A Random Study of Comparing the Efficacy of Antiosteoporosis Therapy at Different Time Points Combined With Oblique Lateral Interbody Fusion in the Treatment of Lumbar Degenerative Disease Patients Complicated With Osteoporosis.

Abstract

Study design: Randomized controlled trials.

Objectives: We conducted this study to compare the clinical efficacy of antiosteoporosis at different starting time points combined with oblique lateral interbody fusion in the treatment of lumbar degenerative disease complicated with patients with osteoporosis.

Background: Seki and colleagues found that perioperative administration of teriparatide was more effective than that of bisphosphonates in preventing complications in osteoporotic females undergoing surgery. Inoue and colleagues found that the injection of teriparatide beginning at least 1 month before surgery was effective in increasing the insertional torque of pedicle screws during surgery in patients with osteoporosis. Ohtori and colleagues concluded that teriparatide improved the quality of the lumbar spine and reduced the incidence of screw loosening.

Materials and methods: Fifty-nine patients were randomly divided into 2 groups: (1) the advanced group (AG; 30 cases) was treated advanced with antiosteoporosis for 3-6 months, followed by surgical treatment, and (2) the simultaneous group (SG; 29 cases) received antiosteoporosis and surgical treatment simultaneously. The primary outcome was cage subsidence rate. Secondary outcomes included screw loosening rate, intervertebral height, Visual Analog Scale, segmental lordosis angle, lumbar lordosis angle, and bone mineral density.

Results: There was no significant difference in the cage subsidence rate ( P = 0.76) and screw loosening rate ( P = 0.98) between the AG and the SG. The immediate postoperative disk height was significantly different from that before surgery, both in the AG and the SG ( P < 0.00001). When compared within the same group at different times, both AG ( P < 0.00001) and SG ( P < 0.00001) had significantly lower Visual Analog Scale scores after surgery than before. Both of the segmental and lumbar lordosis angles after surgery were significantly higher than that of before. At the final follow-up, bone mineral density was significantly higher than that of presurgery in both groups.

Conclusions: Both starting time points of teriparatide treatment were effective in preventing cage subsidence and screw loosening after oblique lateral interbody fusion, without affecting clinical improvement.