Effects of Teriparatide on Complications and Surgical Outcomes in Patients Undergoing Correction of Adult Spinal Deformity: A Retrospective Cohort Study and Cost-Effectiveness Analysis.

Abstract

To provide evidence regarding the effects of teriparatide treatment on mechanical complication, pseudarthrosis, and revision rates in surgical correction for symptomatic adult spinal deformity (SASD), as well as to better define treatment guidelines and assess the cost-effectiveness of treatment. The occurrence of mechanical complications, pseudarthrosis, and revision surgery were obtained in patient's receiving teriparatide treatment as well as in matched controls for a minimum of one year and up to six years postoperatively. Health-related quality of life scores, radiographic parameters, and bone mineral density (BMD) data were collected as secondary measures. A cost-analysis was performed using direct costs of teriparatide treatment and established costs of revision surgery. Each covariate was analyzed using either a χ² or two-tailed t-test. χ² test and contingency tables were used to compare categorical data. Paired t-tests were performed to analyze pre- and post-surgical radiographic and BMD data. All other nominal parametric data were compared using a two-tailed t-test. Preoperative BMD and dual-energy x-ray absorptiometry scores were significantly lower in the treatment arm. The treatment arm had greater preoperative sagittal plane malalignment and greater postoperative correction. The control arm had higher mechanical complication and revision rates. Teriparatide treatment in the context of SASD was found to be cost effective. Teriparatide is an effective treatment for optimization of osteoporotic/osteopenic patients undergoing SASD surgery. Treatment with teriparatide for this patient population is cost-effective. High-powered studies evaluating optimal treatment strategies will be needed to guide future management.