Sawada Yuta, Takahashi Shinji, Yasuda Hiroyuki, Terakawa Masaki, Konishi Sadahiko, Kato Minori, Toyoda Hiromitsu, Suzuki Akinobu, Tamai Koji, Iwamae Masayoshi, Okamura Yuki, Kobayashi Yuto, Nakamura Hiroaki, Terai Hidetomi
Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Spine J. 2025 Jun;25(6):1218-1228. doi: 10.1016/j.spinee.2024.12.021. Epub 2024 Dec 18.
The effect of romosozumab administration in patients undergoing corrective spinal fusion surgery has not yet been analyzed.
To examine the effect of romosozumab administration on reducing the incidence of proximal junctional kyphosis (PJK), particularly PJK due to fractures (PJK-Fx), in patients undergoing spinal corrective fusion surgery.
Retrospective cohort study.
A total of 111 patients aged >50 years underwent corrective fusion surgery (>2 vertebrae) for adult spinal deformity or vertebral compression fracture between June 2010 and July 2023.
The primary outcome was the incidence of PJK, whereas the secondary outcomes were changes in Hounsfield unit (HU) values, surgical complications, and clinical outcomes measured using the Japanese Orthopaedic Association (JOA) and visual analog scale scores.
The patients were divided into the romosozumab (n=32) and nonromosozumab groups (n=79). Romosozumab was typically administered 2 months before surgery in the romosozumab group. Demographic data, surgery-related factors, and radiographic parameters were analyzed. HU values at the upper instrumented vertebra+1 (UIV+1) were measured preoperatively and at 1 year postoperatively. After the univariate analysis of preoperative factors associated with PJK, multivariate logistic regression was used to identify factors associated with PJK.
Romosozumab significantly increased the HU values at UIV+1 (-1.22% vs 13.60%, p<.001) and reduced the incidence of PJK (39.24% vs 18.75%, p=.046), particularly PJK-Fx (26.58% vs 6.25%, p=.019) and osteoporosis-related complications (55.70% vs 34.38%, p=.011). The multivariate analysis showed a significantly lower incidence of PJK (adjusted odds ratio = 0.32, p=.033), particularly PJK-Fx (adjusted odds ratio = 0.15, p=.018). There was a tendency for better JOA scores at 1 year postoperatively in the romosozumab group (21.49 vs 23.62, p=.071).
Romosozumab administration effectively increased bone density and reduced the risk of PJK, particularly PJK-Fx, and osteoporosis-related complications in patients undergoing corrective spinal fusion surgery. Administration of romosozumab 2 months before surgery enhanced bone mineral density and strength, leading to better surgical outcomes and fewer complications. Further long-term studies are needed to confirm these findings and optimize treatment protocols.
尚未分析罗莫佐单抗对接受脊柱矫正融合手术患者的影响。
研究罗莫佐单抗对降低脊柱矫正融合手术患者近端交界性后凸（PJK）发生率的影响，尤其是骨折所致PJK（PJK-Fx）。
回顾性队列研究。
2010年6月至2023年7月期间，共有111例年龄>50岁的患者因成人脊柱畸形或椎体压缩骨折接受了矫正融合手术（>2节椎体）。
主要观察指标为PJK的发生率，次要观察指标为豪斯菲尔德单位（HU）值的变化、手术并发症以及使用日本骨科协会（JOA）和视觉模拟量表评分评估的临床结局。
将患者分为罗莫佐单抗组（n=32）和非罗莫佐单抗组（n=79）。罗莫佐单抗组通常在手术前2个月给药。分析人口统计学数据、手术相关因素和影像学参数。术前及术后1年测量上位内固定椎体+1（UIV+1）的HU值。在对与PJK相关的术前因素进行单因素分析后，采用多因素逻辑回归分析确定与PJK相关的因素。
罗莫佐单抗显著提高了UIV+1的HU值（-1.22%对13.60%，p<.001），并降低了PJK的发生率（39.24%对18.75%，p=.046），尤其是PJK-Fx（26.58%对6.25%，p=.019）和骨质疏松相关并发症（55.70%对34.38%，p=.011）。多因素分析显示PJK的发生率显著降低（调整优势比=0.32，p=.033），尤其是PJK-Fx（调整优势比=0.15，p=.018）。罗莫佐单抗组术后1年JOA评分有改善趋势（21.49对23.62，p=.071）。
在接受脊柱矫正融合手术的患者中，使用罗莫佐单抗可有效增加骨密度，降低PJK尤其是PJK-Fx以及骨质疏松相关并发症的风险。术前两个月使用罗莫佐单抗可提高骨矿物质密度和强度，从而改善手术效果并减少并发症。需要进一步的长期研究来证实这些发现并优化治疗方案。
