Impact of Baseline Denosumab and Teriparatide Treatments in Osteoporotic Patients with Lumbar Spondylolisthesis Undergoing Posterior Decompression and Fusion Surgery of Three or More Levels

Introduction: Osteoporosis is a frequently seen condition in spine practice that is often comorbid with other degenerative conditions of the spine. A diagnosis of osteoporosis has been shown to correlate with worse outcomes in patients undergoing lumbar fusion surgery, especially with respect to complications such as hardware failure and pseudoarthrosis. There is currently a lack of consensus on the impact of various osteoinductive agents on postoperative complications in osteoporotic lumbar fusion patients.

Methods: The PearlDiver Database was queried from 2010-2021 to identify patients with spondylolisthesis and osteoporosis who underwent three-or-more-level lumbar laminectomy and fusion. Patients receiving either denosumab or teriparatide within six months pre-surgery were matched 1:1 with untreated controls by age, gender, and Charlson Comorbidity Index (CCI). The primary outcome was a composite measure of surgical complications including, pseudoarthrosis, mechanical failure, or reoperation within two years of index surgery. Secondary outcomes included 30- and 90-day readmission rates and hospital length of stay. Univariate and multivariable sensitivity analyses compared outcomes between matched cohorts.

Results: The 1:1 matched cohort included 94 patients per group. After, multivariate analysis baseline denosumab treatment within six months pre-operatively was significantly associated with reduced surgery-related complications (OR=0.18, 95% CI: 0.06–0.51, p=0.002) and shorter hospital stays (0-3 days) (OR=3.61, 95% CI: 1.46–9.60, p=0.007), with fewer stays of 6+ days (OR=0.30, 95% CI: 0.10–0.84, p=0.026). Preoperative teriparatide treatment also significantly lowered the incidence of surgical complications within two years of index surgery (OR=0.026, 95% CI: 0.00–0.10, p< 0.001) and 90-day readmissions (OR=0.33, 95% CI: 0.12–0.88, p=0.030).

Conclusion : Our findings indicate that in patients with osteoporosis, baseline treatment with denosumab or teriparatide for 6 months before a primary three- or more-level lumbar laminectomy and fusion surgery is associated with a significant decrease in surgical-related complications including . Preoperative denosumab treatment is also associated with a shorter hospital length of stay, while teriparatide treatment shows an association with a decreased risk of 90-day hospital readmission.