Comparison of Teriparatide and Bisphosphonate Treatment to Reduce Pedicle Screw Loosening After Lumbar Spinal Fusion Surgery in Postmenopausal Women With Osteoporosis From a Bone Quality Perspective

Ohtori, Seiji; Inoue, Gen; Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Ochiai, Nobuyasu; Kishida, Shunji; Kuniyoshi, Kazuki; Aoki, Yasuchika; Nakamura, Junichi; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Kubota, Go; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Takaso, Masashi; Toyone, Tomoaki; Takahashi, Kazuhisa

doi:10.1097/brs.0b013e31828826dd

Cited by 240 publications

(215 citation statements)

References 27 publications

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“…7,14 To avoid these postoperative complications, it may be necessary to implement some augmentation, such as use of a supplemental hook system or sublaminar cables combined with standard short segment PSF, 24 together with treatment of osteoporosis, for example, using parathyroid hormone (PTH). 16 This study had certain limitations. First, patients in this series were elderly, and it was impossible to follow 11 of 30 patients because 9 patients died of other diseases and 2 patients could not visit our hospital postoperatively due to excessive travel distance and/or physical disability.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience

Nakajima¹,

Uchida²,

Honjoh³

et al. 2016

SPI

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OBJECT Low lumbar osteoporotic vertebral collapse (OVC) has not been well documented compared with OVC of the thoracolumbar spine. The differences between low lumbar and thoracolumbar lesions should be studied to provide better treatment. The aim of this study was to clarify the clinical and imaging features as well as outcomes of low lumbar OVC and to discuss the appropriate surgical treatment. METHODS Thirty patients (10 men; 20 women; mean age 79.3 ± 4.7 years [range 70–88 years]) with low lumbar OVC affecting levels below L-3 underwent surgical treatment. The clinical symptoms, morphological features of affected vertebra, sagittal spinopelvic alignment, neurological status before and after surgery, and surgical procedures were reviewed at a mean follow-up period of 2.4 years. RESULTS The main clinical symptom was radicular leg pain. Most patients had old compression fractures at the thoracolumbar level. The affected vertebra was flat-type and concave or H-shaped type, not wedge type as often found in thoracolumbar OVC. There were mismatches between pelvic incidence and lumbar lordosis on plain radiographs. On CT and MR images, foraminal stenosis was seen in 18 patients (60%) and canal stenosis in 24 patients (80%). Decompression with short fusion using a posterior approach was performed. Augmentations of vertebroplasty, posterolateral fusion, and posterior lumbar interbody fusion were performed based on the presence/absence of local kyphosis of lumbar spine, cleft formation, and/or intervertebral instability. Although the neurological and visual analog scale scores improved postoperatively, 8 patients (26.7%) developed postoperative complications mainly related to instrumentation failure. In patients with postoperative complications, lumbar spine bone mineral density was significantly low, but the spinopelvic alignment showed no correlation when compared with those without complications. CONCLUSIONS The main types of low lumbar OVC were flat-type and concave type, which resulted in neurological symptoms by retropulsed bony fragments generating foraminal stenosis and/or canal stenosis. For patients with low lumbar OVC, decompression of the foraminal and canal stenosis with short fusion surgery via posterior approach can improve neurological symptoms. Since these patients are elderly with poor bone quality and other complications, treatments for both OVC and osteoporosis should be provided to achieve good clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience

Nakajima¹,

Uchida²,

Honjoh³

et al. 2016

SPI

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“…In previous clinical series, sacroiliac screw loosening was approximately 10% in mixed populations [31,32]. As known from spine surgery, the risk of screw loosening in patients with osteoporosis can be as much as 25% [30,47]. Thus, the presence of osteoporosis was estimated to double the rate of screw loosening, therefore we set the clinically relevant effect size in this model of osteoporosis as cement resulting in halving of the amount of screw migration.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with osteoporotic bone, however, loosening of the screws frequently is seen [15,30,47]. This is a dynamic process and failure to achieve stable anchorage in sacroiliac screw fixation can result in loosening of the screws, but equally important can be the long-lasting immobilization resulting from pain in patients who are already-frail and deconditioned.…”

Section: Introductionmentioning

confidence: 99%

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

Osterhoff

Dodd

Unno

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Sacroiliac screw fixation in elderly patients with pelvic fractures is prone to failure owing to impaired bone quality. Cement augmentation has been proposed as a possible solution, because in other anatomic areas this has been shown to reduce screw loosening. However, to our knowledge, this has not been evaluated for sacroiliac screws. Questions/purposes We investigated the potential biomechanical benefit of cement augmentation of sacroiliac screw fixation in a cadaver model of osteoporotic bone, specifically with respect to screw loosening, construct survival, and fracture-site motion. Methods Standardized complete sacral ala fractures with intact posterior ligaments in combination with ipsilateral upper and lower pubic rami fractures were created in osteoporotic cadaver pelves and stabilized by three fixation techniques: sacroiliac (n = 5) with sacroiliac screws in S1 and S2, cemented (n = 5) with addition of cement augmentation, and transsacral (n = 5) with a single transsacral screw in S1. A cyclic loading protocol was applied with torque (1.5 Nm) and increasing axial force (250-750 N). Screw loosening, construct survival, and sacral fracture-site motion were measured by optoelectric motion tracking. A sample-size calculation revealed five samples per group to be required to achieve a power of 0.80 to detect 50% reduction in screw loosening. Results Screw motion in relation to the sacrum during loading with 250 N/1.5 Nm was not different among the three groups (sacroiliac: 1.2 mm, range, 0.6-1.9; cemented: 0.7 mm, range, 0.5-1.3; transsacral: 1.1 mm, range, 0.6-2.3) (p = 0.940). Screw subsidence was less in the cemented group (3.0 mm, range, 1.2-3.7) compared with the sacroiliac (5.7 mm, range, 4.7-10

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“…14,26,28,44 We previously reported that teriparatide administered daily for 2 months before surgery reduced the incidence of pedicle screw loosening after instrumented lumbar fusion in postmenopausal women with osteoporosis, suggesting that teriparatide increased not only bone mass, but also the quality of the pedicle cortex. 34 However, a clinical study of the effect of teriparatide on pedicle screw insertional torque in postmenopausal women with osteoporosis has not yet been reported. The purpose of the current prospective study was to examine the efficacy of preoperative teriparatide for affecting insertional torque of pedicle screws investigated during fusion surgery in postmenopausal women with osteoporosis.…”

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confidence: 99%

Teriparatide increases the insertional torque of pedicle screws during fusion surgery in patients with postmenopausal osteoporosis

Inoue

Ueno

Nakazawa

et al. 2014

SPI

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Object The object of this study was to examine the efficacy of preoperative teriparatide treatment for increasing the insertional torque of pedicle screws during fusion surgery in postmenopausal women with osteoporosis. Methods Fusion surgery for the thoracic and/or lumbar spine was performed in 29 postmenopausal women with osteoporosis aged 65–82 years (mean 72.2 years). The patients were divided into 2 groups based on whether they were treated with teriparatide (n = 13) or not (n = 16) before the surgery. In the teriparatide-treated group, patients received preoperative teriparatide therapy as either a daily (20 μg/day, n = 7) or a weekly (56.5 μg/week, n = 6) injection for a mean of 61.4 days and a minimum of 31 days. During surgery, the insertional torque was measured in 212 screws inserted from T-7 to L-5 and compared between the 2 groups. The correlation between the insertional torque and the duration of preoperative teriparatide treatment was also investigated. Results The mean insertional torque value in the teriparatide group was 1.28 ± 0.42 Nm, which was significantly higher than in the control group (1.08 ± 0.52 Nm, p < 0.01). There was no significant difference between the daily and the weekly teriparatide groups with respect to mean insertional torque value (1.34 ± 0.50 Nm and 1.18 ± 0.43 Nm, respectively, p = 0.07). There was negligible correlation between insertional torque and duration of preoperative teriparatide treatment (r2 = 0.05, p < 0.01). Conclusions Teriparatide injections beginning at least 1 month prior to surgery were effective in increasing the insertional torque of pedicle screws during surgery in patients with postmenopausal osteoporosis. Preoperative teriparatide treatment might be an option for maximizing the purchase of the pedicle screws to the bone at the time of fusion surgery.

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Comparison of Teriparatide and Bisphosphonate Treatment to Reduce Pedicle Screw Loosening After Lumbar Spinal Fusion Surgery in Postmenopausal Women With Osteoporosis From a Bone Quality Perspective

Abstract: Our findings suggest that administration of teriparatide increased the quality of the lumbar spine bone marrow and pedicle cortex.

Cited by 240 publications

References 27 publications

Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience

Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

Teriparatide increases the insertional torque of pedicle screws during fusion surgery in patients with postmenopausal osteoporosis

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