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Fogel H, Yeritsyan D, Momenzadeh K, Kheir N, Yeung CM, Abbasian M, Lozano EM, Nazarian RM, Nazarian A. The effect of cannabinoids on single-level lumbar arthrodesis outcomes in a rat model. Spine J 2024; 24:1759-1772. [PMID: 38704096 DOI: 10.1016/j.spinee.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND CONTEXT The opioid epidemic is a public health crisis affecting spine care and pain management. Medical marijuana is a potential nonopioid analgesic yet to be studied in the surgical setting since its effects on bone healing are not fully understood. Studies have demonstrated analgesic and potentially osteoinductive properties of cannabinoids with endocannabinoid receptor expression in bone tissue. PURPOSE We hypothesize that tetrahydrocannabinol (THC) and cannabidiol (CBD) will not decrease bone healing in spinal fusion. STUDY DESIGN Seventy-eight adult Sprague-Dawley rats were used for this study. Utilizing allogenic bone grafts (6 donor rats), posterolateral inter-transverse lumbar fusion at the L4-L5 level was performed. The animals were equally divided into four treatment groups, each receiving 0.1 ml intraperitoneal injections weekly as follows: placebo (saline), 5 mg/kg THC, 5 mg/kg CBD, and a combination of 5 mg/kg THC and 5mg/kg CBD (Combo). METHODS Callus tissue was harvested 2- and 8-weeks postsurgery for qPCR assessment to quantify changes in the expression of osteogenic genes. Manual palpation was done to assess the strength of the L4-L5 arthrodesis on all rats. μCT image-based callus analysis and histology were performed. One-way ANOVA followed by post hoc comparisons was performed. RESULTS μCT demonstrated no significant differences. Treatment groups had slightly increased bone volume and density compared to control. qPCR at 2 weeks indicated downregulated RANKL/OPG ratios skewing towards osteogenesis in the CBD group, with the THC and CBD+THC groups demonstrating a downward trend (p>.05). ALPL, BMP4, and SOST were significantly higher in the CBD group, with CTNNB1 and RUNX2 also showing an upregulating trend. The CBD group showed elevation in Col1A1 and MMP13. Data at eight weeks showed ALPL, RUNX2, BMP4, and SOST were downregulated for all treatment groups. In the CBD+THC group, RANK, RANKL, and OPG were downregulated. OPG downregulation reached significance for the THC and CBD+THC group compared to saline. Interestingly, the RANKL/OPG ratio showed upregulation in the CBD and CBD+THC groups. RANKL showed upregulation in the CBD group. At 2 and 8 weeks, the CBD treatment group showed superior histological progression, increasing between time points. CONCLUSION This study demonstrates that CBD and THC have no adverse effect on bone healing and the rate of spinal fusion in rats. Osteogenic factors were upregulated in the CBD-treated groups at 2 weeks, which indicates a potential for bone regeneration. In this group, compared to control, the RANKL/OPG ratio at the early healing phase demonstrates the inhibition of osteoclast differentiation, enhancing bone formation. Interestingly, it shows promoted osteoclast differentiation at the later healing phase, enhancing bone remodeling. This aligns with the physiological expectation of a lower ratio in the early phases and a higher ratio in the later remodeling phases. CLINICAL SIGNIFICANCE CBD and THC showed no inhibitory effects on bone healing in a spinal fusion model. Moreover, histologic and gene expression analysis demonstrated that CBD may, in fact, enhance bone healing. Further research is needed to confirm the safe usage of THC and CBD in the postoperative setting following spinal fusions.
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Affiliation(s)
- Harold Fogel
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA 02215, USA
| | - Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA 02215, USA
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA 02215, USA
| | - Caleb M Yeung
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA 02215, USA
| | - Edith Martinez Lozano
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA 02215, USA
| | - Rosalynn M Nazarian
- The Pathology Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA 02215, USA; Department of Orthopedic Surgery, Yerevan State Medical University, 2 Koryun Street, Yerevan, 0025, Armenia.
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Makino A, Hasegawa T, Yamamoto T, Takagi H, Takahashi Y, Miyakoshi N, Amizuka N. Abaloparatide promotes bone repair of vertebral defects in ovariectomized rats by increasing bone formation. Bone 2024; 182:117056. [PMID: 38402920 DOI: 10.1016/j.bone.2024.117056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
Osteoporotic vertebral fracture (OVF) is the most common type of osteoporotic fracture and is associated with immobility and mortality. Bone anabolic agents, such as abaloparatide (ABL), are usually administered to patients with OVF to prevent subsequent fractures. Although several studies have shown that bone anabolic agents promote healing of long bone fractures, there is little evidence of their healing effect on vertebral bone fractures. In the present study, we investigated the effect of ABL on vertebral bone defects using ovariectomized (OVX) rats with vertebral body drill-hole defects, an animal model of OVF. Eight-week-old female Sprague-Dawley rats were subjected to OVX, followed by the 32-36 days of bone depletion period, once-daily subcutaneous ABL was administered to OVX rats at a dose of 30 μg/kg for a maximum of 6 weeks from the day of the vertebral defect surgery. We found that ABL significantly increased bone mineral content and improved trabecular structural parameters at the vertebral defect site. Moreover, ABL significantly increased bone strength of the defected vertebrae. Bone histochemical analysis revealed formation of thick trabecular bone networks at the defect site after ABL administration, consistent with an improvement in trabecular structural parameters by ABL. ABL increased ALPase- and PHOSPHO1-positive osteoblastic cells and ALPase/PCNA double-positive cells, indicating enhanced preosteoblast proliferation as well as bone formation at the defect site. On the other hand, ABL did not affect the number of cathepsin K-positive osteoclasts per bone surface, suggesting that ABL did not promote excessive bone resorption. Our findings suggest that ABL is useful not only for preventing secondary vertebral fractures but also for promoting bone healing in OVF.
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Affiliation(s)
- Akito Makino
- Pharmacology Research Department, Teijin Pharma Limited, Tokyo, Japan.
| | - Tomoka Hasegawa
- Developmental Biology of Hard Tissue, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Tomomaya Yamamoto
- Developmental Biology of Hard Tissue, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Hideko Takagi
- Pharmacology Research Department, Teijin Pharma Limited, Tokyo, Japan
| | | | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Norio Amizuka
- Developmental Biology of Hard Tissue, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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Sun Q, Liu F, Fang J, Lian Q, Hu Y, Nan X, Tian FM, Zhang G, Qi D, Zhang L, Zhang J, Luo Y, Zhang Z, Zhou Z. Strontium ranelate retards disc degradation and improves endplate and bone micro-architecture in ovariectomized rats with lumbar fusion induced - Adjacent segment disc degeneration. Bone Rep 2024; 20:101744. [PMID: 38404727 PMCID: PMC10884424 DOI: 10.1016/j.bonr.2024.101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024] Open
Abstract
Objectives Adjacent segment disc degeneration (ASDD) is one of the long-term sequelae of spinal fusion, which is more susceptible with osteoporosis. As an anti-osteoporosis drug, strontium ranelate (SR) has been reported to not only regulate bone metabolism but also cartilage matrix formation. However, it is not yet clear whether SR has a reversal or delaying effect on fusion-induced ASDD in a model of osteoporosis. Materials and methods Fifth three-month-old female Sprague-Dawley rats that underwent L4-L5 posterolateral lumbar fusion (PLF) with spinous-process wire fixation 4 weeks after bilateral ovariectomy (OVX) surgery. Animals were administered vehicle (V) or SR (900 mg/kg/d) orally for 12 weeks post-PLF as follows: Sham+V, OVX + V, PLF + V, OVX + PLF + V, and OVX + PLF + SR. Manual palpation and X-ray were used to evaluate the state of lumbar fusion. Adjacent-segment disc was assessed by histological (VG staining and Scoring), histomorphometry (Disc Height, MVD, Calcification rate and Vascular Bud rate), immunohistochemical (Col-II, Aggrecan, MMP-13, ADAMTS-4 and Caspase-3), and mRNA analysis (Col-I, Col-II, Aggrecan, MMP-13 and ADAMTS-4). Adjacent L6 vertebrae microstructures were evaluated by microcomputed tomography. Results Manual palpation and radiographs showed clear evidence of the fused segment's immobility. After 12 weeks of PLF surgery, a fusion-induced ASDD model was established. Low bone mass caused by ovariectomy can significantly exacerbate ASDD progression. SR exerted a protective effect on adjacent segment intervertebral disc with the underlying mechanism possibly being associated with preserving bone mass to prevent spinal instability, maintaining the functional integrity of endplate vascular microstructure, and regulating matrix metabolism in the nucleus pulposus and annulus fibrosus. Discussion Anti-osteoporosis medication SR treatments not only maintain bone mass and prevent fractures, but early intervention could also potentially delay degenerative conditions linked to osteoporosis. Taken together, our results suggested that SR might be a promising approach for the intervention of fusion-induced ASDD with osteoporosis.
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Affiliation(s)
- Qi Sun
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Fang Liu
- Medical Research Center, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Jiakang Fang
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, People's Republic of China
| | - Qiangqiang Lian
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, People's Republic of China
| | - Yunpeng Hu
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, People's Republic of China
| | - Xinyu Nan
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, People's Republic of China
| | - Fa-Ming Tian
- Medical Research Center, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Guochuan Zhang
- Department of Musculoskeletal Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Dianwen Qi
- Department of Musculoskeletal Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Liu Zhang
- Department of Orthopedic Surgery, Emergency General Hospital, Beijing, People's Republic of China
| | - Jingwen Zhang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yang Luo
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Zuzhuo Zhang
- Department of Radiology, the Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Zhuang Zhou
- Department of Musculoskeletal Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
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Gens L, Marchionatti E, Steiner A, Stoddart MJ, Thompson K, Mys K, Zeiter S, Constant C. Surgical technique and comparison of autologous cancellous bone grafts from various donor sites in rats. J Orthop Res 2023; 41:834-844. [PMID: 35953282 DOI: 10.1002/jor.25429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/29/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
Autologous cancellous bone graft is the gold standard in large bone defect repair. However, studies using autologous bone grafting in rats are rare. To determine the feasibility of autologous cancellous bone graft harvest from different anatomical donor sites (humerus, ilium, femur, tibia, and tail vertebrae) in rats and compare their suitability as donor sites, a total of 13 freshly euthanized rats were used to describe the surgical technique, determine the cancellous bone volume and microstructure, and compare the cancellous bone collected quantitatively and qualitatively. It was feasible to harvest cancellous bone grafts from all five anatomical sites with the humerus and tail being more surgically challenging. The microstructural analysis using micro-computed tomography showed a significantly lower bone volume fraction, bone mineral density, and trabecular thickness of the humerus and iliac crest compared to the femur, tibia, and tail vertebrae. The harvested weight and volume did not differ between the donor sites. All donor sites apart from the femur yielded primary osteogenic cells confirmed by the presence of alkaline phosphatase and Alizarin Red S stain. Bone samples from the iliac crest showed the most consistent outgrowth of osteoprogenitor cells. In conclusion, the tibia and iliac crest may be the most favorable donor sites considering the surgical approach. However, due to the differences in microstructure of the cancellous bone and the consistency of outgrowth of osteoprogenitor cells, the donor sites may have different healing properties, that need further investigation in an in vivo study.
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Affiliation(s)
- Lena Gens
- AO Research Institute Davos, Davos, Switzerland
| | - Emma Marchionatti
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Adrian Steiner
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | | | - Karen Mys
- AO Research Institute Davos, Davos, Switzerland
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Broussolle T, Roux JP, Chapurlat R, Barrey C. Murine models of posterolateral spinal fusion: A systematic review. Neurochirurgie 2023; 69:101428. [PMID: 36871885 DOI: 10.1016/j.neuchi.2023.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Rodent models are commonly used experimentally to assess treatment effectiveness in spinal fusion. Certain factors are associated with better fusion rates. The objectives of the present study were to report the protocols most frequently used, to evaluate factors known to positively influence fusion rate, and to identify new factors. METHOD A systematic literature search of PubMed and Web of Science found 139 experimental studies of posterolateral lumbar spinal fusion in rodent models. Data for level and location of fusion, animal strain, sex, weight and age, graft, decortication, fusion assessment and fusion and mortality rates were collected and analyzed. RESULTS The standard murine model for spinal fusion was male Sprague Dawley rats of 295g weight and 13 weeks' age, using decortication, with L4-L5 as fusion level. The last two criteria were associated with significantly better fusion rates. On manual palpation, the overall mean fusion rate in rats was 58% and the autograft mean fusion rate was 61%. Most studies evaluated fusion as a binary on manual palpation, and only a few used CT and histology. Average mortality was 3.03% in rats and 1.56% in mice. CONCLUSIONS These results suggest using a rat model, younger than 10 weeks and weighing more than 300 grams on the day of surgery, to optimize fusion rates, with decortication before grafting and fusing the L4-L5 level.
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Affiliation(s)
- T Broussolle
- Department of Spine Surgery, P. Wertheimer University Hospital, GHE, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France; Inserm UMR 1033, université Claude-Bernard Lyon 1, Lyon, France.
| | - Jean-Paul Roux
- Inserm UMR 1033, université Claude-Bernard Lyon 1, Lyon, France
| | - R Chapurlat
- Inserm UMR 1033, université Claude-Bernard Lyon 1, Lyon, France
| | - C Barrey
- Department of Spine Surgery, P. Wertheimer University Hospital, GHE, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France; Arts et métiers ParisTech, ENSAM, 151, boulevard de l'Hôpital, 75013 Paris, France
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Morse KW, Moore H, Kumagai H, Hahn W, Koo A, Meyers KN, Bouxsein ML, Brooks DJ, Lanske B, Iyer S, Cunningham M. Abaloparatide Enhances Fusion and Bone Formation in a Rabbit Spinal Arthrodesis Model. Spine (Phila Pa 1976) 2022; 47:1607-1612. [PMID: 35943233 PMCID: PMC10024932 DOI: 10.1097/brs.0000000000004452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective randomized placebo controlled animal trial. OBJECTIVE Determine the effect of daily subcutaneous abaloparatide injection on the intervertebral fusion rate in rabbits undergoing posterolateral fusion. STUDY OF BACKGROUND DATA Despite the wide utilization of spine fusion, pseudarthrosis remains prevalent, and results in increased morbidity. Abaloparatide is a novel analog of parathyroid hormone-related peptide (1-34) and has shown efficacy in a rat posterolateral spine fusion model to increase fusion rates. The effect of abaloparatide on the fusion rate in a larger animal model remains unknown. MATERIALS AND METHODS A total of 24 skeletally mature New Zealand White male rabbits underwent bilateral posterolateral spine fusion. Following surgery, the rabbits were randomized to receive either saline as control or abaloparatide subcutaneous injection daily. Specimens underwent manual assessment of fusion, radiographic analysis with both x-ray and high-resolution peripheral quantitative computed tomography, and biomechanical assessment. RESULTS Rabbits that received abaloparatide had a 100% (10/10) fusion rate compared with 45% (5/11) for controls ( P <0.02) as assessed by manual palpation. Radiographic analysis determined an overall mean fusion score of 4.17±1.03 in the abaloparatide group versus 3.39±1.21 for controls ( P <0.001). The abaloparatide group also had a greater volume of bone formed with a bone volume of 1209±543 mm 3 compared with 551±152 mm 3 ( P <0.001) for controls. The abaloparatide group had significantly greater trabecular bone volume fraction and trabecular thickness and lower specific bone surface and connectivity density in the adjacent levels when compared with controls. Abaloparatide treatment did not impact trabecular number or separation. There were no differences in biomechanical testing in flexion, extension, or lateral bending ( P >0.05) between groups. CONCLUSIONS Abaloparatide significantly increased the fusion rate in a rabbit posterolateral fusion model as assessed by manual palpation. In addition, there were marked increases in the radiographic evaluation of fusion.
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Affiliation(s)
- Kyle W. Morse
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Harold Moore
- Weill Cornell Medical College, New York, NY, USA
| | - Hiroshi Kumagai
- Department of Orthopaedic Surgery, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - William Hahn
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Kathleen N. Meyers
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Mary L. Bouxsein
- Center for Advanced Orthopaedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Daniel J. Brooks
- Center for Advanced Orthopaedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Matthew Cunningham
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
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Xiong Y, Li L, Liu P, Zhou B, Kang Y, Wang G. Effect of Teriparatide Versus Zoledronate on Posterior Lumbar Interbody Fusion in Postmenopausal Women with Osteoporosis. World Neurosurg 2022; 167:e1310-e1316. [PMID: 36096387 DOI: 10.1016/j.wneu.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We evaluated the efficacy of teriparatide versus zoledronate on spinal fusion in osteoporotic patients after posterior lumbar interbody fusion (PLIF). METHODS Postmenopausal women with osteoporosis undergoing PLIF for degenerative spondylolisthesis were randomly assigned to receive either zoledronate or teriparatide. During the 2-year follow-up period, serial radiographs were used to determine fusion status and instrumentation-related sequelae (a composite of adjacent vertebral compressive fracture, instrumentation failure, and fusion failure). The bone mineral density (BMD) and Oswestry disability index (ODI) were also serially measured. RESULTS Of the 77 patients, 36 were in the teriparatide group and 41 in the zoledronate group and had completed the 2-year follow-up assessments. Bony union had been achieved more frequently in the teriparatide group than in the zoledronate group at 6 months postoperatively (P < 0.05), although the overall rate of bone union was comparable between the 2 groups. The incidence of instrumentation-related sequelae was also comparable between the 2 groups (teriparatide vs. zoledronate group, 13.9% vs. 22.0%). Regarding antiosteoporosis, the BMD values had significantly improved in both groups at the last follow-up. The teriparatide group had attained more BMD increments at 12 months postoperatively than had the zoledronate group. Furthermore, the ODI had consistently decreased in both groups with a lower ODI in the teriparatide group than in the zoledronate group at 12 months postoperatively. CONCLUSIONS Among postmenopausal women with osteoporosis, teriparatide showed superior bone union at 6 months and greater BMD improvement at 12 months after PLIF compared with zoledronate administration, although both resulted in similar overall effects on spinal fusion.
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Affiliation(s)
- Yu Xiong
- Department of Spine Surgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Liang Li
- Department of Spine Surgery, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Ping Liu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha City, China
| | - Bin Zhou
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha City, China
| | - Yijun Kang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha City, China
| | - Guoqiang Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha City, China.
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Drakopoulos P, Flevas DA, Galanopoulos IP, Lepetsos P, Zafeiris C. Off-Label Use of Teriparatide in Spine. Cureus 2021; 13:e16522. [PMID: 34430132 PMCID: PMC8376240 DOI: 10.7759/cureus.16522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/12/2022] Open
Abstract
Teriparatide belongs to osteo-anabolic compounds and has been used in recent years to treat patients with osteoporosis, with the benefits of increased bone density. Its osteo-anabolic action has led to the investigation of the use of teriparatide for the improvement of bone quality. Apart from the enhancement of fracture union, teriparatide has been extensively studied in the promotion of fusion rate after spinal fusion. This study summarizes the preclinical and clinical results of the off-label use of teriparatide in the spine, and specifically its intermittent administration after instrumented spinal arthrodesis along with its impact on the spinal bone quality and spinal bone mineral density.
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Affiliation(s)
- Panagiotis Drakopoulos
- Laboratory for the Research of the Musculoskeletal System, University of Athens, KAT Hospital, Athens, GRC.,Orthopaedics, Thriasio General Hospital, Athens, GRC
| | - Dimitrios A Flevas
- Arthroscopy and Orthopaedic Surgery, Metropolitan General Hospital, Athens, GRC
| | | | | | - Christos Zafeiris
- Orthopaedics and Spine Surgery, Metropolitan General Hospital, Athens, GRC
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Sun Q, Tian FM, Liu F, Fang JK, Hu YP, Lian QQ, Zhou Z, Zhang L. Denosumab alleviates intervertebral disc degeneration adjacent to lumbar fusion by inhibiting endplate osteochondral remodeling and vertebral osteoporosis in ovariectomized rats. Arthritis Res Ther 2021; 23:152. [PMID: 34049577 PMCID: PMC8161944 DOI: 10.1186/s13075-021-02525-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 05/05/2021] [Indexed: 01/22/2023] Open
Abstract
Background Although adjacent segmental intervertebral disc degeneration (ASDD) is one of the most common complications after lumbar fusion, its exact mechanism remains unclear. As an antibody to RANKL, denosumab (Dmab) effectively reduces bone resorption and stimulates bone formation, which can increase bone mineral density (BMD) and improve osteoporosis. However, it has not been confirmed whether Dmab has a reversing or retarding effect on ASDD. Methods Three-month-old female Sprague-Dawley rats that underwent L4–L5 posterolateral lumbar fusion (PLF) with spinous-process wire fixation 4 weeks after bilateral ovariectomy (OVX) surgery were given Dmab 4 weeks after PLF surgery (OVX+PLF+Dmab group). In addition, the following control groups were defined: Sham, OVX, PLF, and OVX+PLF (n=12 each). Next, manual palpation and X-ray were used to evaluate the state of lumbar fusion. The bone microstructure in the lumbar vertebra and endplate as well as the disc height index (DHI) of L5/6 was evaluated by microcomputed tomography (μCT). The characteristic alterations of ASDD were identified via Safranin-O green staining. Osteoclasts were detected using tartrate-resistant acid phosphatase (TRAP) staining, and the biomechanical properties of vertebrae were evaluated. Aggrecan (Agg), metalloproteinase-13 (MMP-13), and a disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS-4) expression in the intervertebral disc were detected by immunohistochemistry and real-time polymerase chain reaction (RT-PCR) analysis. In addition, the expression of CD24 and Sox-9 was assessed by immunohistochemistry. Results Manual palpation showed clear evidence of the fused segment’s immobility. Compared to the OVX+PLF group, more new bone formation was observed by X-ray examination in the OVX+PLF+Dmab group. Dmab significantly alleviated ASDD by retaining disc height index (DHI), decreasing endplate porosity, and increasing vertebral biomechanical properties and BMD. TRAP staining results showed a significantly decreased number of active osteoclasts after Dmab treatment, especially in subchondral bone and cartilaginous endplates. Moreover, the protein and mRNA expression results in discs (IVDs) showed that Dmab not only inhibited matrix degradation by decreasing MMP-13 and ADAMTS-4 but also promoted matrix synthesis by increasing Agg. Dmab maintained the number of notochord cells by increasing CD24 but reducing Sox-9. Conclusions These results suggest that Dmab may be a novel therapeutic target for ASDD treatment.
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Affiliation(s)
- Qi Sun
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Fa-Ming Tian
- Medical Research Center, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Fang Liu
- Medical Research Center, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Jia-Kang Fang
- Medical Research Center, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Yun-Peng Hu
- Medical Research Center, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Qiang-Qiang Lian
- Medical Research Center, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Zhuang Zhou
- Department of Bone and Soft Tissue Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Liu Zhang
- Department of Orthopedic Surgery, Hebei Medical University, 361 Zhongshan ERoad, Hebei, 050000, Shijiazhuang, People's Republic of China.
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10
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Lo WC, Tsai LW, Yang YS, Chan RWY. Understanding the Future Prospects of Synergizing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery with Ceramics and Regenerative Cellular Therapies. Int J Mol Sci 2021; 22:3638. [PMID: 33807361 PMCID: PMC8037583 DOI: 10.3390/ijms22073638] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022] Open
Abstract
Transforaminal lumber interbody fusion (TLIF) is the last resort to address the lumber degenerative disorders such as spondylolisthesis, causing lower back pain. The current surgical intervention for these abnormalities includes open TLIF. However, in recent years, minimally invasive TLIF (MIS-TLIF) has gained a high momentum, as it could minimize the risk of infection, blood loss, and post-operative complications pertaining to fusion surgery. Further advancement in visualizing and guiding techniques along with grafting cage and materials are continuously improving the safety and efficacy of MIS-TLIF. These assistive techniques are also playing a crucial role to increase and improve the learning curve of surgeons. However, achieving an appropriate output through TLIF still remains a challenge, which might be synergized through 3D-printing and tissue engineering-based regenerative therapy. Owing to their differentiation potential, biomaterials such as stem/progenitor cells may contribute to restructuring lost or damaged tissues during MIS-TLIF, and this therapeutic efficacy could be further supplemented by platelet-derived biomaterials, leading to improved clinical outcomes. Thus, based on the above-mentioned strategies, we have comprehensively summarized recent developments in MIS-TLIF and its possible combinatorial regenerative therapies for rapid and long-term relief.
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Affiliation(s)
- Wen-Cheng Lo
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (Y.-S.Y.); (R.W.Y.C.)
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Lung-Wen Tsai
- Department of Medical Education and Research, Taipei Medical University Hospital, Taipei 11031, Taiwan;
| | - Yi-Shan Yang
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (Y.-S.Y.); (R.W.Y.C.)
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
| | - Ryan Wing Yuk Chan
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (Y.-S.Y.); (R.W.Y.C.)
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
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11
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Arlt H, Besschetnova T, Ominsky MS, Fredericks DC, Lanske B. Effects of systemically administered abaloparatide, an osteoanabolic PTHrP analog, as an adjuvant therapy for spinal fusion in rats. JOR Spine 2021; 4:e1132. [PMID: 33778406 PMCID: PMC7984001 DOI: 10.1002/jsp2.1132] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/26/2020] [Accepted: 11/04/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Abaloparatide is a parathyroid hormone receptor agonist that increases bone formation and reduces vertebral and nonvertebral fracture risk in women with postmenopausal osteoporosis. Animal studies indicate abaloparatide stimulates vertebral bone formation and enhances bony bridging and biomechanical stability of fracture calluses. AIMS The current study is evaluating the potential utility for abaloparatide as an adjunct therapy for spinal fusions. MATERIAL AND METHODS The effects of 14 or 28 days of daily subcutaneous injections of abaloparatide (20 μg/kg/d) or vehicle were evaluated in 32 male Sprague-Dawley rats starting 1 day after noninstrumented posterolateral fusion (PLF) with bone autograft. Fusion mass microarchitecture was analyzed by micro-computed tomography (micro-CT) and serum markers of bone formation and bone resorption were evaluated. Motion segments were scored in a blinded manner as fused or unfused by postmortem radiography and manual palpation. RESULTS Abaloparatide-treated rats showed higher bone formation (serum osteocalcin) at day 14 and 28 compared with vehicle controls, without increases in the bone resorption marker serum TRACP-5b. Micro-CT showed greater trabecular number in fusion masses from the abaloparatide group vs vehicle controls at day 14. Manual palpation and radiography indicated no fusions in either group at day 14, whereas 25% of vehicle-treated rats and 50% of abaloparatide-treated rats had bilateral fusion at day 28. DISCUSSION AND CONCLUSION In summary, this rat PLF model showed that abaloparatide treatment was associated with higher levels of the bone formation marker osteocalcin, improved fusion mass architecture, and a non- significant 2-fold higher fusion rate compared with vehicle.
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Affiliation(s)
- Heike Arlt
- Research & DevelopmentRadius Health, Inc.WalthamMassachusettsUSA
| | | | | | - Douglas C. Fredericks
- Department of Orthopedics and RehabilitationUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Beate Lanske
- Research & DevelopmentRadius Health, Inc.WalthamMassachusettsUSA
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12
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Yu D, Kim S, Jeon I. Therapeutic Effect of Teriparatide for Osteoporotic Thoracolumbar Burst Fracture in Elderly Female Patients. J Korean Neurosurg Soc 2020; 63:794-805. [PMID: 33105532 PMCID: PMC7671788 DOI: 10.3340/jkns.2020.0110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/02/2020] [Indexed: 12/14/2022] Open
Abstract
Objective Teriparatide is known as an effective anabolic agent not only for severe osteoporosis but also for bone healing and union. We explored the possibility of teriparatide as an alternative treatment option for osteoporotic thoracolumbar (TL) burst fracture.
Methods This retrospective study enrolled 35 female patients with mean age of 73.77±6.71 years (61–88) diagnosed as osteoporotic TL burst fracture with ≥4 of thoracolumbar injury classification and severity (TLICS) score and no neurological deficits. All patients were treated by teriparatide only (12 of group A), teriparatide plus vertebroplasty (12 of group B), or surgical fixation with fusion (11 of group C), and followed up for 12 months. Radiological outcomes were evaluated using radiological parameters including kyphotic angle (KA), segmental vertebral kyphotic angle (SVKA), compression ratio (CR), and vertebral body height (anterior [AH], middle [MH], posterior [PH]). Functional outcomes were evaluated using visual analog scale (VAS) and Macnab classification (MC).
Results There were no statistical significant differences in age, bone mineral density (-3.36±0.73), and TLICS score (4.34±0.48) among the three groups (p>0.05). Teriparatide was administered during 8.63±2.32 months in group A and B. In 12-month radiological outcomes, there were significant restoration in SVKA, CR, AH, and MH of group B and KA, SVKA, CR, AH, and MH of group C compared to group A with no radiological changes (p<0.05). All groups showed similar significant improvements in 12-month functional outcomes, although group B and C showed a better 1-month VAS, 1-month MC, 3-month MC compared to group A (p<0.05).
Conclusion Non-surgical treatment with teriparatide showed similar 12-month functional outcomes compared to surgical fixation with fusion. The additional vertebroplasty to teriparatide and surgical fixation with fusion were more helpful to improve short-term functional outcomes with structural restoration compared to teriparatide only.
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Affiliation(s)
- Dongwoo Yu
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Sungho Kim
- Department of Neurosurgery, Bogang Hospital, Daegu, Korea
| | - Ikchan Jeon
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
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13
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Emam H, Leach D, Sun Z, Tee BC, Karatas B, Kim DG, Jatana C. The Effect of Parathyroid Hormone Analogues When Added to Mineralized Bone Xenografts. J ORAL IMPLANTOL 2020; 46:372-379. [DOI: 10.1563/aaid-joi-d-19-00016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Implants can be a treatment option when there is sufficient quantity and quality of bone to provide support for long-term success. In the reconstruction of defects, autogenous bone remains the gold standard for its osteogenic and compatibility properties. However, the disadvantage of secondary surgery and the associated donor site morbidity prompts researchers to develop the ideal bone substitute for optimum bone reconstruction. Parathyroid hormone (PTH1-34) has provided a new option for improvement in bone regeneration. This study used a pig model to evaluate the effectiveness of parathyroid hormone when added to a xenograft, Bio-Oss, in reconstructing mandible defects. Six domestic pigs were used to create 3 posterior mandibular defects measuring 2 × 1-cm bilaterally with a total of 36 defects to simulate tooth extraction sites in humans. The defects were grafted in random order and divided into 3 groups as follows: control (no graft), Bio-Oss without PTH, and Bio-Oss with PTH. Defects were assessed with cone beam computerized tomography (CBCT), micro computerized tomography (microCT), nanoindentation, and histology. Results showed that adding PTH1-34 significantly enhanced the graft construct. CBCT showed a significant increase in the degree of bone mineralization. Nanoindentation showed increased hardness of regenerated bone and accelerated bone mineralization with PTH. MicroCT analysis revealed a trend toward higher bone regeneration and mineralization. The histological analysis showed a positive trend of the increase in cortical bone thickness and mineral apposition rate. In conclusion, the local addition of PTH1-34 to a xenograft has shown promising results to enhance bone regeneration in the reconstruction of mandibular defects.
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Affiliation(s)
- Hany Emam
- Division of Oral and Maxillofacial Surgery, The Ohio State University College of Dentistry, Columbus, Ohio
| | - Daniel Leach
- Division of Oral and Maxillofacial Surgery, The Ohio State University College of Dentistry, Columbus, Ohio
| | - Zongyang Sun
- Division of Orthodontics, The Ohio State University College of Dentistry, Columbus, Ohio
| | - Boon Ching Tee
- Division of Orthodontics, The Ohio State University College of Dentistry, Columbus, Ohio
| | - Berfin Karatas
- Division of Orthodontics, The Ohio State University College of Dentistry, Columbus, Ohio
| | - Do-Gyoon Kim
- Division of Orthodontics, The Ohio State University College of Dentistry, Columbus, Ohio
| | - Courtney Jatana
- Division of Oral and Maxillofacial Surgery, The Ohio State University College of Dentistry, Columbus, Ohio
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14
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Driscoll JA, Lubbe R, Jakus AE, Chang K, Haleem M, Yun C, Singh G, Schneider AD, Katchko KM, Soriano C, Newton M, Maerz T, Li X, Baker K, Hsu WK, Shah RN, Stock SR, Hsu EL. 3D-Printed Ceramic-Demineralized Bone Matrix Hyperelastic Bone Composite Scaffolds for Spinal Fusion. Tissue Eng Part A 2020; 26:157-166. [PMID: 31469055 PMCID: PMC7044791 DOI: 10.1089/ten.tea.2019.0166] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/23/2019] [Indexed: 12/31/2022] Open
Abstract
Although numerous spinal biologics are commercially available, a cost-effective and safe bone graft substitute material for spine fusion has yet to be proven. In this study, "3D-Paints" containing varying volumetric ratios of hydroxyapatite (HA) and human demineralized bone matrix (DBM) in a poly(lactide-co-glycolide) elastomer were three-dimensional (3D) printed into scaffolds to promote osteointegration in rats, with an end goal of spine fusion without the need for recombinant growth factor. Spine fusion was evaluated by manual palpation, and osteointegration and de novo bone formation within scaffold struts were evaluated by laboratory and synchrotron microcomputed tomography and histology. The 3:1 HA:DBM composite achieved the highest mean fusion score and fusion rate (92%), which was significantly greater than the 3D printed DBM-only scaffold (42%). New bone was identified extending from the host transverse processes into the scaffold macropores, and osteointegration scores correlated with successful fusion. Strikingly, the combination of HA and DBM resulted in the growth of bone-like spicules within the DBM particles inside scaffold struts. These spicules were not observed in DBM-only scaffolds, suggesting that de novo spicule formation requires both HA and DBM. Collectively, our work suggests that this recombinant growth factor-free composite shows promise to overcome the limitations of currently used bone graft substitutes for spine fusion. Impact Statement Currently, there exists a no safe, yet highly effective, bone graft substitute that is well accepted for use in spine fusion procedures. With this work, we show that a three-dimensional printed scaffold containing osteoconductive hydroxyapatite and osteoinductive demineralized bone matrix that promotes new bone spicule formation, osteointegration, and successful fusion (stabilization) when implemented in a preclinical model of spine fusion. Our study suggests that this material shows promise as a recombinant growth factor-free bone graft substitute that could safely promote high rates of successful fusion and improve patient care.
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Affiliation(s)
- J. Adam Driscoll
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois
- Simpson Querrey Institute, Chicago, Illinois
| | - Ryan Lubbe
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois
- Simpson Querrey Institute, Chicago, Illinois
| | - Adam E. Jakus
- Simpson Querrey Institute, Chicago, Illinois
- Department of Materials Science and Engineering, Northwestern University Evanston, Illinois
- Transplant Division, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Kevin Chang
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois
- Simpson Querrey Institute, Chicago, Illinois
| | - Meraaj Haleem
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois
- Simpson Querrey Institute, Chicago, Illinois
| | - Chawon Yun
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois
- Simpson Querrey Institute, Chicago, Illinois
| | - Gurmit Singh
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois
- Simpson Querrey Institute, Chicago, Illinois
| | - Andrew D. Schneider
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois
- Simpson Querrey Institute, Chicago, Illinois
| | - Karina M. Katchko
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois
- Simpson Querrey Institute, Chicago, Illinois
| | | | - Michael Newton
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, Michigan
| | - Tristan Maerz
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, Michigan
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Xin Li
- Simpson Querrey Institute, Chicago, Illinois
| | - Kevin Baker
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, Michigan
- Department of Orthopaedic Surgery, Oakland University—William Beaumont School of Medicine, Rochester, Michigan
| | - Wellington K. Hsu
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois
- Simpson Querrey Institute, Chicago, Illinois
| | - Ramille N. Shah
- Simpson Querrey Institute, Chicago, Illinois
- Department of Materials Science and Engineering, Northwestern University Evanston, Illinois
- Transplant Division, Department of Surgery, Northwestern University, Chicago, Illinois
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, Michigan
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Stuart R. Stock
- Simpson Querrey Institute, Chicago, Illinois
- Department of Cell and Molecular Biology, Northwestern University, Evanston, Illinois
| | - Erin L. Hsu
- Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois
- Simpson Querrey Institute, Chicago, Illinois
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15
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Isogai N, Hosogane N, Funao H, Nojiri K, Suzuki S, Okada E, Ueda S, Hikata T, Shiono Y, Watanabe K, Watanabe K, Kaito T, Yamashita T, Fujiwara H, Nagamoto Y, Terai H, Tamai K, Matsuoka Y, Suzuki H, Nishimura H, Tagami A, Yamada S, Adachi S, Ohtori S, Orita S, Furuya T, Yoshii T, Ushio S, Inoue G, Miyagi M, Saito W, Imagama S, Ando K, Sakai D, Nukaga T, Kiyasu K, Kimura A, Inoue H, Nakano A, Harimaya K, Kawaguchi K, Yokoyama N, Oishi H, Doi T, Ikegami S, Shimizu M, Futatsugi T, Kakutani K, Yurube T, Oshima M, Uei H, Aoki Y, Takahata M, Iwata A, Seki S, Murakami H, Yoshioka K, Endo H, Hongo M, Nakanishi K, Abe T, Tsukanishi T, Ishii K. The Surgical Outcomes of Spinal Fusion for Osteoporotic Vertebral Fractures in the Lower Lumbar Spine with a Neurological Deficit. Spine Surg Relat Res 2020; 4:199-207. [PMID: 32864485 PMCID: PMC7447347 DOI: 10.22603/ssrr.2019-0079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/07/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction Osteoporotic vertebral fracture (OVF) is the most common osteoporotic fracture, and some patients require surgical intervention to improve their impaired activities of daily living with neurological deficits. However, many previous reports have focused on OVF around the thoracolumbar junction, and the surgical outcomes of lumbar OVF have not been thoroughly discussed. We aimed to investigate the surgical outcomes for lumbar OVF with a neurological deficit. Methods Patients who underwent fusion surgery for thoracolumbar OVF with a neurological deficit were enrolled at 28 institutions. Clinical information, comorbidities, perioperative complications, Japanese Orthopaedic Association scores, visual analog scale scores, and radiographic parameters were compared between patients with lower lumbar fracture (L3-5) and those with thoracolumbar junction fracture (T10-L2). Each patient with lower lumbar fracture (L group) was matched with to patients with thoracolumbar junction fracture (T group). Results A total 403 patients (89 males and 314 females, mean age: 73.8 ± 7.8 years, mean follow-up: 3.9 ± 1.7 years) were included in this study. Lower lumbar OVF was frequently found in patients with lower bone mineral density. After matching, mechanical failure was more frequent in the L group (L group: 64%, T group: 39%; p < 0.001). There was no difference between groups in the clinical and radiographical outcomes, although the rates of complication and revision surgery were still high in both groups. Conclusions The surgical intervention for OVF is effective in patients with myelopathy or radiculopathy regardless of the surgical level, although further study is required to improve clinical and radiographical outcomes. Level of evidence Level III
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Affiliation(s)
- Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan.,Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naobumi Hosogane
- Department of Orthopedic Surgery, Kyorin University, Tokyo, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan.,Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kenya Nojiri
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Ueda
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomohiro Hikata
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuta Shiono
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kei Watanabe
- Department of Orthopedic Surgery, Niigata University, Niigata, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Osaka University, Suita, Japan
| | - Tomoya Yamashita
- Department of Orthopedic Surgery, Osaka University, Suita, Japan
| | | | | | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka City University, Osaka, Japan
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka City University, Osaka, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Tagami
- Department of Orthopedic Surgery, Nagasaki University, Nagasaki, Japan
| | - Shuta Yamada
- Department of Orthopedic Surgery, Nagasaki University, Nagasaki, Japan
| | - Shinji Adachi
- Department of Orthopedic Surgery, Nagasaki University, Nagasaki, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Chiba University, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopedic Surgery, Chiba University, Chiba, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuta Ushio
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Gen Inoue
- Department of Orthopedic Surgery, Kitasato University, Sagamihara, Japan
| | - Masayuki Miyagi
- Department of Orthopedic Surgery, Kitasato University, Sagamihara, Japan
| | - Wataru Saito
- Department of Orthopedic Surgery, Kitasato University, Sagamihara, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University, Nagoya, Japan
| | - Daisuke Sakai
- Department of Orthopedic Surgery, Tokai University, Isehara, Japan
| | - Tadashi Nukaga
- Department of Orthopedic Surgery, Tokai University, Isehara, Japan
| | - Katsuhito Kiyasu
- Department of Orthopedic Surgery, Kochi University, Nankoku, Japan
| | - Atsushi Kimura
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Hirokazu Inoue
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Atsushi Nakano
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Katsumi Harimaya
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | | | | | - Hidekazu Oishi
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - Toshiro Doi
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University, Matsumoto, Japan
| | - Masayuki Shimizu
- Department of Orthopaedic Surgery, Shinshu University, Matsumoto, Japan
| | | | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masashi Oshima
- Department of Orthopedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Hiroshi Uei
- Department of Orthopedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Yasuchika Aoki
- Department of Orthopedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Masahiko Takahata
- Department of Orthopedic Surgery, Hokkaido University, Sapporo, Japan
| | - Akira Iwata
- Department of Orthopedic Surgery, Hokkaido University, Sapporo, Japan
| | - Shoji Seki
- Department of Orthopedic Surgery, University of Toyama, Toyama, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Kanazawa University, Kanazawa, Japan
| | | | - Hirooki Endo
- Department of Orthopedic Surgery, Iwate Medical University, Morioka, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University, Akita, Japan
| | | | - Tetsuya Abe
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | | | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan.,Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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16
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Dam C, Jung UW, Park KM, Huh J, Park W. Effect of teriparatide on early sinus graft healing in the ovariectomized rabbit. Clin Oral Implants Res 2019; 31:264-273. [PMID: 31837052 DOI: 10.1111/clr.13565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 11/21/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the effect of administering intermittent parathyroid hormone 1-34 [teriparatide, (PTH)] on the maxillary sinus lift and bone grafting in osteoporotic rabbits induced by ovariectomy and glucocorticoid. MATERIALS AND METHODS Ovariectomies were performed on 20 female New Zealand white rabbits that were randomly divided into two groups: (a) the PTH group (n = 10), in which 10 μg kg-1 day-1 PTH was injected subcutaneously 5 days a week for 5 weeks (from 1 week before until 4 weeks after sinus surgery), and (b) the saline group (n = 10), in which saline substituted PTH at the same dose, mode of administration, and duration. Bone grafting with bovine bone mineral was augmented into 13 sinuses, and bone grafts and implants were simultaneously performed in seven sinuses, in both groups. Animals were sacrificed at 4 weeks after surgery. To determine whether PTH was an effective treatment for osteoporosis, we measured the bone mineral density (BMD) of the right femur using micro-computed tomography and performed radiographic and histometric analyses of the maxillary sinus surgery site. The Mann-Whitney test was used for statistical analysis. RESULTS It was found that BMD increased in the femur, whereas none of the radiographic and histometric parameters differed significantly between the groups in the sinus, while there were large interindividual variations within groups. CONCLUSIONS These findings suggest that intermittent PTH does not promote new bone formation in the augmented maxillary sinus of ovariectomized rabbits.
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Affiliation(s)
- Chugeum Dam
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea
| | - Kyeong-Mee Park
- Department of Advanced General Dentistry, Human Identification Research Institute, Yonsei University College of Dentistry, Seoul, Korea
| | - Jisun Huh
- Department of Dental Education, Yonsei University College of Dentistry, Seoul, Korea
| | - Wonse Park
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
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Evaluation of therapeutic effects of teriparatide in a rat model of zoledronic acid-induced bisphosphonate-related osteonecrosis. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2019. [DOI: 10.1016/j.ajoms.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Abstract
Since FDA approval in 2002, teriparatide has gained popularity as an anabolic therapy for the treatment of osteoporosis. Animal studies have suggested a role for teriparatide in spine surgery. Several recent studies have demonstrated adjunctive use of teriparatide in osteoporotic patients undergoing spine fusions improves fusion rates, decreases time to union, and decreases osteoporosis-related complications such as proximal junctional kyphosis. On the basis of the available literature, we outline an algorithm for the use of teriparatide in spine surgery.
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19
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Weekly Teriparatide Administration and Preoperative Anterior Slippage of the Cranial Vertebra Next to Fusion Segment < 2 mm Promote Osseous Union After Posterior Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2019; 44:E288-E297. [PMID: 30095791 DOI: 10.1097/brs.0000000000002833] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A multicenter case-control study. OBJECTIVE The aim of this study was to investigate the independent predictors of osseous union after posterior lumbar interbody fusion (PLIF). SUMMARY OF BACKGROUND DATA PLIF is usually performed to treat lumbar degenerative diseases in elderly patients. Some patients exhibit intervertebral pseudoarthrosis. METHODS We analyzed 66 elderly patients with osteoporosis who underwent PLIF from 2011 to 2014 (all women, mean age 71 years, follow-up period ≥6 months). Patients were randomly allocated to receive either treatment with weekly teriparatide, starting at 1 week postoperatively, or no teriparatide. Preoperative lumbar spine radiographs were obtained, and the amount of anterior slippage was measured. Osseous union was assessed by computed tomography at 6 months postoperatively. RESULTS Thirty-three patients (50%) showed complete osseous union, while 33 did not. Teriparatide was administered in 20 (61%) patients of the union group and in 9 (27%) patients of the nonunion group (P < 0.01). The preoperative anterior slippage of the cranial vertebra next to fusion segment < 2 mm was observed in 16 (49%) and 4 (12%) patients in the union and nonunion groups, respectively (P < 0.01). Multivariate regression analysis showed that teriparatide administration (odds ratio, 4.75; 95% confidence interval: 1.51-14.90; P < 0.01) and preoperative anterior slippage of the cranial vertebra next to fusion segment < 2 mm (odds ratio, 5.90; 95% confidence interval: 1.53-22.70; P < 0.01) were independently associated with osseous union within 6 months after PLIF. At 6 months postoperatively, the mean femoral neck bone mineral density significantly increased by 1.1% in the union group and decreased by 1.3% in the nonunion group (P < 0.05). CONCLUSION Weekly teriparatide administration and preoperative anterior slippage of the cranial vertebra next to fusion segment < 2 mm were independent predictors of osseous union within 6 months after PLIF. Our findings suggest that biological and mechanical factors may influence the improvement of spinal fusion. LEVEL OF EVIDENCE 4.
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Park KM, Hu KS, Choi H, Oh SE, Kim HI, Park W, Kim S. Synergistic effect of hyperbaric oxygen therapy with PTH [1-34] on calvarial bone graft in irradiated rat. Oral Dis 2019; 25:822-830. [PMID: 30633848 DOI: 10.1111/odi.13037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/13/2018] [Accepted: 09/07/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine the synergistic effect of parathyroid hormone (PTH) [1-34] in combination with hyperbaric oxygen (HBO) on bone graft in a rat calvarial bone defect model under impaired osteogenic conditions. MATERIALS AND METHODS Twenty-four rats were divided into three groups. Localized radiation with a single 12 Gy dose was administered to the calvaria. Four weeks after radiation, calvarial circular defects were created in the parietal bones. All defects were filled with biphasic calcium phosphate. After the bone graft, PTH [1-34] was injected subcutaneously, and HBO was administered. At 6 weeks after the bone graft, the rats were sacrificed, and specimens were harvested. RESULTS Histomorphometric evaluation showed that the percentage of new bone area was higher in the PTH and PTH/HBO groups than in the control group. The percent residual material area was decreased in the PTH/HBO group compared with the control group. The percentage blood vessel number was highest in the PTH group. Micro-CT evaluation showed that the new bone volume was highest in the PTH/HBO group. The residual material volume was lowest in the PTH/HBO group. CONCLUSION Within the limitations of this study, our data indicate that PTH combined with HBO may reverse radiation-induced impairment of bone healing.
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Affiliation(s)
- Kyeong-Mee Park
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kyung-Seok Hu
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyunmin Choi
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Seo-Eun Oh
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Hyeong-Il Kim
- Department of Restorative Dentistry, School of Dental Medicine, University at Buffalo, Buffalo, New York
| | - Wonse Park
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sungtae Kim
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
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Zandi M, Dehghan A, Gheysari F, Rezaeian L, Mohammad Gholi Mezerji N. Evaluation of teriparatide effect on healing of autografted mandibular defects in rats. J Craniomaxillofac Surg 2019; 47:120-126. [DOI: 10.1016/j.jcms.2018.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/23/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022] Open
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Yolcu Y, Alvi M, Wanderman N, Carlson B, Sebastian A, Bydon M, Freedman B. Effect of teriparatide use on bone mineral density and spinal fusion: a narrative review of animal models. Int J Neurosci 2018; 129:814-820. [PMID: 30587048 DOI: 10.1080/00207454.2018.1564051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose of the study: Teriparatide (Human recombinant Parathyroid Hormone 1-34) is an anabolic agent that is frequently used in patients with osteoporosis and has been extensively investigated with animal model and clinical studies in current literature. The purpose of the study was to evaluate the impact of teriparatide on bone mineral density and fusion. Materials and methods: The findings from preclinical studies that have investigated the role of teriparatide in animal models are summarized in presented review. Results: Overall, the studies show an improvement in bone mineral density and increased fusion rates for osteoporotic animals undergoing spine fusion with teriparatide use. Conclusion: Further studies should be conducted for unanswered questions, such as teriparatide use before surgery, the effect on cervical fusion and surgery related complications.
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Affiliation(s)
- Yagiz Yolcu
- a Mayo Clinic Neuro-Informatics Laboratory , Mayo Clinic , Rochester , MN , USA.,b Department of Neurologic Surgery , Mayo Clinic , Rochester , MN , USA
| | - Mohammed Alvi
- a Mayo Clinic Neuro-Informatics Laboratory , Mayo Clinic , Rochester , MN , USA.,b Department of Neurologic Surgery , Mayo Clinic , Rochester , MN , USA
| | - Nathan Wanderman
- c Department of Orthopaedic Surgery , Mayo Clinic , Rochester , MN , USA
| | - Bayard Carlson
- c Department of Orthopaedic Surgery , Mayo Clinic , Rochester , MN , USA
| | - Arjun Sebastian
- c Department of Orthopaedic Surgery , Mayo Clinic , Rochester , MN , USA
| | - Mohamad Bydon
- a Mayo Clinic Neuro-Informatics Laboratory , Mayo Clinic , Rochester , MN , USA.,b Department of Neurologic Surgery , Mayo Clinic , Rochester , MN , USA
| | - Brett Freedman
- c Department of Orthopaedic Surgery , Mayo Clinic , Rochester , MN , USA
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Wojda SJ, Donahue SW. Parathyroid hormone for bone regeneration. J Orthop Res 2018; 36:2586-2594. [PMID: 29926970 DOI: 10.1002/jor.24075] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/18/2018] [Indexed: 02/04/2023]
Abstract
Delayed healing and/or non-union occur in approximately 5-10% of the fractures that occur annually in the United States. Segmental bone loss increases the probability of non-union. Though grafting can be an effective treatment for segmental bone loss, autografting is limited for large defects since a limited amount of bone is available for harvest. Parathyroid hormone (PTH) is a key regulator of calcium homeostasis in the body and plays an important role in bone metabolism. Presently PTH is FDA approved for use as an anabolic treatment for osteoporosis. The anabolic effect PTH has on bone has led to research on its use for bone regeneration applications. Numerous studies in animal models have indicated enhanced fracture healing as a result of once daily injections of PTH. Similarly, in a human case study, non-union persisted despite treatment attempts with internal fixation, external fixation, and autograft in combination with BMP-7, until off label use of PTH1-84 was utilized. Use of a biomaterial scaffold to locally deliver PTH to a defect site has also been shown to improve bone formation and healing around dental implants in dogs and drill defects in sheep. Thus, PTH may be used to promote bone regeneration and provide an alternative to autograft and BMP for the treatment of large segmental defects and non-unions. This review briefly summarizes the unmet clinical need for improved bone regeneration techniques and how PTH may help fill that void by both systemically and locally delivered PTH for bone regeneration applications. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2586-2594, 2018.
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Affiliation(s)
- Samantha J Wojda
- Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado
| | - Seth W Donahue
- Department of Biomedical Engineering, University of Massachusetts, Amherst, Massachusetts
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Makino T, Tsukazaki H, Ukon Y, Tateiwa D, Yoshikawa H, Kaito T. The Biological Enhancement of Spinal Fusion for Spinal Degenerative Disease. Int J Mol Sci 2018; 19:ijms19082430. [PMID: 30126106 PMCID: PMC6121547 DOI: 10.3390/ijms19082430] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/04/2018] [Accepted: 08/14/2018] [Indexed: 12/16/2022] Open
Abstract
In this era of aging societies, the number of elderly individuals who undergo spinal arthrodesis for various degenerative diseases is increasing. Poor bone quality and osteogenic ability in older patients, due to osteoporosis, often interfere with achieving bone fusion after spinal arthrodesis. Enhancement of bone fusion requires shifting bone homeostasis toward increased bone formation and reduced resorption. Several biological enhancement strategies of bone formation have been conducted in animal models of spinal arthrodesis and human clinical trials. Pharmacological agents for osteoporosis have also been shown to be effective in enhancing bone fusion. Cytokines, which activate bone formation, such as bone morphogenetic proteins, have already been clinically used to enhance bone fusion for spinal arthrodesis. Recently, stem cells have attracted considerable attention as a cell source of osteoblasts, promising effects in enhancing bone fusion. Drug delivery systems will also need to be further developed to assure the safe delivery of bone-enhancing agents to the site of spinal arthrodesis. Our aim in this review is to appraise the current state of knowledge and evidence regarding bone enhancement strategies for spinal fusion for degenerative spinal disorders, and to identify future directions for biological bone enhancement strategies, including pharmacological, cell and gene therapy approaches.
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Affiliation(s)
- Takahiro Makino
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Hiroyuki Tsukazaki
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Yuichiro Ukon
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Daisuke Tateiwa
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Hideki Yoshikawa
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Takashi Kaito
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
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Holmes CA, Ishida W, Elder BD, Lo SFL, Chen YA, Kim E, Locke J, Taylor M, Witham TF. The Effects of High-Dose Parathyroid Hormone Treatment on Fusion Outcomes in a Rabbit Model of Posterolateral Lumbar Spinal Fusion Alone and in Combination with Bone Morphogenetic Protein 2 Treatment. World Neurosurg 2018; 115:e366-e374. [DOI: 10.1016/j.wneu.2018.04.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 04/07/2018] [Accepted: 04/09/2018] [Indexed: 01/21/2023]
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Kim JW, Park SW, Kim YB, Ko MJ. The Effect of Postoperative Use of Teriparatide Reducing Screw Loosening in Osteoporotic Patients. J Korean Neurosurg Soc 2018; 61:494-502. [PMID: 29724093 PMCID: PMC6046574 DOI: 10.3340/jkns.2017.0216] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/23/2017] [Indexed: 11/27/2022] Open
Abstract
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 μg 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.
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Affiliation(s)
- Jae Wook Kim
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Young Baeg Kim
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
| | - Myeong Jin Ko
- Department of Neurosurgery, Chung-Ang University Hospital, Seoul, Korea
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Liu Y, Levack AE, Marty E, Or O, Samuels BP, Redko M, Lane JM. Anabolic agents: what is beyond osteoporosis? Osteoporos Int 2018; 29:1009-1022. [PMID: 29627891 PMCID: PMC5949085 DOI: 10.1007/s00198-018-4507-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/23/2018] [Indexed: 02/06/2023]
Abstract
Osteoporosis is a common skeletal disorder characterized by low bone mass, which leads to reduced bone strength and an increased risk of fractures. Anabolic agents have been shown to improve bone mass and decrease fracture risk in osteoporosis patients by directly stimulating osteoblasts to produce new bone. Currently, two anabolic agents are available in the USA: recombinantly produced teriparatide (TPTD), which is the fully active (1-34) amino active sequence of human parathyroid hormone (PTH), and abaloparatide (APTD), a synthetic analog of parathyroid hormone-related peptide (PTHrP). At present, both agents are approved only for treatment of patients with osteoporosis at high risk of fracture. Nonetheless, their anabolic properties have led to off-label application in additional settings which include spine fusion, osteonecrosis of the jaw, arthroplasty, and fracture healing. In this article, we summarize available scientific literature regarding the efficacy, effectiveness, and safety of TPTD in these off-label settings.
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Affiliation(s)
- Y Liu
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA
| | - A E Levack
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA
| | - E Marty
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA
| | - O Or
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery, Hadassah Medical Center, 91120, Jerusalem, Israel
| | - B P Samuels
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA
| | - M Redko
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA
| | - J M Lane
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA.
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Abstract
PURPOSE In patients undergoing lumbar fusion, osteoporosis has been shown to lead to poorer outcomes and greater incidence of fusion-related complications. Given the undesirable effect of osteoporosis on lumbar fusion surgery, a number of medications have been proposed for use in the peri- and postoperative period to mitigate risks and enhance outcomes. The purpose of this review was to summarize and synthesize the current literature regarding medical management of osteoporosis in the context of lumbar fusion surgery. METHODS A literature search of PubMed, Embase, and Web of Science was conducted in October 2016, using permutations of various search terms related to osteoporosis, medications, and lumbar fusion. RESULTS Teriparatide injections may lead to faster, more successful fusion, and may reduce fusion-related complications. Bisphosphonate therapy likely does not hinder fusion outcomes and may be useful in reducing certain complications of fusion in osteoporotic patients. Calcitonin and selective estrogen receptor modulator therapy show mixed results, but more research is necessary to make a recommendation. Vitamin D deficiency is associated with poor fusion outcomes, but evidence for supplementation in patients with normal serum levels is weak. CONCLUSIONS Overall, the current body of research appears to support the use of teriparatide therapy to enhance lumbar fusion outcomes in the osteoporotic patient, although the extent of research on this topic is limited. Additionally, very little evidence exists to cease any of the mentioned osteoporosis treatments prior to lumbar fusion.
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Affiliation(s)
| | | | - Vafa Tabatabaie
- Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Endocrinology, Montefiore Medical Center, Bronx, NY, USA
| | - Woojin Cho
- Albert Einstein College of Medicine, Bronx, NY, USA. .,Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA.
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Nishitani K, Mietus Z, Beck CA, Ito H, Matsuda S, Awad HA, Ehrhart N, Schwarz EM. High dose teriparatide (rPTH1-34) therapy increases callus volume and enhances radiographic healing at 8-weeks in a massive canine femoral allograft model. PLoS One 2017; 12:e0185446. [PMID: 29020057 PMCID: PMC5636088 DOI: 10.1371/journal.pone.0185446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/12/2017] [Indexed: 01/15/2023] Open
Abstract
Small animal studies have demonstrated significant high-dose recombinant parathyroid hormone1-34 (rPTH1-34) effects on intercalary allograft healing. Towards a human adjuvant therapy to decrease non-unions, we evaluated rPTH1-34 safety and efficacy in a clinically relevant canine femoral allograft model. Adult female mongrel hounds (n = 20) received a 5cm mid-diaphyseal osteotomy reconstructed with a plated allograft, and were randomized to: 1) Placebo (n = 5; daily saline), 2) Continuous rPTH1-34 (n = 7; 5 μg/kg/day s.c. from day 1-55 post-op), or 3) Delayed rPTH1-34 (n = 8; 5 μg/kg/day s.c. from day 14-28 post-op). Safety was assessed by physical behavior and blood calcium monitoring. Cone beam CT (CB-CT) was performed on days 14, 28 and 56 post-op to assess 2D cortical healing, 3D bone volume, and Union Ratio. Biomechanical testing and dynamic histomorphometry were also performed. The high drug dose was poorly tolerated, as most dogs receiving rPTH1-34 had to be given intravenous saline, and one dog died from hypercalcemia. Continuous rPTH1-34 significantly increased 2D healing and callus volumes at 4-weeks versus Placebo, and sustained the significant increase in cortical union at 8-week (p<0.05). These rPTH1-34 effects were confirmed by histomorphometry, revealing significant increases in mineral apposition rates (MAR) on host bone and graft-host junctions (p<0.05). Delayed rPTH1-34 significantly increased callus volume and MAR at 8 weeks (p<0.05). Although no biomechanical differences were observed, as expected for early healing, the results demonstrated that 2D RUST scoring significantly correlated with torsional biomechanics (p<0.01). In conclusion, 8-weeks of intermittent high-dose rPTH1-34 treatment significantly increases callus formation and accelerates bony union of intercalary massive allografts in a clinically relevant canine model, but with serious side-effects from hypercalcemia.
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Affiliation(s)
- Kohei Nishitani
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Orthopaedics Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Zachary Mietus
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States of America
| | - Christopher A. Beck
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Orthopedics, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hiromu Ito
- Department of Orthopaedics Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedics Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hani A. Awad
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States of America
- Department of Orthopedics, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Nicole Ehrhart
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States of America
| | - Edward M. Schwarz
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States of America
- Department of Orthopedics, University of Rochester Medical Center, Rochester, NY, United States of America
- * E-mail:
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Cho DC, Ryu K, Kim KT, Sung JK. The Therapeutic Effects of Combination Therapy with Curcumin and Alendronate on Spine Fusion Surgery in the Ovariectomized Rats. KOREAN JOURNAL OF SPINE 2017; 14:35-40. [PMID: 28704906 PMCID: PMC5518429 DOI: 10.14245/kjs.2017.14.2.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 12/11/2022]
Abstract
Objective The purpose of this study was to evaluate the therapeutic effects of combination therapy with curcumin and alendronate on spine fusion surgery in ovariectomized rats. Methods Thirty-two female Sprague-Dawley rats (12 weeks old) underwent bilateral ovariectomy (OVX). Eight weeks after surgery, animals underwent intertransverse spine fusion at L4–5. The rats were randomly distributed amongst 4 groups; untreated OVX group, curcumin administered group, alendronate administered group, and the combination therapy group. At 8 weeks after fusion surgery, the animals were sacrificed and the fusion mass was assessed by manual palpation, radiographic scan, and micro-computed tomographic scan. In addition, mechanical strength was determined by a 3-point bending test. Results Based on the results of manual palpation testing and 3-dimensional micro-computed tomography scanning, solid bone fusion rate was 50% (4 of 8) in the OVX group, 75% (6 of 8) in the alendronate-only and curcumin-only group, and 87.5% (7 of 8) in the combination therapy group, respectively. The combination therapy group had a higher fusion rate compared with the other treatment groups, though not statistically significantly (p>0.05). And the combination therapy group had a significant increase in fusion volume at 8 weeks after spine fusion surgery compared with curcumin-only group (p=0.039). The 3-point bending test showed that combination therapy group had a significantly greater maximal load value compared to that of curcumin-only group (p=0.024). Conclusion The present study demonstrated that additional treatment of curcumin and alendronate after spine fusion surgery in rat can promote higher fusion volume, and improve bone mechanical strength.
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Affiliation(s)
- Dae-Chul Cho
- Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Kyoungsu Ryu
- Department of Neurosurgery, Halla Hospital, Jeju, Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Joo-Kyung Sung
- Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Korea
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Does Discontinuing Teriparatide Treatment and Replacing It with Bisphosphonate Maintain the Volume of the Bone Fusion Mass after Lumbar Posterolateral Fusion in Women with Postmenopausal Osteoporosis? Asian Spine J 2017; 11:272-277. [PMID: 28443172 PMCID: PMC5401842 DOI: 10.4184/asj.2017.11.2.272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/01/2016] [Accepted: 10/05/2016] [Indexed: 12/03/2022] Open
Abstract
Study Design Retrospective case series. Purpose The purpose of this study was to determine whether discontinuing teriparatide treatment and replacing it with bisphosphonate treatment maintains the volume of the fusion mass after posterolateral fusion (PLF) in women with postmenopausal osteoporosis. Overview of Literature Clinical data support the efficacy of parathyroid hormone (PTH) for lumbar PLF. However, the use of PTH is limited to 2 years. Methods We treated 19 women diagnosed with osteoporosis and degenerative spondylolisthesis with teriparatide (20 µg daily subcutaneously). All patients underwent one-level instrumented PLF. Teriparatide was used during 2 months prior to surgery and more than 8 months after surgery. After discontinuing teriparatide treatment, all patients used bisphosphonate (17.5 mg risedronate weekly, oral administration). Area of the fusion mass across the transverse processes at one segment was determined on an anteroposterior radiograph at 1, 2, and 3 years after surgery. Results We followed 19 patients for 3 years. The average duration of teriparatide treatment was 11.5 months. The bone union rate was 95%. The average area of the bone fusion mass was not significantly different between the right and left sides at 1, 2, or 3 years after surgery (p>0.05). Conclusions This study showed that replacing teriparatide treatment with bisphosphonate maintained the bone fusion mass volume after PLF in women with postmenopausal osteoporosis.
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Chaudhary N, Lee JS, Wu JY, Tharin S. Evidence for Use of Teriparatide in Spinal Fusion Surgery in Osteoporotic Patients. World Neurosurg 2017; 100:551-556. [DOI: 10.1016/j.wneu.2016.11.135] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 11/26/2022]
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Yeh YC, Yang CC, Tai CL, Tsai TT, Lai PL, Fu TS, Niu CC, Chen LH, Chen WJ. Characterization of a novel caudal vertebral interbody fusion in a rat tail model: An implication for future material and mechanical testing. Biomed J 2017; 40:62-68. [PMID: 28411885 PMCID: PMC6138589 DOI: 10.1016/j.bj.2016.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 07/12/2016] [Indexed: 11/30/2022] Open
Abstract
Background Of the proposed animal interbody fusion models, rat caudal discs have gained popularity in disc research due to their strong resemblance to human discs with respect to geometry, composition and mechanical properties. The purpose of this study is to demonstrate an efficient, repeatable and easily accessible animal model of interbody fusion for future research into mechanical testing and graft materials. Methods Twelve 12-week-old female Sprague–Dawley (SD) rats underwent caudal interbody fusion of the third and fourth coccygeal vertebrae of the tail. Serial radiological evaluation, and histological evaluation and manual palpation after sacrifice were performed to assess the fusion quality. Mechanical testing of functional units (FUs) of non-operated and operated segments was compared using a three-point bending test. Results At postoperative 12 weeks, callus formation was observed at the fusion sites in all rats, with the mean radiological evaluations of 2.75/3 according to the Bransford classification. Newly formed bone tissue was also observed in all rats with the mean histological score of 5.85/7, according to the Emery grading system. No palpable gaps and obvious change of bending stiffness was observed in the operated segments. The mean bending stiffness of the FUs was statistically higher than that of the control FUs (26.57 ± 6.71 N/mm vs. 12.45 ± 3.21 N/mm, p < 0.01). Conclusion The rat caudal disc interbody fusion model proved to be an efficient, repeatable and easily accessible model. Future research into adjuvant treatments like growth factor injection and alternative fusion materials under conditions of osteoporosis using this model would be worthwhile.
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Affiliation(s)
- Yu-Cheng Yeh
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Chun Yang
- Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Lung Tai
- Graduate Institute of Medical Mechatronics, Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Lih-Huei Chen
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Jer Chen
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Parathyroid Hormone (1-34) Might Not Improve Early Bone Healing after Sinus Augmentation in Healthy Rabbits. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6087676. [PMID: 28280735 PMCID: PMC5322440 DOI: 10.1155/2017/6087676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/06/2017] [Accepted: 01/18/2017] [Indexed: 12/27/2022]
Abstract
Purpose. This study evaluated the effect of administering intermittent parathyroid hormone [PTH (1-34), henceforth PTH] on the early-stage bone healing of maxillary sinus augmentation in healthy rabbits. Materials and Methods. Bovine bone mineral was grafted on the sinuses of 20 female New Zealand white rabbits. The animals were randomly divided into two groups, PTH (n = 10) or saline (n = 10), in which either PTH or saline was injected subcutaneously 5 days a week for 2 weeks. Half of the animals in each group were killed at 2 weeks postoperatively and the other half were killed at 4 weeks postoperatively. The dosage of PTH was 10 μg/kg/day. Radiographic and histomorphometric analyses were performed. Result. The new bone area (NBA) did not differ significantly between the PTH and saline groups. The NBA in the PTH group in the total augmented area and in the demarcated window, center, and Schneiderian membrane regions increased significantly from 2 to 4 weeks. The number of osteoclasts decreased significantly from 2 to 4 weeks in both groups, with no difference between the two groups. Conclusion. Intermittent PTH might not stimulate new bone formation in healthy rabbits during the first 4 weeks of healing.
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Ishida W, Elder BD, Holmes C, Lo SFL, Witham TF. Variables Affecting Fusion Rates in the Rat Posterolateral Spinal Fusion Model with Autogenic/Allogenic Bone Grafts: A Meta-analysis. Ann Biomed Eng 2016; 44:3186-3201. [PMID: 27473706 DOI: 10.1007/s10439-016-1701-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/21/2016] [Indexed: 01/14/2023]
Abstract
The rat posterolateral spinal fusion model with autogenic/allogenic bone graft (rat PFABG) has been increasingly utilized as an experimental model to assess the efficacy of novel fusion treatments. The objective of this study was to investigate the reliability of the rat PFABG model and examine the effects of different variables on spinal fusion. A web-based literature search from January, 1970 to September, 2015, yielded 26 studies, which included 40 rat PFABG control groups and 449 rats. Data regarding age, weight, sex, and strain of rats, graft volume, graft type, decorticated levels, surgical approach, institution, the number of control rats, fusion rate, methods of fusion assessment, and timing of fusion assessment were collected and analyzed. The primary outcome variable of interest was fusion rate, as evaluated by manual palpation. Fusion rates varied widely, from 0 to 96%. The calculated overall fusion rate was 46.1% with an I 2 value of 62.4, which indicated moderate heterogeneity. Weight >300 g, age >14 weeks, male rat, Sprague-Dawley strain, and autogenic coccyx grafts increased fusion rates with statistical significance. Additionally, an assessment time-point ≥8 weeks had a trend towards statistical significance (p = 0.070). Multi-regression analysis demonstrated that timing of assessment and age as continuous variables, as well as sex as a categorical variable, can predict the fusion rate with R 2 = 0.82. In an inter-institution reliability analysis, the pooled overall fusion rate was 50.0% [44.8, 55.3%], with statistically significant differences among fusion outcomes at different institutions (p < 0.001 and I 2 of 72.2). Due to the heterogeneity of fusion outcomes, the reliability of the rat PFABG model was relatively limited. However, selection of adequate variables can optimize its use as a control group in studies evaluating the efficacy of novel fusion therapies.
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Affiliation(s)
- Wataru Ishida
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St., Room 6007, Baltimore, MD, 21287, USA
| | - Benjamin D Elder
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St., Room 6007, Baltimore, MD, 21287, USA.
| | - Christina Holmes
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St., Room 6007, Baltimore, MD, 21287, USA
| | - Sheng-Fu L Lo
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St., Room 6007, Baltimore, MD, 21287, USA
| | - Timothy F Witham
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St., Room 6007, Baltimore, MD, 21287, USA
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Lubelski D, Choma TJ, Steinmetz MP, Harrop JS, Mroz TE. Perioperative Medical Management of Spine Surgery Patients With Osteoporosis. Neurosurgery 2016; 77 Suppl 4:S92-7. [PMID: 26378362 DOI: 10.1227/neu.0000000000000939] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Management of spine surgery patients with osteoporosis is challenging because of the difficulty of instrumenting and the potential complications, including nonunion and adjacent level fractures. Treatment of this patient population should involve a multidisciplinary approach including the spine surgeon, primary care physician, endocrinologist, and physical therapist. Indication for preoperative treatment before spinal fusion surgery is unclear. All patients should receive calcium and vitamin D. Hormone replacement therapy, including estrogen or selective estrogen receptor modulators, should be considered for elderly female patients with decreased bone mass. Bisphosphonates or intermittent parathyroid hormone are reserved for those with significant bone loss in the spine. Pretreatment with antiresorption medications affect bone remodeling, which is a vital part of graft incorporation and fusion. Although there have been numerous animal studies, there is limited clinical evidence. Accordingly, surgery should be delayed, if possible, to treat the osteoporosis before the intervention. Treatment may include bisphosphonates, as well as newer agents, such as recombinant parathyroid hormone. Further clinical data are needed to understand the relative advantages/disadvantage of antiresorptive vs anabolic agents, as well as the impact of administration of these medications before vs after fusion surgery. Future clinical studies will enable better understanding of the impact of current therapies on biomechanics and fusion outcomes in this unique and increasingly prevalent patient population.
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Affiliation(s)
- Daniel Lubelski
- *Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; ‡Cleveland Clinic Center for Spine Health, Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio; §Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; ¶Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri; ‖Department of Neurosurgery, Jefferson University School of Medicine, Philadelphia, Pennsylvania
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Zhou Z, Tian FM, Gou Y, Wang P, Zhang H, Song HP, Shen Y, Zhang YZ, Zhang L. Enhancement of Lumbar Fusion and Alleviation of Adjacent Segment Disc Degeneration by Intermittent PTH(1-34) in Ovariectomized Rats. J Bone Miner Res 2016; 31:828-38. [PMID: 26542457 DOI: 10.1002/jbmr.2736] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 10/27/2015] [Accepted: 11/03/2015] [Indexed: 01/07/2023]
Abstract
Osteoporosis, which is prevalent in postmenopausal or aged populations, is thought to be a contributing factor to adjacent segment disc degeneration (ASDD), and the incidence and extent of ASDD may be augmented by osteopenia. Parathyroid hormone (PTH) (1-34) has already been shown to be beneficial in osteoporosis, lumbar fusion and matrix homeostasis of intervertebral discs. However, whether PTH(1-34) has a reversing or retarding effect on ASDD in osteopenia has not been confirmed. In the present study, we evaluated the effects of intermittent PTH(1-34) on ASDD in an ovariectomized (OVX) rat model. One hundred 3-month-old female Sprague-Dawley rats underwent L4 -L5 posterolateral lumbar fusion (PLF) with spinous-process wire fixation 4 weeks after OVX surgery. Control groups were established accordingly. PTH(1-34) was intermittently administered immediately after PLF surgery and lasted for 8 weeks using the following groups (n = 20) (V = vehicle): Sham+V, OVX+V, Sham+PLF+V, OVX+PLF+V, OVX+PLF+PTH. The fused segments showed clear evidence of eliminated motion on the fusion-segment based on manual palpation. Greater new bone formation in histology was observed in PTH-treated animals compared to the control group. The extent of ASDD was significantly increased by ovariotomy. Intermittent PTH(1-34) significantly alleviated ASDD by preserving disc height, microvessel density, relative area of vascular buds, endplate thickness and the relative area of endplate calcification. Moreover, protein expression results showed that PTH(1-34) not only inhibited matrix degradation by decreasing MMP-13, ADAMTS-4 and Col-I, but also promote matrix synthesis by increasing Col-II and Aggrecan. In conclusion, PTH(1-34), which effectively improves lumbar fusion and alleviates ASDD in ovariectomized rats, may be a potential candidate to ameliorate the prognosis of lumbar fusion in osteopenia.
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Affiliation(s)
- Zhuang Zhou
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Fa-Ming Tian
- Medical Research Center, North China University of Science and Technology, Tangshan, China
| | - Yu Gou
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Peng Wang
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Heng Zhang
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Hui-Ping Song
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Yong Shen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ying-Ze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liu Zhang
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, China
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dos Santos RAB, Ferreira MS, Mafra CES, Holzhausen M, de Lima LAPA, Mendes Pannuti C, César Neto JB. Synthetic Parathyroid Hormone May Augment Bone Volume in Autogenous Grafts: A Study in Rats. J Periodontol 2016; 87:66-73. [DOI: 10.1902/jop.2015.140638] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Liu CC, Tian FM, Zhou Z, Wang P, Gou Y, Zhang H, Wang WY, Shen Y, Zhang YZ, Zhang L. Protective effect of calcitonin on lumbar fusion-induced adjacent-segment disc degeneration in ovariectomized rat. BMC Musculoskelet Disord 2015; 16:342. [PMID: 26552386 PMCID: PMC4640157 DOI: 10.1186/s12891-015-0788-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/23/2015] [Indexed: 02/06/2023] Open
Abstract
Background Intervertebral disc (IVD) degeneration and pathological changes in the spinal cord are major causes of back pain. In addition to its well-established anti-resorptive effect on bone, calcitonin (CT) potentially exerts protective effects on IVD degeneration in ovariectomized rats. However, possible therapeutic effects of CT on lumbar fusion-induced adjacent-segment disc degeneration (ASDD) have not been investigated yet. In this study, we examined the effects of CT on IVD degeneration adjacent to a lumbar fusion in ovariectomized rats. Methods Posterolateral lumbar fusion (PLF) at L4–5 was performed 4 weeks after ovariectomy (OVX) or sham surgery in female Sprague–Dawley rats. Following PLF + OVX, rats received either salmon CT (OVX + PLF + sCT, 16 IU/Kg/2d) or vehicle (OVX + PLF + V) treatment for 12 weeks; the remaining rats were divided into Sham + V, OVX + V, and PLF + V groups. Fusion status was analyzed by manual palpation and radiography. Adjacent segment disc was assessed by histological, histomorphometric, immunohistochemical analysis. L6 vertebrae microstructures were evaluated by micro-computed tomography. Results Histological analysis showed more severe ASDD occurred in OVX + PLF + V rats compared with the OVX + V or PLF + V groups. CT treatment suppressed the score for ASDD, increased disc height, and decreased the area of endplate calcification. Immunohistochemical staining demonstrated that CT decreased the expression of collagen type-I, matrix metalloproteinase-13, and a disintegrin and metalloproteinase with thrombospondin motifs-4, whereas it increased the expression of collagen type-II and aggrecan in the disc. Micro-computed tomography indicated that CT increased bone mass and improved the microstructure of the L6 vertebrae. Conclusions These results suggest that CT can prevent ASDD, induce beneficial changes in IVD metabolism, and inhibit deterioration of the trabecular microarchitecture of vertebrae in osteoporotic rats with lumbar fusion.
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Affiliation(s)
- Chang-Cheng Liu
- Orthopaedic Research Institution of Hebei, Third Hospital of Hebei Medical University, Shijiazhuang, 050017, P.R. China
| | - Fa-Ming Tian
- Medical Research Center, North China University of Science and Technology, Tangshan, 063000, P. R. China.
| | - Zhuang Zhou
- Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, No. 73 Jianshe South Rd., Tangshan, Hebei, 063000, P.R. China.
| | - Peng Wang
- Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, No. 73 Jianshe South Rd., Tangshan, Hebei, 063000, P.R. China.
| | - Yu Gou
- Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, No. 73 Jianshe South Rd., Tangshan, Hebei, 063000, P.R. China.
| | - Heng Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, No. 73 Jianshe South Rd., Tangshan, Hebei, 063000, P.R. China.
| | - Wen-Ya Wang
- Department of Pathology, School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, 063000, P. R. China.
| | - Yong Shen
- Orthopaedic Research Institution of Hebei, Third Hospital of Hebei Medical University, Shijiazhuang, 050017, P.R. China.
| | - Ying-Ze Zhang
- Orthopaedic Research Institution of Hebei, Third Hospital of Hebei Medical University, Shijiazhuang, 050017, P.R. China.
| | - Liu Zhang
- Orthopaedic Research Institution of Hebei, Third Hospital of Hebei Medical University, Shijiazhuang, 050017, P.R. China. .,Department of Orthopedic Surgery, Affiliated Hospital of North China University of Science and Technology, No. 73 Jianshe South Rd., Tangshan, Hebei, 063000, P.R. China.
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Alendronate Prevents Intervertebral Disc Degeneration Adjacent to a Lumbar Fusion in Ovariectomized Rats. Spine (Phila Pa 1976) 2015; 40:E1073-83. [PMID: 26731708 DOI: 10.1097/brs.0000000000001092] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A model of disc degeneration adjacent to a lumbar fusion in osteoporotic rats. OBJECTIVE We determined the effect of alendronate (ALN) on the disc degeneration adjacent to a lumbar fusion in ovariectomized rats. SUMMARY OF BACKGROUND DATA Adjacent-segment disc degeneration (ASDD) is one of the negative sequelae of spinal fusion. Previous studies have shown that ALN can alleviate disc degeneration. However, no data have been documented regarding the effect of ALN on ASDD after posterolateral lumbar fusion (PLF) in osteoporosis. METHODS 50 female Sprague-Dawley rats underwent either a sham operation (sham) (n = 20) or bilateral ovariectomy (OVX) (n = 30). 4 weeks later, all but 10 rats from each group underwent PLF consisting of an intertransverse process spinal fusion using autologous-iliac-bone grafts with spinous-process wire fixation at the L4-L5 segment. Animals were subcutaneously administered vehicle (V) or ALN (70 μg/kg/wk) for 12 weeks post-PLF as follows: Sham+V, OVX+V, PLF+V, OVX+PLF+V, and OVX+PLF+ALN. Fusion status was analyzed by manual palpation and radiography. Adjacent-segment disc was assessed by histological, histomorphometric, immunohistochemical, and mRNA analysis. L6 vertebrae microstructures were evaluated by microcomputed tomography. RESULTS The fused segments showed clear evidence of fusion based on manual palpation and radiographs. The OVX+PLF+V group showed more severe degenerative alterations and higher histological scores in the disc than the Sham+V, OVX+V, and PLF+V groups (P < 0.05). Compared with the OVX+PLF+V group, the OVX+PLF+ALN group exhibited significantly improved bone mass and vertebrae microstructures (P < 0.05), an increased disc height, and a decreased endplate calcification area (P < 0.05). ALN also significantly decreased Col-I, MMP-13, and ADAMTS-4 expression and increased Col-II and Aggrecan expression in the disc matrix (P < 0.05). CONCLUSION ALN effectively alleviated ASDD post-PLF in ovariectomized rats. These data indicate that ALN can be used as a potential therapeutic agent to attenuate ASDD progression in osteoporosis.
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Kömürcü E, Özyalvaçlı G, Kaymaz B, Gölge UH, Göksel F, Cevizci S, Adam G, Ozden R. Effects of Local Administration of Boric Acid on Posterolateral Spinal Fusion with Autogenous Bone Grafting in a Rodent Model. Biol Trace Elem Res 2015; 167:77-83. [PMID: 25728510 DOI: 10.1007/s12011-015-0274-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/13/2015] [Indexed: 11/29/2022]
Abstract
Spinal fusion is among the most frequently applied spinal surgical procedures. The goal of the present study was to evaluate whether the local administration of boric acid (BA) improves spinal fusion in an experimental spinal fusion model in rats. Currently, there is no published data that evaluates the possible positive effects if the local administration of BA on posterolateral spinal fusion. Thirty-two rats were randomly divided into four independent groups: no material was added at the fusion area for group 1; an autogenous morselized corticocancellous bone graft was used for group 2; an autogenous morselized corticocancellous bone graft with boric acid (8.7 mg/kg) for group 3; and only boric acid was placed into the fusion area for group 4. The L4-L6 spinal segments were collected at week 6, and the assessments included radiography, manual palpation, and histomorphometry. A statistically significant difference was determined between the groups with regard to the mean histopathological scores (p = 0.002), and a paired comparison was made with the Mann-Whitney U test to detect the group/groups from which the difference originated. It was determined that only the graft + BA practice increased the histopathological score significantly with regard to the control group (p = 0.002). Whereas, there was no statistically significant difference between the groups in terms of the manual assessment of fusion and radiographic analysis (respectively p = 0.328 and p = 0.196). This preliminary study suggests that BA may clearly be useful as a therapeutic agent in spinal fusion. However, further research is required to show the most effective dosage of BA on spinal fusion, and should indicate whether BA effects spinal fusion in the human body.
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Affiliation(s)
- Erkam Kömürcü
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey,
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More than 6 Months of Teriparatide Treatment Was More Effective for Bone Union than Shorter Treatment Following Lumbar Posterolateral Fusion Surgery. Asian Spine J 2015; 9:573-80. [PMID: 26240717 PMCID: PMC4522448 DOI: 10.4184/asj.2015.9.4.573] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 12/23/2022] Open
Abstract
Study Design Retrospective case series. Purpose To examine the most effective duration of teriparatide use for spinal fusion in women with postmenopausal osteoporosis. Overview of Literature We reported that daily subcutaneous injection of teriparatide (parathyroid hormone) significantly improved bone union after instrumented lumbar posterolateral fusion (PLF) in women with postmenopausal osteoporosis when compared with oral administration of bisphosphonate. However, the most effective duration of teriparatide use for spinal fusion has not been explored. Methods Forty-five women with osteoporosis diagnosed with degenerative spondylolisthesis from one of the three treatment groups were evaluated based on: short-duration treatment (average, 5.5 months; n=15; daily subcutaneous injection of 20 µg teriparatide), long-duration treatment (average, 13.0 months; n=15; daily subcutaneous injection of 20 µg teriparatide), and bisphosphonate treatment (average, 13.0 months; n=15; weekly oral administration of 17.5 mg risedronate). All patients underwent PLF with a local bone graft. Fusion rate and duration of bone union were evaluated 1.5 years after surgery. Results Bone union rate and average duration for bone union were 92% and 7.5 months in the long-duration treatment group, 80% and 8.5 months in the short-duration treatment group, and 70% and 10.0 months in the bisphosphonate treatment group, respectively. Results of bone union rate and average duration for bone union in the teriparatide treatment groups were significantly superior to those in the bisphosphonate treatment group (p<0.05); whereas, significantly superior results were observed in long-duration treatment group when compared with short-duration treatment group (p<0.05). Conclusions Daily injection of teriparatide for bone union was more effective than oral administration of bisphosphonate. Furthermore, a longer period of teriparatide treatment for bone union was more effective than a shorter period of same treatment.
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Morimoto T, Kaito T, Matsuo Y, Sugiura T, Kashii M, Makino T, Iwasaki M, Yoshikawa H. The bone morphogenetic protein-2/7 heterodimer is a stronger inducer of bone regeneration than the individual homodimers in a rat spinal fusion model. Spine J 2015; 15:1379-90. [PMID: 25733023 DOI: 10.1016/j.spinee.2015.02.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/26/2014] [Accepted: 02/18/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Bone morphogenetic proteins (BMPs) are a group of dimeric growth factors that belong to the transforming growth factor super family and are capable of eliciting new bone formation. Previous studies have suggested that the coexpression of two different BMP genes in a cell can result in the production of BMP heterodimers that are more potent than homodimers. However, because of the difficulty in optimizing the level of BMP gene expression, the coexpression of two different BMP genes also produces BMP homodimers as a by-product. These homodimers could, in theory, interact with the heterodimers. PURPOSE To elucidate the effects of a BMP-2/7 heterodimer, which were investigated in depth using purified BMP-2/7 heterodimers, BMP-2 homodimers, and BMP-7 homodimers in a rat spinal fusion model. METHODS Bilateral posterolateral fusion at L4-L5 was performed in four different groups: control group animals were implanted with collagen carriers alone; BMP-7 group animals with collagen carriers+1 μg of BMP-7 homodimer; BMP-2 group animals with collagen carriers+1 μg of BMP-2 homodimer; and BMP-2/7 group animals with collagen carriers+1 μg of the BMP-2/7 heterodimer. The following assessments were performed: bone microstructural analysis of the fusion mass and tissue volume (TV) with microcomputed tomography (micro-CT); fusion assessment with manual palpation testing and three-dimensional CT images; and bone histomorphometrical analysis of the fusion mass. RESULTS The fusion scores, as determined by radiography, and the TV of the newly formed bone, as determined by micro-CT, were significantly higher in the BMP-2/7 heterodimer group than the other groups (p<.0001). The microstructural indices of the newly formed bone did not differ between the groups. Moreover, histologic analysis of the fused spines revealed that the formation of the trabecular bone bridging the transverse process was the highest in this group. CONCLUSIONS This study demonstrated that BMP-2/7 heterodimer is a stronger inducer of bone regeneration than BMP-2 or -7 homodimers. The use of a purified BMP-2/7 heterodimer may represent an efficient alternative to the current clinical use of BMP-2 or -7 homodimers. Further studies as to the side effects of BMP-2/7 heterodimer are required.
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Affiliation(s)
- Tokimitsu Morimoto
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Yohei Matsuo
- Department of Orthopedic Biomaterial Science, Graduate School of Medicine, Osaka University, 2-2 Yamadaok, Suita, Osaka 565-0871, Japan
| | - Tsuyoshi Sugiura
- Department of Orthopedic Biomaterial Science, Graduate School of Medicine, Osaka University, 2-2 Yamadaok, Suita, Osaka 565-0871, Japan
| | - Masafumi Kashii
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takahiro Makino
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Motoki Iwasaki
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Sugiura T, Kashii M, Matsuo Y, Morimoto T, Honda H, Kaito T, Iwasaki M, Yoshikawa H. Intermittent administration of teriparatide enhances graft bone healing and accelerates spinal fusion in rats with glucocorticoid-induced osteoporosis. Spine J 2015; 15:298-306. [PMID: 25110274 DOI: 10.1016/j.spinee.2014.08.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 07/07/2014] [Accepted: 08/02/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There has been no study regarding the effect of intermittent administration of teriparatide (TPTD [recombinant human parathyroid hormone (1-34)]) on spinal fusion in patients with glucocorticoid-induced osteoporosis (GIOP). PURPOSE To elucidate the effect of intermittent administration of TPTD on spinal fusion in rats with GIOP. STUDY DESIGN An experimental animal study of rats under continuous glucocorticoid (GC) exposure undergoing spinal fusion surgery and administration of TPTD or saline. METHODS Male 8-week-old rats (n=18) were administered 5 mg/kg methylprednisolone (MP) for 12 weeks. After 6 weeks of MP administration, the rats underwent posterolateral spinal fusion (L4-L5) with iliac crest autograft. Then, five times a week, they were given either saline or 40 μg/kg TPTD for 6 weeks. The following assessments were performed: time-course bone microstructural analysis of the fusion mass and adjacent vertebrae (L6), with in vivo microcomputed tomography (μCT); fusion assessment, with manual palpation testing and three-dimensional CT images; and bone histomorphometrical analysis of the fusion mass. RESULTS In the TPTD group, values for bone volume and other bone microstructural parameters at the fusion mass increased and peaked 4 weeks after surgery, and these values were significantly greater than those for the control (CNT) group at 4 and 6 weeks after surgery. Fusion assessment showed that fusion rate was higher in the TPTD group than in the CNT group (CNT group: 56%, TPTD group: 89%). Bone histomorphometry revealed that values for bone formation parameters were significantly higher in the TPTD group than in the CNT group. CONCLUSIONS Under continuous GC exposure in a rat model of spinal fusion, intermittent TPTD administration accelerated bone modeling and remodeling predominantly by stimulating bone formation at the fusion mass and increasing the fusion rate. Intermittent TPTD administration also improved bone microarchitecture of adjacent vertebrae.
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Affiliation(s)
- Tsuyoshi Sugiura
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Masafumi Kashii
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Yohei Matsuo
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Tokimitsu Morimoto
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hirotsugu Honda
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Motoki Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hideki Yoshikawa
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Zhang D, Huang D, Huang Y, Liu Y, Lin B, Yu C, Mou Y, Wu W, Zhang H, Lin H. Efficacy of combined therapy of periosteum and bone allograft in a critical-sized defect model in New Zealand white rabbits. Med Sci Monit 2014; 20:2394-403. [PMID: 25417209 PMCID: PMC4251546 DOI: 10.12659/msm.891103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Large segmental bone defects caused by trauma, infection, or bone tumor resection are difficult to cure and have been a problem in the field of bone repair for decades. The objective of this study was to discuss the efficacy of combined therapy of free periosteum and bone allograft in treating bone defects and to provide a theoretical basis for clinical application of this therapy. Material/Methods A unilateral tibia cortical defect model in New Zealand white rabbits was established according to Girolamo method. Total 48 rabbits were randomized into 3 groups: a simple bone defect group (n=16), an autogenous bone graft group (n=16), and a periosteum and bone allograft combined therapy group (n=16). The efficacy was evaluated by imaging inspections and scoring, HE staining, and RT-PCR in postoperative weeks 2, 4, 8, and 12. Results The results of imaging and histopathological inspections in the study indicated that in postoperative weeks 4, 8, and 12 the experimental and control groups had statistically significant differences in Lane-Sandhu radiographic scoring and relative bone density when compared with the simple bone defect group (P<0.05). The RT-PCR results suggested that the expression of SPP-1, BMP-2, and VEGF in the experimental group was higher than in the control group (P<0.05) and the expression of Col Iα1 in the control group was higher than in the experimental group (P<0.05). Conclusions Efficacies of the combined therapy (periosteum combined with bone allografting) and the criterion standard therapy (autogenous bone grafting) are equivalent in treating bone defects in New Zealand white rabbits.
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Affiliation(s)
- Dawei Zhang
- Department of Traumatic and Microsurgical, The Third Affiliated Hospital of Southern Medical University and Second People's Hospital of Guangdong Province, Guangzhou, China (mainland)
| | - Dong Huang
- Department of Traumatic and Microsurgical, The Third Affiliated Hospital of Southern Medical University and Second People's Hospital of Guangdong Province, Guangzhou, China (mainland)
| | - Yongjun Huang
- Department of Traumatic and Microsurgical, The Third Affiliated Hospital of Southern Medical University and Second People's Hospital of Guangdong Province, Guangzhou, China (mainland)
| | - Yuanhang Liu
- Department of Traumatic and Microsurgical, The Third Affiliated Hospital of Southern Medical University and Second People's Hospital of Guangdong Province, Guangzhou, China (mainland)
| | - Bochuan Lin
- Department of Traumatic and Microsurgical, The Third Affiliated Hospital of Southern Medical University and Second People's Hospital of Guangdong Province, Guangzhou, China (mainland)
| | - Chaoqun Yu
- Department of Traumatic and Microsurgical, The Third Affiliated Hospital of Southern Medical University and Second People's Hospital of Guangdong Province, Guangzhou, China (mainland)
| | - Yong Mou
- Department of Traumatic and Microsurgical, The Third Affiliated Hospital of Southern Medical University and Second People's Hospital of Guangdong Province, Guangzhou, China (mainland)
| | - Weichi Wu
- Department of Traumatic and Microsurgical, The Third Affiliated Hospital of Southern Medical University and Second People's Hospital of Guangdong Province, Guangzhou, China (mainland)
| | - Huiru Zhang
- Department of Traumatic and Microsurgical, The Third Affiliated Hospital of Southern Medical University and Second People's Hospital of Guangdong Province, Guangzhou, China (mainland)
| | - Hao Lin
- Department of Traumatic and Microsurgical, The Third Affiliated Hospital of Southern Medical University and Second People's Hospital of Guangdong Province, Guangzhou, China (mainland)
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Park SB, Park SH, Kang YK, Chung CK. The time-dependent effect of ibandronate on bone graft remodeling in an ovariectomized rat spinal arthrodesis model. Spine J 2014; 14:1748-57. [PMID: 24486470 DOI: 10.1016/j.spinee.2014.01.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 12/23/2013] [Accepted: 01/17/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In osteoporotic patients undergoing spinal arthrodesis, the use of bisphosphonates (BPs) remains controversial with regard to bone fusion. There is no consensus about the appropriate time to give BPs to patients with osteoporosis undergoing spinal arthrodesis. PURPOSE We aimed to study the effect of BPs, given at different times, on the bone response to osteoporotic spinal arthrodesis. STUDY DESIGN/SETTING Radiological, histologic, and molecular assessments of bone formation after the different administration time of ibandronate in an ovariectomized (OVX) rat spinal fusion model. METHODS Female Sprague-Dawley rats (n=100) were OVX (n=80) or non-OVX operated (n=20) and randomized into five groups: non-OVX, osteoporosis, and osteoporosis with early, simultaneous, and late BP groups. Eight weeks after ovariectomy, lumbar spinal arthrodesis was performed using autologous tailbones. Animals were killed 4 and 8 weeks after arthrodesis, and bone formation was assessed by measuring bone mineral density (BMD), messenger RNA expression, manual palpation, radiological evaluation, and histomorphometry. RESULTS Compared with late administration, early administration of ibandronate increased femur BMD in OVX rats and did not hinder bone fusion. Radiological analysis showed that groups given early ibandronate had increased bone volume in the grafted site 8 weeks after surgery. Histomorphometric analysis showed that ibandronate positively affected endochondral and intramembranous ossification. In the OVX groups, ibandronate increased bone turnover to a level similar to that in the non-OVX group. These findings suggested that early administration of ibandronate did not inhibit osteogenesis, including endochondral and intramembranous ossification and fusion rate. CONCLUSIONS Our results suggest that the early administration of BPs may not hinder the bone fusion of osteoporotic patients undergoing spinal arthrodesis.
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Affiliation(s)
- Sung Bae Park
- Department of Neurosurgery, Seoul National University Boramae Medical Center, 5 Gil 20, Boramae-Road, Dongjak-Gu, Seoul, Korea
| | - Seong Hoon Park
- Department of Radiology and the Institute for Metalbolic Disease, Wonkwang University School of Medicine, Shinyong-Dong, Iksan, Jeonbuk, Korea
| | - Yun Kyung Kang
- Department of Pathology, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea.
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Morimoto T, Kaito T, Kashii M, Matsuo Y, Sugiura T, Iwasaki M, Yoshikawa H. Effect of Intermittent Administration of Teriparatide (Parathyroid Hormone 1-34) on Bone Morphogenetic Protein-Induced Bone Formation in a Rat Model of Spinal Fusion. J Bone Joint Surg Am 2014; 96:e107. [PMID: 24990981 DOI: 10.2106/jbjs.m.01097] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although clinical bone morphogenetic protein (BMP) therapy is effective at enhancing bone formation in patients managed with spinal arthrodesis, the required doses are very high. Teriparatide (parathyroid hormone 1-34) is approved by the U.S. Food and Drug Administration to treat osteoporosis and is a potent anabolic agent. In this study, intermittent administration of parathyroid hormone 1-34 combined with transplantation of BMP was performed to elucidate the effect of parathyroid hormone 1-34 on the fusion rate and quality of newly formed bone in a rat model. METHODS A total of forty-eight male Sprague-Dawley rats underwent posterolateral lumbar spinal arthrodesis with one of three different treatments with recombinant human (rh) BMP-2: (1) 0 μg (control), (2) 2 μg (low dose), or (3) 50 μg (high dose). Each of the rhBMP-2 treatments was studied in combination with intermittent injections of either parathyroid hormone 1-34 (180 μg/kg/wk) or saline solution starting two weeks before the operation and continuing until six weeks after the operation. Osseous fusion was assessed with use of radiographs and a manual palpation test. Microstructural indices of the newly formed bone were evaluated with use of micro-computed tomography. The serum markers of bone metabolism were also quantified. RESULTS The fusion rate in the group treated with 2 μg of rhBMP-2 significantly increased (from 57% to 100%) with the administration of parathyroid hormone 1-34 (p < 0.05). The fusion rates in the other groups did not change significantly with the administration of parathyroid hormone 1-34. The bone volume density of the newly formed bone significantly increased in both the 2-μg and 50-μg rhBMP-2 treatment groups with the administration of parathyroid hormone 1-34 (p < 0.01). Micro-computed tomography scans of the newly formed bone clearly demonstrated an abundance of trabecular bone formation in the group treated with parathyroid hormone 1-34. In addition, serum levels of osteocalcin were significantly increased in the parathyroid hormone 1-34 treatment group. CONCLUSIONS Intermittent administration of parathyroid hormone 1-34 significantly increased fusion rates in the group treated with low-dose rhBMP-2, and it improved the quality of the newly formed bone in both the high and low-dose groups in a rat model of rhBMP-2-induced spinal fusion. CLINICAL RELEVANCE Our results suggest that the combined administration of rhBMP-2 and parathyroid hormone 1-34 may lead to efficient bone regeneration.
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Affiliation(s)
- Tokimitsu Morimoto
- Departments of Orthopedic Surgery (T.M., T.K., M.K., M.I., and H.Y.) and Orthopedic Biomaterial Science (Y.M. and T.S.), Graduate School of Medicine, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871 Japan. E-mail address for T. Kaito:
| | - Takashi Kaito
- Departments of Orthopedic Surgery (T.M., T.K., M.K., M.I., and H.Y.) and Orthopedic Biomaterial Science (Y.M. and T.S.), Graduate School of Medicine, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871 Japan. E-mail address for T. Kaito:
| | - Masafumi Kashii
- Departments of Orthopedic Surgery (T.M., T.K., M.K., M.I., and H.Y.) and Orthopedic Biomaterial Science (Y.M. and T.S.), Graduate School of Medicine, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871 Japan. E-mail address for T. Kaito:
| | - Yohei Matsuo
- Departments of Orthopedic Surgery (T.M., T.K., M.K., M.I., and H.Y.) and Orthopedic Biomaterial Science (Y.M. and T.S.), Graduate School of Medicine, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871 Japan. E-mail address for T. Kaito:
| | - Tsuyoshi Sugiura
- Departments of Orthopedic Surgery (T.M., T.K., M.K., M.I., and H.Y.) and Orthopedic Biomaterial Science (Y.M. and T.S.), Graduate School of Medicine, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871 Japan. E-mail address for T. Kaito:
| | - Motoki Iwasaki
- Departments of Orthopedic Surgery (T.M., T.K., M.K., M.I., and H.Y.) and Orthopedic Biomaterial Science (Y.M. and T.S.), Graduate School of Medicine, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871 Japan. E-mail address for T. Kaito:
| | - Hideki Yoshikawa
- Departments of Orthopedic Surgery (T.M., T.K., M.K., M.I., and H.Y.) and Orthopedic Biomaterial Science (Y.M. and T.S.), Graduate School of Medicine, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871 Japan. E-mail address for T. Kaito:
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Low parathyroid hormone levels in patients who underwent/would undergo hemodialysis result in bone graft failure after posterolateral fusion. Spine (Phila Pa 1976) 2014; 39:327-31. [PMID: 24299716 DOI: 10.1097/brs.0000000000000132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case series. OBJECTIVE To reveal the association between levels of parathyroid hormone (PTH) and outcome of bone fusion in patients who underwent/would undergo hemodialysis. SUMMARY OF BACKGROUND DATA Among the different bone lesions observed in patients who underwent/would undergo hemodialysis, adynamic bone disease is regarded as a factor associated with bone graft failure because of severely reduced bone turnover. Although PTH levels reflect the pathological findings of bone lesions in patients who underwent/would undergo hemodialysis, the relationship between PTH levels and the outcome of bone fusion in patients who underwent/would undergo hemodialysis has not been investigated. METHODS Patients who underwent/would undergo hemodialysis (n = 48) with lumbar spine lesion underwent posterolateral spinal fusion with instrumentation. The outcome of bone fusion was assessed radiographically 12 months after surgery, and sensitivity and specificity were determined using preoperative PTH levels as the standard. RESULTS A significant difference in PTH levels was observed between the good fusion (mean, 235.4 pg/mL) and poor fusion (mean, 100.0 pg/mL) groups. The intersection of the sensitivity and specificity plots, generated using preoperative PTH levels, was 150 pg/mL, and the area under the receiver operating characteristic curve was 0.72. CONCLUSION Low PTH levels are a risk factor for bone graft failure in patients who underwent/would undergo hemodialysis. Accordingly, PTH level can be a useful predictor of the outcome of bone fusion. LEVEL OF EVIDENCE 4.
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Yamaguchi T, Inoue N, Sah RL, Lee YP, Taborek AP, Williams GM, Moseley TA, Bae WC, Masuda K. Micro-computed tomography-based three-dimensional kinematic analysis during lateral bending for spinal fusion assessment in a rat posterolateral lumbar fusion model. Tissue Eng Part C Methods 2014; 20:578-87. [PMID: 24199634 DOI: 10.1089/ten.tec.2013.0439] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rat posterolateral lumbar fusion (PLF) models have been used to assess the safety and effectiveness of new bone substitutes and osteoinductive growth factors using palpation, radiography, micro-computed tomography (μCT), and histology as standard methods to evaluate spinal fusion. Despite increased numbers of PLF studies involving alternative bone substitutes and growth factors, the quantitative assessment of treatment efficacy during spinal motion has been limited. The purpose of this study was to evaluate the effect of spinal fusion on lumbar spine segment stability during lateral bending using a μCT-based three-dimensional (3D) kinematic analysis in the rat PLF model. Fourteen athymic male rats underwent PLF surgery at L4/5 and received bone grafts harvested from the ilium and femurs of syngeneic rats (Isograft, n=7) or no graft (Sham, n=7). At 8 weeks after the PLF surgery, spinal fusion was assessed by manual palpation, plain radiography, μCT, and histology. To determine lumbar segmental motions at the operated level during lateral bending, 3D kinematic analysis was performed. The Isograft group, but not the Sham group, showed spinal fusion on manual palpation (6/7), solid fusion mass in radiographs (6/7), as well as bone bridging in μCT and histological images (5/7). Compared to the Sham group, the Isograft group revealed limited 3D lateral bending angular range of motion and lateral translation during lateral bending at the fused segment where disc height narrowing was observed. This μCT-based 3D kinematic analysis can provide a quantitative assessment of spinal fusion in a rat PLF model to complement current gold standard methods used for efficacy assessment of new therapeutic approaches.
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Affiliation(s)
- Tomonori Yamaguchi
- 1 Department of Orthopaedic Surgery, School of Medicine, University of California , San Diego, La Jolla, California
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Qiu Z, Wei L, Liu J, Sochacki KR, Liu X, Bishop C, Ebraheim M, Yang H. Effect of intermittent PTH (1-34) on posterolateral spinal fusion with iliac crest bone graft in an ovariectomized rat model. Osteoporos Int 2013; 24:2693-700. [PMID: 23756875 DOI: 10.1007/s00198-013-2385-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 03/13/2013] [Indexed: 10/26/2022]
Abstract
SUMMARY Intermittent treatment with high-dose parathyroid hormone (PTH) enhances the quantity and quality of the fusion callus and reduces healing time of posterolateral spinal fusion with autologous iliac bone grafts in ovariectomized osteoporotic female Sprague-Dawley rats. Intermittent PTH (1-34) could be an appropriate adjunctive therapy for osteoporotic patients undergoing posterolateral intertransverse process fusion. INTRODUCTION The study was designed to test the hypothesis that intermittent administration of PTH improves spinal fusion rates in a randomized controlled, ovariectomized osteoporotic rat spinal fusion model. METHODS Thirty-six 10-week-old Sprague-Dawley rats were ovariectomized and underwent bilateral posterolateral L4-L5 spinal fusion with autologous iliac bone graft 6 weeks later. The experimental (PTH) group (18 rats) received daily subcutaneously administered injections of PTH (1-34) at 30 μg/kg/day starting on the day of operation. The control group (18 rats) received a subcutaneously administered injection of normal saline of the same volume. Nine rats from each group were sacrificed at 4 and 6 weeks. After sacrifice, the L4-L5 vertebral segments were removed and analyzed by plain radiographs, μ-CT, histomorphometry, and serum bone metabolism marker. RESULTS The PTH group had a significantly higher fusion rate and X-ray fusion score than the control group at 4 and 6 weeks (p < 0.05). μ-CT and histological analysis showed that the fusion bone volume and cortical thickness for the PTH group were significantly higher than those for the control group at 4 and 6 weeks (p < 0.05). Metabolic marker analysis also showed significant difference between the two groups. The serum osteocalcin was significantly higher in the PTH group at 4 and 6 weeks, and levels of N-terminal peptide of type I collagen were significantly higher at 4 weeks (p < 0.05). CONCLUSION Intermittent treatment with high-dose PTH enhances the quantity of the fusion callus and reduces the healing time of posterolateral spinal fusion with autologous iliac bone grafts in ovariectomized osteoporotic female Sprague-Dawley rats.
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Affiliation(s)
- Z Qiu
- The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu, 215006, China
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