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학제간연구 과학기술학 뇌인지과학 기술정책 기타 복합학

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논문 기본 정보

자료유형
학술저널
저자정보
Kim, Jae Wook (Department of Neurosurgery, Chung-Ang University Hospital) Park, Seung Won (Department of Neurosurgery, Chung-Ang University Hospital) Kim, Young Baeg (Department of Neurosurgery, Chung-Ang University Hospital) Ko, Myeong Jin (Department of Neurosurgery, Chung-Ang University Hospital)
저널정보
대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제61권 제4호
발행연도
2018.1
수록면
494 - 502 (9page)

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Objective : The loosening of pedicle screws (PS) is one of the frequent problems of spinal surgery in the patients with osteoporosis. Previous studies had revealed that intermittent injection of teriparatide could reduce PS loosening by improving bone mass and quality when their patients took parathyroid hormone for a considerable duration before surgery. However, although the teriparatide is usually used after spine surgery in most clinical situations, there was no report on the efficacy of teriparatide treatment started after spine surgery. The purpose of this retrospective study was to examine the efficacy of teriparatide treatment started immediately after lumbar spinal surgery to prevent pedicle screw loosening in patients with osteoporosis. Methods : We included 84 patients with osteoporosis and degenerative lumbar disease who underwent transforaminal interbody fusion and PS fixation and received parathyroid hormone or bisphosphonate (BP) postoperatively. They were divided into teriparatide group (daily injection of $20{\mu}g$ of teriparatide for 6 months, 33 patients, 172 screws) and BP group (weekly oral administration of 35 mg of risedronate, 51 patients, 262 screws). Both groups received calcium (500 mg/day) and cholecalciferol (1000 IU/day) together. The screw loosening was evaluated with simple radiographic exams at 6 and 12 months after the surgery. We counted the number of patients with PS loosening and the number of loosened PS, and compared them between the two groups. Clinical outcomes were evaluated using visual analog scale (VAS) and Oswestry disability index (ODI) preoperatively, and at 12 months after surgery. Results : There was no significant difference in the age, sex, diabetes, smoking, bone mineral density, body mass index, and the number of fusion levels between the two groups. The number of PS loosening within 6 months after surgery did not show a significant difference between the teriparatide group (6.9%, 12/172) and the BP group (6.8%, 18/272). However, during 6-12 months after surgery, it was significantly lower in the teriparatide group (2.3%, 4/172) than the BP group (9.2%, 24/272) (p<0.05). There was no significant difference in the number of patients showing PS loosening between the teriparatide and BP groups. The teriparatide group showed a significantly higher degree of improvement of the bone mineral density (T-score) than that of BP group (p<0.05). There was no significant difference in the pre- and post-operative VAS and ODI between the groups. Conclusion : Our data suggest that the teriparatide treatment starting immediately after lumbar spinal fusion surgery could reduce PS loosening compared to BP.
#Parathyroid hormone #Teriparatide #Spinal fusion

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참고문헌 (45)

참고문헌 신청
Abe Y / 2007 / Enhancement of graft bone healing by intermittent administration of human parathyroid hormone (1-34) in a rat spinal arthrodesis model / Bone 41:775~785 Crossref Arlot M / 2005 / Differential effects of teriparatide and alendronate on bone remodeling in postmenopausal women assessed by histomorphometric parameters / J Bone Miner Res 20:1244~1253 Crossref Bothmann M / 2008 / Dynesys fixation for lumbar spine degeneration / Neurosurg Rev 31:189~196 Crossref Bransford R / 2007 / Effect of zoledronic acid in an L6-L7 rabbit spine fusion model / Eur Spine J 16:557~562 Crossref Chin DK / 2007 / Prevalence of osteoporosis in patients requiring spine surgery: incidence and significance of osteoporosis in spine disease / Osteoporos Int 18:1219~1224 Crossref

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