Background: Osteoporotic patients undergoing multi-level anterior cervical discectomy and fusion (ACDF) are at increased risk of pseudarthrosis and perioperative complications, including higher rates of reoperation compared to non-osteoporotic individuals. Teriparatide, an anabolic agent used in osteoporosis treatment, has shown promise in enhancing fusion and reducing complications in lumbar spine procedures, but its role in multi-level ACDF remains unclear.
Purpose: The purpose of this study was to evaluate the impact of postoperative teriparatide use on outcomes in osteoporotic patients undergoing multi-level anterior cervical discectomy and fusion (ACDF). Specifically, the study aimed to determine whether teriparatide could reduce long-term complications such as pseudarthrosis, revision surgery, and mechanical loosening, while also assessing its association with early postoperative complications.
Methods: This retrospective cohort study used the TriNetX research network to identify osteoporotic patients undergoing multi-level ACDF. Patients were divided into two groups: those who received teriparatide postoperatively (n = 69) and those who did not (n = 1,722). After 5:1 propensity score matching based on age, sex, obesity, smoking status, type 2 diabetes, and history of pseudarthrosis, 67 patients in the treatment group and 335 in the control group were analyzed. Multivariate logistic regression assessed 90-day medical and surgical complications and 2-year outcomes including pseudarthrosis, revision surgery, mechanical loosening, and surgical site infection (SSI).
Results: At 90 days, the teriparatide group had significantly higher rates of wound dehiscence (8.96% vs. 1.19%, OR = 5.96, P = 0.011), DVT (10.45% vs. 1.19%, OR = 10.29, P < 0.001), postoperative anemia (19.40% vs. 5.37%, OR = 2.44, P = 0.007), and transfusions (16.42% vs. 2.09%, OR = 4.74, P = 0.002). At 2 years, teriparatide use was associated with significantly lower rates of pseudarthrosis (4.48% vs. 12.24%, OR = 0.16, P < 0.001), revision surgery (7.46% vs. 20.90%, OR = 0.14, P < 0.001), and mechanical loosening (5.97% vs. 7.16%, OR = 0.02, P = 0.004). However, SSI was higher in the teriparatide group at 2 years (8.96% vs. 2.39%, OR = 17.56, P < 0.001).
Conclusions: Postoperative teriparatide treatment in osteoporotic patients undergoing multi-level ACDF was associated with reduced rates of pseudarthrosis, revision, and mechanical loosening at 2 years. However, it was also linked to increased early postoperative complications, including wound dehiscence, anemia, DVT, transfusions, and higher rates of SSI. Clinicians should weigh these risks and benefits when considering teriparatide use in this population.
