Impact of Baseline Denosumab and Teriparatide Treatments in Osteoporotic Lumbar Spondylolisthesis Patients Undergoing One- to Two-Level Posterior Decompression and Fusion Surgery
Janesh Karnati, B.A.: No financial relationships to disclose
Introduction: Osteoporosis occurs with advancing age and is often concomitant with spine degenerative pathologies. In clinical imaging studies, findings are routinely consistent with patient clinical presentations and symptoms. When osteoporotic patients undergo lumbar fusion surgery, they most often do not do well complication-wise, especially when surgical planning fails to accommodate pretreatment measures in these patients. Clinical studies to establish this evidence in lumbar spine patients are yet to be established in the spine literature.
Methods: The PearlDiver Database was queried from 2010-2021 for spondylolisthesis patients with osteoporosis who underwent one- to two-level lumbar laminectomy and fusion. Patients receiving denosumab or teriparatide within six months before surgery were grouped and propensity-matched 1:1 with untreated controls based on age, gender, and Charlson Comorbidity Index (CCI). Sensitivity analyses (univariate and multivariable) were performed to compare the primary outcome—surgical complications (pseudoarthrosis, mechanical failure, or reoperation) within two years of index surgery. Secondary outcomes included 30- and 90-day readmissions and hospital length of stay.
Results: The matched cohort included 137 patients per group. Six-month preoperative denosumab treatment was significantly associated with reduced surgery-related complications (OR=0.20, 95% CI: 0.09–0.42, p< 0.001) at two years. A baseline teriparatide treatment was associated with lower surgery-related complication rates (OR=0.09, 95% CI: 0.04–0.19, p< 0.001). Similarly, a 6-month baseline teriparatide treatment before the index surgery was significantly associated with a reduced risk of 30-day, [OR= 0.28, 95% CI: (0.11 to 0.65), (p=0.004)], and 90-day [OR= 0.17, 95% CI: (0.07 to 0.37), (p < 0.001)], hospital readmission postoperatively. No significant differences were observed in hospital length of stay between the matched cohorts (p>0.05).
Conclusion : Our findings indicate that in patients with osteoporosis, baseline treatment with denosumab or teriparatide for 6 months before a primary one- to two-level lumbar laminectomy and fusion surgery is associated with a significant decrease in surgical-related complications while teriparatide treatment shows an association with a decreased risk of 30-day and 90-day hospital readmission.