Efficacy of Teriparatide on Prior Use to Lumbar Fusion Surgery in Patients with Poor Bone Health

Table of Content

Introduction

Disorders of the vertebral column are highly prevalent in the elderly and frequently present with symptoms due to spinal disorders. Poor bone health can create challenges in management which are amplified for patients undergoing spinal fusion. Teriparatide is a parathyroid hormone (PTH) analog and has shown to improved outcomes postoperatively, however, the impact of preoperative teriparatide use on long-term complications remains unclear

Aim

To compare the two-year complication rates for patients who have poor bone health, with or without teriparatide pretreatment before lumbar fusion procedures.

Patient Profile

 Patients with poor bone health undergoing any lumbar fusion surgery

Methods

  •  Patients with poor bone health undergoing any lumbar fusion surgery
    • Teriparatide = 42 patients
    • Non-teriparatide =114 patients
  • Baseline demographics, patient and surgery related factors, and two-year complications were collected through a retrospective chart review
  • To evaluate the association between teriparatide usage and development of any related postoperative complication, multivariable logistic regression was performed

Study Outcomes

Primary outcomes included

  • 30-day readmissions,
  • related re-operations
  • adjacent segment disease (ASD)
  • proximal junctional kyphosis (PJK)
  • proximal junctional failure (PJF)
  • screw loosening
  • pseudoarthrosis
  • vertebral compression fracture (VCF) at any point within 2 years following the procedure

Secondary outcomes included

  • 30-day related readmissions and 2-year related reoperations.
  • Patients documented as having a related postoperative complication were defined as being diagnosed with PJK, PJF, screw loosening, post-operative VCF or pseudoarthrosis related to the lumbar fusion within 2 years

Results

  • The median age (IQR) for the teriparatide group was 62 years while the non-teriparatide group had a median (IQR) age of 70 years
  • No statistically significant differences in the rates of individual complications between two groups were observed
  • Teriparatide use was significantly associated with decreased odds of related 2-year osteoporosis-related complications (p = 0.049)
  • Rates of PJK and PJF were higher in teriparatide group
  • No patients on teriparatide were documented with related 30-day readmission, eight patients in the non-teriparatide group were readmitted, five of which were for procedure related pain as the most common cause
Figure 1: Comparison of peri- and 2-year postoperative outcomes

ASD: Adjacent segment disease, PJK: Proximal Junctional Kyphosis, VCF: Vertebral Compression Fracture, PJF: Proximal Junctional Failure, IQR: Interquartile Range.

Conclusion

  • In this study use of teriparatide prior to lumbar fusion procedures demonstrated reduced rate of individual complications as well as an association with decreased related 2-year complications
  •  Findings indicated that improved outcomes might be seen in patients with osteopenia and osteoporosis when pre-treating with teriparatide

Reference

Clinical Neurology and Neurosurgery. 2020; 198: 106244