Jon Ottesen1*, Hans Tropp1,2.3 and Torsten Johansson4
1Department of Orthopedics, Linkoping University, Sweden
2Department of Clinical and Experimental Medicine, Linkoping University, Sweden
3Centre for Medical Image Science and Visualization (CMIV), Linkoping University, Sweden
4Department of Orthopedics, Vrinnevi Hospital, Sweden
Earlier studies have shown Positive Effects of Teriparatide (PTH 1-34) on fracture healing in animal models and in humans. The clinical and radiological effects of PTH on Posterolateral Lumbar Fusion (PLF) in humans are still unclear. The primary aim of this study was to determine whether PTH enhances fusion on computed tomography scans 6 months and more than 2 years after uninstrumented PLF. Secondary aims were evaluation of pain, function and quality of life at 3 and 6 months and >2 years postoperatively. Uninstrumented PLF surgery was performed on 33 patients with lumbar spinal stenosis at 1 or 2 levels. The patients were randomized postoperatively into a PTH group or a control group. In the PTH group, a daily dose of PTH for 28 days was initiated within 2 days postoperatively. At postoperative follow-up at 3, 6 months and >2 years, pain (Visual Analogue Scale [VAS]/ Numerical Rating Scale [NRS]), the Oswestry Disability Index (ODI) and quality of life (EQ-5D) were recorded. The grade of fusion was assessed with 3D computed tomography scans 6 months and 2 years postoperatively by two independent radiologists. The results for radiographic PLF, VAS/NRS, ODI, and EQ-5D were similar in both groups. Fusion in both groups had no influence on ODI. A daily dose of PTH subcutaneously over a 28-day period did not enhance posterolateral lumbar fusion or clinical outcome compared with controls in patients with lumbar spinal stenosis at 1 or 2 levels.
Ottesen J, Tropp H, Johansson T. Teriparatide (PTH 1-34) Seems not to Enhance Spinal Fusion in Humans: A Prospective Randomized Study on 33 Patients. Clin Surg. 2021; 6: 3312..