Effect of romosozumab administration on proximal junctional kyphosis in corrective spinal fusion surgery

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY Spine Journal Pub Date : 2024-12-18 DOI:10.1016/j.spinee.2024.12.021

Yuta Sawada MD , Shinji Takahashi MD , Hiroyuki Yasuda MD , Masaki Terakawa MD , Sadahiko Konishi MD , Minori Kato MD , Hiromitsu Toyoda MD , Akinobu Suzuki MD , Koji Tamai MD , Masayoshi Iwamae MD , Yuki Okamura MD , Yuto Kobayashi MD , Hiroaki Nakamura MD , Hidetomi Terai MD

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Abstract

BACKGROUND CONTEXT

The effect of romosozumab administration in patients undergoing corrective spinal fusion surgery has not yet been analyzed.

PURPOSE

To examine the effect of romosozumab administration on reducing the incidence of proximal junctional kyphosis (PJK), particularly PJK due to fractures (PJK-Fx), in patients undergoing spinal corrective fusion surgery.

DESIGN

Retrospective cohort study.

PATIENT SAMPLE

A total of 111 patients aged >50 years underwent corrective fusion surgery (>2 vertebrae) for adult spinal deformity or vertebral compression fracture between June 2010 and July 2023.

OUTCOME MEASURES

The primary outcome was the incidence of PJK, whereas the secondary outcomes were changes in Hounsfield unit (HU) values, surgical complications, and clinical outcomes measured using the Japanese Orthopaedic Association (JOA) and visual analog scale scores.

METHODS

The patients were divided into the romosozumab (n=32) and nonromosozumab groups (n=79). Romosozumab was typically administered 2 months before surgery in the romosozumab group. Demographic data, surgery-related factors, and radiographic parameters were analyzed. HU values at the upper instrumented vertebra+1 (UIV+1) were measured preoperatively and at 1 year postoperatively. After the univariate analysis of preoperative factors associated with PJK, multivariate logistic regression was used to identify factors associated with PJK.

RESULTS

Romosozumab significantly increased the HU values at UIV+1 (-1.22% vs 13.60%, p<.001) and reduced the incidence of PJK (39.24% vs 18.75%, p=.046), particularly PJK-Fx (26.58% vs 6.25%, p=.019) and osteoporosis-related complications (55.70% vs 34.38%, p=.011). The multivariate analysis showed a significantly lower incidence of PJK (adjusted odds ratio = 0.32, p=.033), particularly PJK-Fx (adjusted odds ratio = 0.15, p=.018). There was a tendency for better JOA scores at 1 year postoperatively in the romosozumab group (21.49 vs 23.62, p=.071).

CONCLUSION

Romosozumab administration effectively increased bone density and reduced the risk of PJK, particularly PJK-Fx, and osteoporosis-related complications in patients undergoing corrective spinal fusion surgery. Administration of romosozumab 2 months before surgery enhanced bone mineral density and strength, leading to better surgical outcomes and fewer complications. Further long-term studies are needed to confirm these findings and optimize treatment protocols.

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罗莫索单抗治疗矫正脊柱融合术中近端关节后凸的疗效。

背景背景：romosozumab给药对脊柱矫正融合手术患者的影响尚未分析。目的：研究romosozumab在脊柱矫正融合手术患者中降低近端交界性后凸（PJK）发生率的作用，特别是骨折引起的PJK （PJK- fx）。设计：回顾性队列研究患者样本：在2010年6月至2023年7月期间，共有111例年龄> - 50岁的患者因成人脊柱畸形或椎体压缩性骨折接受了矫正融合手术（> - 2椎体）。结果测量：主要结果是PJK的发生率，而次要结果是Hounsfield单位（HU）值的变化、手术并发症和使用日本骨科协会（JOA）和视觉模拟量表评分测量的临床结果。方法：将患者分为单抗组（n=32）和非单抗组（n=79）。Romosozumab组通常在手术前2个月给药。分析了人口统计学资料、手术相关因素和影像学参数。术前和术后1年分别测量上固定椎体+1 （UIV+1）处的HU值。在对术前与PJK相关的因素进行单因素分析后，采用多因素logistic回归来确定与PJK相关的因素。结果：Romosozumab显著提高了uv +1时的HU值（-1.22% vs. 13.60%）。结论：Romosozumab可有效增加骨密度，降低PJK，特别是PJK- fx的风险，以及脊柱矫正融合手术患者骨质疏松相关并发症。术前2个月给予romosozumab可增强骨密度和强度，导致更好的手术结果和更少的并发症。需要进一步的长期研究来证实这些发现并优化治疗方案。

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来源期刊

Spine Journal 医学-临床神经学

CiteScore

8.20

自引率

6.70%

发文量

680

审稿时长

13.1 weeks

期刊介绍： The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.