Baroudi Makeen, Daher Mohammad, Maheshwari Krish, Singh Manjot, Nassar Joseph E, McDonald Christopher L, Diebo Bassel G, Daniels Alan H
Department of Orthopedic Surgery, The Warren Alpert Medical School, Brown University, Providence, RI 02912, USA.
J Clin Med. 2024 Nov 26;13(23):7173. doi: 10.3390/jcm13237173.
Adult spinal deformity (ASD) commonly affects older adults, with up to 68% prevalence in those over 60, and is often complicated by osteoporosis, which reduces bone mineral density (BMD) and increases surgical risks. Osteoporotic patients undergoing ASD surgery face higher risks of complications like hardware failure, pseudoarthrosis, and proximal junctional kyphosis (PJK). Medical management with antiresorptive medications (e.g., bisphosphonates, SERMs, and denosumab) and anabolic agents (e.g., teriparatide, abaloparatide, and romosozumab) can improve BMD and reduce complications. While bisphosphonates reduce fracture risk, teriparatide and newer agents like romosozumab show promise in increasing bone density and improving fusion rates. Surgical adaptations such as consideration of age-adjusted alignment, fusion level selection, cement augmentation, and the use of expandable screws or tethers enhance surgical outcomes in osteoporotic patients. Specifically, expandable screws and cement augmentation have been shown to improve fixation stability. However, further research is needed to evaluate the effectiveness of these treatments, specifically in osteoporotic ASD patients.
成人脊柱畸形（ASD）通常影响老年人，60岁以上人群的患病率高达68%，且常并发骨质疏松症，这会降低骨密度（BMD）并增加手术风险。接受ASD手术的骨质疏松患者面临更高的并发症风险，如内固定失败、假关节形成和近端交界性后凸畸形（PJK）。使用抗吸收药物（如双膦酸盐、选择性雌激素受体调节剂和地诺单抗）和促合成药物（如特立帕肽、阿巴洛帕肽和罗莫单抗）进行药物治疗可改善骨密度并减少并发症。虽然双膦酸盐可降低骨折风险，但特立帕肽和罗莫单抗等新型药物在增加骨密度和提高融合率方面显示出前景。手术调整，如考虑年龄调整后的对线、融合节段选择、骨水泥强化以及使用可扩张螺钉或束带，可提高骨质疏松患者的手术效果。具体而言，可扩张螺钉和骨水泥强化已被证明可提高固定稳定性。然而，需要进一步研究来评估这些治疗方法的有效性，特别是在骨质疏松性ASD患者中。
