Effect of bisphosphonates or teriparatide on mechanical complications after posterior instrumented fusion for osteoporotic vertebral fracture: a multi-center retrospective study

Abstract Background: While the indications of parathyroid hormone (PTH) in osteoporosis prevention and management have been established, its indications in the treatment of osteoporotic vertebral fractures remain unknown. This study aimed to compare the effects of intervention (percutaneous vertebroplasty followed by anti-resorptive agents) and conservative treatment (PTH administration) in patients with osteoporotic vertebral fractures, as well as to investigate the optimal duration of PTH administration. Methods: A retrospective study was conducted using data of patients treated for osteoporotic vertebral fractures between January 2015 and November 2019. Treatment was selected based on the patient’s age, comorbidities, and patient’s preference after explaining the expected advantages and disadvantages of each treatment. Group C was administered PTH injections once weekly, whereas Group I underwent vertebroplasty followed by the administration of anti-resorptive agents. Radiological and clinical parameters were analyzed between two groups.Results: This study enrolled 58 patients (77 vertebrae). Group C included 24 patients (38 vertebrae) with average age of 77.50 ± 7.19 years (range, 65–85 years), average bone mineral density (BMD) of −3.39 ± 0.86 (range, −2.5 to −5.8), average follow-up period of 27.47 ± 7.60 weeks (range, 12–49 weeks). Group I included 34 patients (39 vertebrae) with an average age of 76.20 ± 8.67 years (range, 65–92 years), average BMD of −3.35 ± 0.91 (range, −2.5 to −5.1), average follow-up period of 30.82 ± 10.95 weeks (range, 16–59 weeks). There was no significant difference between the two groups in initial demographic, clinical and radiographic parameters. Group I showed significantly better clinical and radiological outcome during the last follow-up. Regarding side effects in Group C, two cases of dizziness (8.3%), nausea and vomiting (8.3%) were reported. In Group I, cement leakage was found in 26 vertebrae (66.7%), and cement leakage complications were observed in four patients (11.8%). Conclusion: Conservative treatment using PTH injection demonstrated slower pain relief and lesser suppression of vertebral height loss than vertebroplasty. However, PTH injection demonstrated a lower risk of procedure-related complications. The patient’s age, preference, and general condition with respect to the procedure’s risk should be considered when determining treatment options for osteoporotic vertebral fracture in old age.

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Effect of Bisphosphonates or Teriparatide on Mechanical Complications after Posterior Instrumented Fusion for Osteoporotic Vertebral Fracture: A Multi-center Retrospective Study

10.21203/rs.3.rs-15464/v1 ◽

2020 ◽

Author(s):

Atsuyuki Kawabata ◽

Toshitaka Yoshii ◽

Takashi Hirai ◽

Shuta Ushio ◽

Takashi Kaito ◽

...

Keyword(s):

Retrospective Study ◽

Vertebral Fractures ◽

Complication Rate ◽

Visual Analogue Scale Pain ◽

Primary Osteoporosis ◽

Mechanical Complication ◽

Instrumented Fusion ◽

Osteoporotic Vertebral Fractures ◽

Posterior Instrumented Fusion ◽

Reoperation Rates

Abstract Background: The optimal treatment of osteoporosis after reconstruction surgery for osteoporotic vertebral fractures (OVF) remains unclear. In this multicentre retrospective study, we investigated the effects of typically used agents for osteoporosis, namely, bisphosphonates (BP) and teriparatide (TP), on surgical results in patients with osteoporotic vertebral fractures. Methods: Retrospectively registered data were collected from 27 universities and affiliated hospitals in Japan. We compared the effects of BP vs TP on postoperative mechanical complication rates, implant-related reoperation rates, and clinical outcomes in patients who underwent posterior instrumented fusion for OVF and had been followed up at least for 2 years. Data were analysed according to whether the osteoporosis was primary or glucocorticoid-induced. Results: A total of 165 patients who underwent posterior instrumented fusion for OVF were included. The overall mechanical complication rate was significantly lower in the TP group than in the BP group (BP vs TP: 73.0% vs. 55.7%, p = 0.018). The screw backout rate was significantly lower and the rates of new vertebral fractures and pseudoarthrosis tended to be lower in the TP group than in the BP group. However, there were no significant differences in lumbar functional scores and visual analogue scale pain scores or in implant-related reoperation rates between the two groups. The incidence of pseudoarthrosis was significantly higher in patients with glucocorticoid-induced osteoporosis (GIOP) than in those with primary osteoporosis; however, the pseudoarthrosis rate was reduced by using TP. The use of TP also tended to reduce the overall mechanical complication rate in both primary osteoporosis and GIOP. Conclusions: The overall mechanical complication rate was lower in patients who received TP than in those who received a BP postoperatively, regardless of type of osteoporosis. The incidence of pseudoarthrosis was significantly higher in patients with GIOP, but the use of TP reduced the rate of pseudoarthrosis in GIOP patients.

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Does an osteoporotic vertebral fracture treated by balloon kyphoplasty successfully achieve bone union during the follow-up? A retrospective study with a minimum 2-year follow-up

Journal of Orthopaedics ◽

10.1016/j.jor.2017.08.005 ◽

2017 ◽

Vol 14 (4) ◽

pp. 480-483

Author(s):

Kiyoshi Tarukado ◽

Osamu Tono ◽

Katsumi Harimaya ◽

Toshio Doi

Keyword(s):

Retrospective Study ◽

Vertebral Fracture ◽

Balloon Kyphoplasty ◽

Bone Union ◽

Osteoporotic Vertebral Fracture

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Effect of Bisphosphonates or Teriparatide on Mechanical Complications after Posterior Instrumented Fusion for Osteoporotic Vertebral Fracture: A Multi-center Retrospective Study

10.21203/rs.3.rs-15464/v2 ◽

2020 ◽

Author(s):

Atsuyuki Kawabata ◽

Toshitaka Yoshii ◽

Takashi Hirai ◽

Shuta Ushio ◽

Takashi Kaito ◽

...

Keyword(s):

Retrospective Study ◽

Vertebral Fractures ◽

Complication Rate ◽

Visual Analogue Scale Pain ◽

Primary Osteoporosis ◽

Mechanical Complication ◽

Instrumented Fusion ◽

Osteoporotic Vertebral Fractures ◽

Posterior Instrumented Fusion ◽

Reoperation Rates

Abstract Background: The optimal treatment of osteoporosis after reconstruction surgery for osteoporotic vertebral fractures (OVF) remains unclear. In this multicentre retrospective study, we investigated the effects of typically used agents for osteoporosis, namely, bisphosphonates (BP) and teriparatide (TP), on surgical results in patients with osteoporotic vertebral fractures.Methods: Retrospectively registered data were collected from 27 universities and affiliated hospitals in Japan. We compared the effects of BP vs TP on postoperative mechanical complication rates, implant-related reoperation rates, and clinical outcomes in patients who underwent posterior instrumented fusion for OVF and had been followed up at least for 2 years. Data were analysed according to whether the osteoporosis was primary or glucocorticoid-induced.Results: A total of 165 patients who underwent posterior instrumented fusion for OVF were included. The overall mechanical complication rate was significantly lower in the TP group than in the BP group (BP vs TP: 73.0% vs. 55.7%, p = 0.018). The screw backout rate was significantly lower and the rates of new vertebral fractures and pseudoarthrosis tended to be lower in the TP group than in the BP group. However, there were no significant differences in lumbar functional scores and visual analogue scale pain scores or in implant-related reoperation rates between the two groups. The incidence of pseudoarthrosis was significantly higher in patients with glucocorticoid-induced osteoporosis (GIOP) than in those with primary osteoporosis; however, the pseudoarthrosis rate was reduced by using TP. The use of TP also tended to reduce the overall mechanical complication rate in both primary osteoporosis and GIOP. Conclusions: The overall mechanical complication rate was lower in patients who received TP than in those who received a BP postoperatively, regardless of type of osteoporosis. The incidence of pseudoarthrosis was significantly higher in patients with GIOP, but the use of TP reduced the rate of pseudoarthrosis in GIOP patients.

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Synergistic effect of sarcopenia and poor balance on osteoporotic vertebral fracture in Chinese patients with rheumatoid arthritis

Clinical Rheumatology ◽

10.1007/s10067-021-05703-w ◽

2021 ◽

Author(s):

Yang-fan Chen ◽

He-xiang Zong ◽

Sheng-qian Xu ◽

Yi-ran Chu ◽

Jian-xiong Wang ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Vertebral Fracture ◽

Synergistic Effect ◽

Chinese Patients ◽

Osteoporotic Vertebral Fracture

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Cervical 1-2 Posterior Instrumented Fusion Utilizing Computer-Assisted Navigation With Harvest of Rib Strut Autograft: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab029 ◽

2021 ◽

Author(s):

Timothy J Yee ◽

Michael J Strong ◽

Matthew S Willsey ◽

Mark E Oppenlander

Keyword(s):

Surface Area ◽

Odontoid Process ◽

Odontoid Fracture ◽

Patient Specific ◽

Computer Assisted ◽

Type Ii ◽

Instrumented Fusion ◽

Assisted Navigation ◽

Patient Consent ◽

Posterior Instrumented Fusion

Abstract Nonunion of a type II odontoid fracture after the placement of an anterior odontoid screw can occur despite careful patient selection. Countervailing factors to successful fusion include the vascular watershed zone between the odontoid process and body of C2 as well as the relatively low surface area available for fusion. Patient-specific factors include osteoporosis, advanced age, and poor fracture fragment apposition. Cervical 1-2 posterior instrumented fusion is indicated for symptomatic nonunion. The technique leverages the larger posterolateral surface area for fusion and does not rely on bony growth in a watershed zone. Although loss of up to half of cervical rotation is expected after C1-2 arthrodesis, this may be better tolerated in the elderly, who may have lower physical demands than younger patients. In this video, we discuss the case of a 75-yr-old woman presenting with intractable mechanical cervicalgia 7 mo after sustaining a type II odontoid fracture and undergoing anterior odontoid screw placement at an outside institution. Cervical radiography and computed tomography exhibited haloing around the screw and nonunion across the fracture. We demonstrate C1-2 posterior instrumented fusion with Goel-Harms technique (C1 lateral mass and C2 pedicle screws), utilizing computer-assisted navigation, and modified Sonntag technique with rib strut autograft. Posterior C1-2-instrumented fusion with rib strut autograft is an essential technique in the spine surgeon's armamentarium for the management of C1-2 instability, which can be a sequela of type II dens fracture. Detailed video demonstration has not been published to date. Appropriate patient consent was obtained.

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