Teriparatide improves volumetric bone mineral density and fine bone structure in the UIV+1 vertebra, and reduces bone failure type PJK after surgery for adult spinal deformity

Yagi, Mitsuru; Ohne, Hideaki; Konomi, Tsunehiko; Fujiyoshi, Kanehiro; Kaneko, Shinjiro; Komiyama, Takafumi; Takemitsu, Masakazu; Yato, Yoshiyuki; Machida, Masafumi; Asazuma, Takashi

doi:10.1007/s00198-016-3676-6

Cited by 110 publications

(86 citation statements)

References 39 publications

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“…Thus, caution should be exercised when considering the risk of PJK type fracture in PD patients. Yagi et al reported that teriparatide treatment started immediately after surgery resulted in a decrease in rates of PJK-type bone fracture [25]. If BMD is low, then administration of osteoporotic drugs such as teriparatide could be a viable option to decrease the risk of complications, as suggested in the previous study.…”

Section: Resultsmentioning

confidence: 77%

Sagittal alignment changes and postoperative complications after adult spinal deformity surgery in patients with Parkinson’s disease: A multi-institutional retrospective study

Kawabata

Yoshii

Sakai

et al. 2020

Preprint

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Background: Parkinson's disease (PD) has been reported to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, those reports are limited, and few have made direct comparisons with patients who do not have PD. Methods:We retrospectively reviewed all surgically treated patients with ASD and at least 2 years of follow-up. Among them, 27 had PD (PD(+) group). Clinical data were collected on early and late postoperative complications and revision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. From the same database, we also retrieved 206 controls without PD (PD(−) group) matched for age, sex, and body mass index.Results: For early complications, the PD(+) group showed a higher rate of delirium than the PD(−) group. Deep vein thrombosis and pulmonary embolism rates tended to be higher in the PD(+) group.For late complications, the rate of pseudarthrosis was significantly higher in the PD(+) group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD(+) group (p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD(+) group.Conclusion: Extra attention should be paid to perioperative complications, especially delirium and thrombosis, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of revision surgery due to mechanical complications were higher in these patients. BackgroundParkinson's disease (PD) is a neurodegenerative disorder, the main symptoms of which are rigidity, bradykinesia, and gait disorder. With population aging, the number of patients with this age-related disorder is increasing [1]. In severe cases, PD causes postural disorder, such as anterocollis, Pisa syndrome, and camptocormia [2][3][4][5]. Reports have shown that these postural abnormalities increase susceptibility to rigid spinal deformities [2,3] and that patients with PD develop adult spinal deformity (ASD) more frequently than the general population in the same age groups [6].Recent studies have shown that ASD negatively affects health-related quality of life [7,8]. Surgical 4 treatment has been shown to provide better health-related quality of life outcomes than non-surgical treatment, especially in patients with severe deformity [9]. However, high complication rates have been reported with revision rates of up to 47%. Surgical complications are generally divided into perioperative and late complications. Perioperative complications include epidural hematoma, deep vein thrombosis (DVT), and pulmonary embolism (PE), which are usually seen during or soon after surgery. Late complications, such as junctional kyphosis, rod fracture, and pseudarthrosis, typically occur more than 1 month after surgery and are mainly caused by continuous mechanical stress.Ge...

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Section: Resultsmentioning

confidence: 77%

Sagittal alignment changes and postoperative complications after adult spinal deformity surgery in patients with Parkinson’s disease: A multi-institutional retrospective study

Kawabata

Yoshii

Sakai

et al. 2020

Preprint

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“…Yagi and colleagues reported on the effectiveness of teriparatide as a protective treatment for junctional fracture following ASD surgery in women with osteoporosis or osteopenia. 93 Although their clinical effectiveness remains under investigation, junctional tethers are an emerging technique with potential to reduce PJK risk (Fig. 7).…”

Section: Pseudarthrosis and Instrumentation Failurementioning

confidence: 99%

“…32,36 In the future, more aggressive attention to bone optimization may also reduce junctional fractures. 93 Ongoing advances in junctional tethers may also provide another approach to reduce PJK. 7…”

Section: Advances To Further Reduce Complicationsmentioning

confidence: 99%

Treatment of adult thoracolumbar spinal deformity: past, present, and future

Smith

Shaffrey

Ames

et al. 2019

Journal of Neurosurgery: Spine

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Care of the patient with adult spinal deformity (ASD) has evolved from being primarily supportive to now having the ability to directly treat and correct the spinal pathology. The focus of this narrative literature review is to briefly summarize the history of ASD treatment, discuss the current state of the art of ASD care with focus on surgical treatment and current challenges, and conclude with a discussion of potential developments related to ASD surgery.In the past, care for ASD was primarily based on supportive measures, including braces and assistive devices, with few options for surgical treatments that were often deemed high risk and reserved for rare situations. Advances in anesthetic and critical care, surgical techniques, and instrumentation now enable almost routine surgery for many patients with ASD. Despite the advances, there are many remaining challenges currently impacting the care of ASD patients, including increasing numbers of elderly patients with greater comorbidities, high complication and reoperation rates, and high procedure cost without clearly demonstrated cost-effectiveness based on standard criteria. In addition, there remains considerable variability across multiple aspects of ASD surgery. For example, there is currently very limited ability to provide preoperative individualized counseling regarding optimal treatment approaches (e.g., operative vs nonoperative), complication risks with surgery, durability of surgery, and likelihood of achieving individualized patient goals and satisfaction. Despite the challenges associated with the current state-of-the-art ASD treatment, surgery continues to be a primary option, as multiple reports have demonstrated the potential for surgery to significantly improve pain and disability. The future of ASD care will likely include techniques and technologies to markedly reduce complication rates, including greater use of navigation and robotics, and a shift toward individualized medicine that enables improved counseling, preoperative planning, procedure safety, and patient satisfaction.Advances in the care of ASD patients have been remarkable over the past few decades. The current state of the art enables almost routine surgical treatment for many types of ASD that have the potential to significantly improve pain and disability. However, significant challenges remain, including high complication rates, lack of demonstrated cost-effectiveness, and limited ability to meaningfully counsel patients preoperatively on an individual basis. The future of ASD surgery will require continued improvement of predictability, safety, and sustainability.

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“…Bei Osteoporose befürworten die Autoren inzwischen eine aggressive 6-monatige medikamentöse Therapie vor dem elektiven Eingriff. Neben der Gabe von Vitamin D und Calcium hat hier vor allem der Einsatz von Teriparatid, einem rekombinanten humanen Parathyroidhormon (rhPTH), gute Resultate gezeigt [16].…”

Section: Klassifikationunclassified

Adulte Skoliosen

2019

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ZusammenfassungDurch die global alternde Bevölkerung tritt die degenerative Lumbalskoliose (DLS) im Erwachsenenalter immer mehr in den Vordergrund und repräsentiert somit einen Großteil der spinalen Deformitäten. Durch die schleichende Progredienz der Erkrankung entsteht ein massiver Leidensdruck der Patienten. Die konservative Therapie der DLS zeigt ernüchternde Resultate, weshalb bei Versagen der nicht-chirurgischen Behandlungskonzepte häufig die operative Therapie indiziert wird. Neben relativ simplen Dekompressionen für milde Formen der DLS mit isolierten klaudikativen bzw. radikulären Beschwerden, können komplexe und komplikationsreiche Wirbelkörperosteotomien sowie kombinierte ventro-dorsale Eingriffe zur Anwendung kommen. Klassifikationssysteme und Einteilungen dienen zur Graduierung der Deformität und können bei der Wahl der adäquaten operativen Technik bzw. dem Ausmaß des operativen Eingriffs hilfreich sein. Neben der primären koronaren Korrektur sollte insbesondere eine sagittale Korrektur erfolgen, da das sagittale Profil einen engen Zusammenhang mit der Patientenzufriedenheit aufweist und zudem Einfluss auf die Progression der Deformität haben kann. Dieser Artikel soll einen Überblick zur degenerativen Lumbalskoliose als Hauptvertreter der adulten Skoliosen und ihren Behandlungsmöglichkeiten geben.

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Teriparatide improves volumetric bone mineral density and fine bone structure in the UIV+1 vertebra, and reduces bone failure type PJK after surgery for adult spinal deformity

Abstract: Prophylactic TP treatment improved the volumetric BMD and fine bone structure at UIV+1 and reduced the PJK-type 2 incidence.

Cited by 110 publications

References 39 publications

Sagittal alignment changes and postoperative complications after adult spinal deformity surgery in patients with Parkinson’s disease: A multi-institutional retrospective study

Sagittal alignment changes and postoperative complications after adult spinal deformity surgery in patients with Parkinson’s disease: A multi-institutional retrospective study

Treatment of adult thoracolumbar spinal deformity: past, present, and future

Adulte Skoliosen

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