Impact of Baseline Denosumab and Teriparatide Treatments in Osteoporotic Cervical Degenerative Disc Disease Patients Undergoing Cervical Decompression and Fusion Surgery
Janesh Karnati, B.A.: No financial relationships to disclose
Introduction: Osteoporosis is a common clinical finding in patients needing cervical laminectomy and fusion. Decreased bone mineral density and unbalanced bone remodeling present a challenge for the immediate stability of spinal constructs as well as long-term fusion. The optimal preoperative management of osteoporotic patients undergoing cervical fusion has yet to be established in the spine literature, and further research is needed on the role of osteoinductive drugs for these patients.
Methods: The PearlDiver Database was queried from 2010-2019 to identify patients with degenerative disc disease and osteoporosis who underwent cervical laminectomy and fusion. Patients treated with denosumab or teriparatide within six months pre-surgery were matched 1:1 with untreated controls based on age, gender, and Charlson Comorbidity Index. The primary outcome was 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 96 patients in each treatment group and the control group, respectively. In a multivariate analysis, baseline teriparatide treatment 6 months prior to the index surgery was associated with significantly lower rates in 90-day hospital readmission [OR= 0.30, 95% CI: (0.11 to 0.78), (p=0.015)] following the index surgery. Similarly, a baseline denosumab treatment within 6 months before the index CSDF surgery was associated with a significant decrease in 30-day hospital readmission [OR= 0.25, 95% CI: (0.08 to 0.69), (p=0.010)] and 90-day hospital readmission [OR= 0.33, 95% CI: (0.13 to 0.81), (p=0.018)] two years following index surgery. No significant differences were observed in surgery-related complications or hospital length of stay between either of the matched cohorts and the control cohort (p>0.05).
Conclusion : Our findings indicate that in patients with osteoporosis with underlying degenerative disc disease, baseline treatment with denosumab or teriparatide for at least 6 months before a primary cervical laminectomy and fusion surgery is associated with a significant decrease in hospital readmission at 90 days.