in adult spinal deformity patients with compromised bone quality. Future research should focus on optimizing the treatment protocols, assessing the long-term outcomes of newer agents in the spine surgery population, and developing cost-effective strategies to improve access to these promising therapies.
骨质疏松症和低骨密度（BMD）给成人脊柱畸形手术带来了重大挑战，增加了诸如椎体压缩骨折、内固定失败、近端交界性后凸/失败以及假关节形成等并发症的风险。本叙述性综述探讨了目前关于脊柱畸形患者骨骼健康优化策略的证据。术前筛查和医学优化至关重要，补充维生素D显示出特别的益处。在药物制剂中，双膦酸盐在提高融合率和减少与内固定相关的并发症方面显示出疗效，尽管效果可能会延迟。特立帕肽，一种甲状旁腺激素类似物，在加速融合和增强椎弓根螺钉固定方面显示出前景。像阿巴洛帕肽和罗莫佐单抗这样的新型促合成代谢药物需要进一步研究，但显示出潜力。特别是罗莫佐单抗，与其他治疗相比，在较短时间内已证明腰椎骨密度有显著改善。诸如骨水泥强化和使用更大的椎间融合器等手术技术可以降低骨质疏松患者的风险。总体而言，建议采用包括医学优化、适当的药物治疗和量身定制的手术技术在内的多方面方法，以改善骨质量受损的成人脊柱畸形患者的治疗效果。未来的研究应侧重于优化治疗方案，评估脊柱手术人群中新型药物的长期疗效，并制定具有成本效益的策略，以增加获得这些有前景疗法的机会。
