Advertisement

European Spine Journal

, Volume 26, Issue 3, pp 691–697 | Cite as

An effect comparison of teriparatide and bisphosphonate on posterior lumbar interbody fusion in patients with osteoporosis: a prospective cohort study and preliminary data

  • Pyung Goo Cho
  • Gyu Yeul Ji
  • Dong Ah Shin
  • Yoon Ha
  • Do Heum Yoon
  • Keung Nyun Kim
Original Article

Abstract

Purpose

Our purpose was to evaluate the efficacy of teriparatide for posterior lumbar interbody fusion (PLIF) in osteoporotic women.

Methods

Forty-seven osteoporotic patients underwent PLIF with pedicle screw fixation for degenerative lumbar stenosis and instability. Patients were divided into two groups. The teriparatide group (n = 23) was injected subcutaneously with teriparatide (20 μg daily) for 3-month cycles alternating with 3-month periods of oral sodium alendronate for 12 months. The bisphosphonate group (n = 24) was administered oral sodium alendronate (91.37 mg/week) for ≥1 year. Serial plain radiography, computed tomography, and bone mineral densitometry (BMD) evaluations were performed. Fusion rate, bony fusion duration, and T score changes were evaluated. Clinical data [pain scores, Prolo’s functional scale, and Oswestry disability index (ODI)] were also serially evaluated.

Results

The teriparatide group showed earlier fusion than the bisphosphonate group. The average period of bone fusion was 6.0 ± 4.8 months in the teriparatide group but 10.4 ± 7.2 months in the bisphosphonate group. The bone fusion rate in the teriparatide group was higher than that in the bisphosphonate group at 6 months; however, there was no difference 12 and 24 months after surgery. Pain scores and ODI were not significantly different between groups. BMD scores in the teriparatide group were significantly improved compared with the bisphosphonate group 2 years after surgery.

Conclusions

There was no significant improvement in overall fusion rate and clinical outcome in our patients after injection of teriparatide, but the teriparatide group showed faster bony union and highly improved BMD scores.

Keywords

Spinal fusion Osteoporosis Teriparatide Bisphosphonate 

Notes

Compliance with ethical standards

Conflict of interest

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

References

  1. 1.
    Stonecipher T, Wright S (1989) Posterior lumbar interbody fusion with facet-screw fixation. Spine 14:468–471CrossRefPubMedGoogle Scholar
  2. 2.
    Baeksgaard L, Andersen KP, Hyldstrup L (1998) Calcium and vitamin D supplementation increases spinal BMD in healthy, postmenopausal women. Osteoporos Int 8:255–260. doi: 10.1007/s001980050062 CrossRefPubMedGoogle Scholar
  3. 3.
    Sakeb N, Ahsan K (2013) Comparison of the early results of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in symptomatic lumbar instability. Indian journal of orthopaedics 47:255–263. doi: 10.4103/0019-5413.111484 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Mummaneni PV, Pan J, Haid RW, Rodts GE (2004) Contribution of recombinant human bone morphogenetic protein-2 to the rapid creation of interbody fusion when used in transforaminal lumbar interbody fusion: a preliminary report. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 1:19–23. doi: 10.3171/spi.2004.1.1.0019 CrossRefPubMedGoogle Scholar
  5. 5.
    Ajiboye RM, Hamamoto JT, Eckardt MA, Wang JC (2015) Clinical and radiographic outcomes of concentrated bone marrow aspirate with allograft and demineralized bone matrix for posterolateral and interbody lumbar fusion in elderly patients. Eur Spine J 24:2567–2572. doi: 10.1007/s00586-015-4117-5 CrossRefPubMedGoogle Scholar
  6. 6.
    Andersen T, Christensen FB, Langdahl BL, Ernst C, Fruensgaard S, Ostergaard J, Andersen JL, Rasmussen S, Niedermann B, Hoy K, Helmig P, Holm R, Lindblad BE, Hansen ES, Egund N, Bunger C (2010) Fusion mass bone quality after uninstrumented spinal fusion in older patients. Eur Spine J 19:2200–2208. doi: 10.1007/s00586-010-1373-2 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Ohtori S, Inoue G, Orita S, Yamauchi K, Eguchi Y, Ochiai N, Kishida S, Kuniyoshi K, Aoki Y, Nakamura J, Ishikawa T, Miyagi M, Kamoda H, Suzuki M, Kubota G, Sakuma Y, Oikawa Y, Inage K, Sainoh T, Takaso M, Ozawa T, Takahashi K, Toyone T (2012) Teriparatide accelerates lumbar posterolateral fusion in women with postmenopausal osteoporosis: prospective study. Spine 37:E1464–E1468. doi: 10.1097/BRS.0b013e31826ca2a8 CrossRefPubMedGoogle Scholar
  8. 8.
    Ito Z, Matsuyama Y, Sakai Y, Imagama S, Wakao N, Ando K, Hirano K, Tauchi R, Muramoto A, Matsui H, Matsumoto T, Kanemura T, Yoshida G, Ishikawa Y, Ishiguro N (2010) Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion. Spine 35:E1101–E1105. doi: 10.1097/BRS.0b013e3181de4f2e CrossRefPubMedGoogle Scholar
  9. 9.
    Voor MJ, Mehta S, Wang M, Zhang YM, Mahan J, Johnson JR (1998) Biomechanical evaluation of posterior and anterior lumbar interbody fusion techniques. J Spinal Disord 11:328–334CrossRefPubMedGoogle Scholar
  10. 10.
    Okuyama K, Abe E, Suzuki T, Tamura Y, Chiba M, Sato K (2001) Influence of bone mineral density on pedicle screw fixation: a study of pedicle screw fixation augmenting posterior lumbar interbody fusion in elderly patients. Spine J 1:402–407CrossRefPubMedGoogle Scholar
  11. 11.
    Hasegawa K, Abe M, Washio T, Hara T (2001) An experimental study on the interface strength between titanium mesh cage and vertebra in reference to vertebral bone mineral density. Spine 26:957–963CrossRefPubMedGoogle Scholar
  12. 12.
    Halvorson TL, Kelley LA, Thomas KA, Whitecloud TS 3rd, Cook SD (1994) Effects of bone mineral density on pedicle screw fixation. Spine 19:2415–2420CrossRefPubMedGoogle Scholar
  13. 13.
    Datta NS (2011) Osteoporotic fracture and parathyroid hormone. World J Orthop 2:67–74. doi: 10.5312/wjo.v2.i8.67 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Al Barbarawi MM, Audat ZM, Allouh MZ (2015) Analytical comparison study of the clinical and radiological outcome of spine fixation using posterolateral, posterior lumber interbody and transforaminal lumber interbody spinal fixation techniques to treat lumber spine degenerative disc disease. Scoliosis 10:17. doi: 10.1186/s13013-015-0040-0 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Agazzi S, Reverdin A, May D (1999) Posterior lumbar interbody fusion with cages: an independent review of 71 cases. J Neurosurg 91:186–192PubMedGoogle Scholar
  16. 16.
    Ma Y, Guo L, Cai X (2001) Posterior interbody fusion or posterolateral fusion for discogenic low back pain. Zhonghua yi xue za zhi 81:1253–1255PubMedGoogle Scholar
  17. 17.
    Cavagna R, Tournier C, Aunoble S, Bouler JM, Antonietti P, Ronai M, Le Huec JC (2008) Lumbar decompression and fusion in elderly osteoporotic patients: a prospective study using less rigid titanium rod fixation. J Spinal Disord Tech 21:86–91. doi: 10.1097/BSD.0b013e3180590c23 CrossRefPubMedGoogle Scholar
  18. 18.
    Lehman RA Jr, Dmitriev AE, Cardoso MJ, Helgeson MD, Christensen CL, Raymond JW, Eckel TT, Riew KD (2010) Effect of teriparatide [rhPTH(1,34)] and calcitonin on intertransverse process fusion in a rabbit model. Spine 35:146–152. doi: 10.1097/BRS.0b013e3181b71a96 CrossRefPubMedGoogle Scholar
  19. 19.
    Ming N, Cheng JT, Rui YF, Chan KM, Kuhstoss S, Ma YL, Sato M, Wang Y, Li G (2012) Dose-dependent enhancement of spinal fusion in rats with teriparatide (PTH[1-34]). Spine 37:1275–1282. doi: 10.1097/BRS.0b013e31824ac089 CrossRefPubMedGoogle Scholar
  20. 20.
    Ohtori S, Inoue G, Orita S, Yamauchi K, Eguchi Y, Ochiai N, Kishida S, Kuniyoshi K, Aoki Y, Nakamura J, Ishikawa T, Miyagi M, Kamoda H, Suzuki M, Kubota G, Sakuma Y, Oikawa Y, Inage K, Sainoh T, Takaso M, Toyone T, Takahashi K (2013) 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. Spine 38:E487–E492. doi: 10.1097/BRS.0b013e31828826dd CrossRefPubMedGoogle Scholar
  21. 21.
    Nagahama K, Kanayama M, Togawa D, Hashimoto T, Minami A (2011) Does alendronate disturb the healing process of posterior lumbar interbody fusion? A prospective randomized trial. J Neurosurg Spine 14:500–507. doi: 10.3171/2010.11.spine10245 CrossRefPubMedGoogle Scholar
  22. 22.
    Koski AM, Loyttyniemi E, Vaananen H, Laine H, Niskanen L, Nevalainen PI, Korpi-Hyovalti E, Valimaki MJ (2013) The effectiveness of teriparatide in the clinical practice–attenuation of the bone mineral density outcome by increasing age and bisphosphonate pretreatment. Ann Med 45:230–235. doi: 10.3109/07853890.2012.742560 CrossRefPubMedGoogle Scholar
  23. 23.
    Liu X, Wang Y, Qiu G, Weng X, Yu B (2014) A systematic review with meta-analysis of posterior interbody fusion versus posterolateral fusion in lumbar spondylolisthesis. Eur Spine J 23:43–56. doi: 10.1007/s00586-013-2880-8 CrossRefPubMedGoogle Scholar
  24. 24.
    Miwa T, Sakaura H, Yamashita T, Suzuki S, Ohwada T (2013) Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion. Eur Spine J 22:2864–2868. doi: 10.1007/s00586-013-2863-9 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Molinari RW, Gerlinger T (2001) Functional outcomes of instrumented posterior lumbar interbody fusion in active-duty US servicemen: a comparison with nonoperative management. Spine J 1:215–224CrossRefPubMedGoogle Scholar
  26. 26.
    Langdahl BL, Rajzbaum G, Jakob F, Karras D, Ljunggren O, Lems WF, Fahrleitner-Pammer A, Walsh JB, Barker C, Kutahov A, Marin F (2009) Reduction in fracture rate and back pain and increased quality of life in postmenopausal women treated with teriparatide: 18-month data from the European Forsteo Observational Study (EFOS). Calcif Tissue Int 85:484–493. doi: 10.1007/s00223-009-9299-6 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Cosman F, Nieves J, Zion M, Woelfert L, Luckey M, Lindsay R (2005) Daily and cyclic parathyroid hormone in women receiving alendronate. N Engl J Med 353:566–575. doi: 10.1056/NEJMoa050157 CrossRefPubMedGoogle Scholar
  28. 28.
    Sudo H, Oda I, Abumi K, Ito M, Kotani Y, Hojo Y, Minami A (2003) In vitro biomechanical effects of reconstruction on adjacent motion segment: comparison of aligned/kyphotic posterolateral fusion with aligned posterior lumbar interbody fusion/posterolateral fusion. J Neurosurg 99:221–228PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Pyung Goo Cho
    • 1
  • Gyu Yeul Ji
    • 2
  • Dong Ah Shin
    • 2
  • Yoon Ha
    • 2
  • Do Heum Yoon
    • 2
  • Keung Nyun Kim
    • 2
  1. 1.Department of NeurosurgeryBundang Jesaeng HospitalSeongnam-siRepublic of Korea
  2. 2.Department of NeurosurgeryYonsei University College of MedicineSeoulRepublic of Korea

Personalised recommendations