P73. Impact of Baseline Denosumab and Teriparatide Treatments in Osteoporotic Patients with Lumbar Spondylolisthesis Undergoing Posterior Decompression and Fusion Surgery of Three or More Levels: A Propensity Score-Matched Analysis

• Published in: The spine journal 2024-09, Vol.24 (9), p.S98-S98
• Main Authors: Van Halm-Lutterodt, Nicholas, Ansari, Kashif, Storlie, Nicholas R, Jiang, Miki, Mesregah, Mohamed Kamal Mostafa, Tao, Xu, Mensah, Mercy Bartels, Agyeman, Nana, Adogwa, Owoicho, Childress, Kelly
• Format: Article
• Language: English
• ISSN: 1529-9430
• DOI: 10.1016/j.spinee.2024.06.094

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. To evaluate the effect of baseline denosumab and teriparatide treatment on fusion-related complications in patients with lumbar spondylolisthesis undergoing three- or more-level lumbar laminectomy and fusion. Retrospective database analysis. A total of 282 spondylolisthesis patients with osteoporotic phenotype were trichotomized and score-matched, with n= (94) in each compared cohort. Composite measure of surgical-related complication (pseudoarthrosis or mechanical/implant failure or return to the operating room) outcome. The PearlDiver Database was queried from January 2010 to December 2021 for spondylolisthesis patients with an underlying osteoporosis diagnosis who underwent three-or-more-level lumbar spine surgery (laminectomy and fusion). Patients with either of the osteoinductive drug treatments six months before surgery were pooled and dichotomized into the denosumab group and teriparatide group, and propensity-matched with patients that did not receive any of the osteoinductive treatments (control group) in a ratio of 1:1 while employing age, gender, and Charlson comorbidity index (CCI) as matching covariates. A sensitivity analysis [univariate and multivariable analyses] was performed by head-to-head comparison of the primary outcome [a composite function (CF) of 1 was ascribed and defined as any patient with either one or more of the following surgical complications: pseudoarthrosis or mechanical failure or return to the operating room] between the matched cohorts at 2-year following the index surgery. Secondary outcomes include a comparison of 30-day, and 90-day hospital readmission, and hospital length of stay between the matched cohorts. The 1:1 matched cohort included 94 patients in each treatment group and the control group, respectively. Following multivariate analysis, treatment with denosumab treatment for 6 months before the index procedure was significantly associated with a decrease in surgery-related composite complications [OR= 0.18, 95% CI: (0