J Rheum Dis.  2011 Jun;18(2):114-117.

Change of the Halo Sign and the Grafted Bone according to the Usage of Teriparatide for the Correction Loss due to Screw Loosening after Corrective Osteotomy

• Park YS
• Kim JH
• Lee CH

Abstract

Among osteoporosis medications, Teriparatide is an agent that promotes bone formation and it seems to have an effect, due to an anabolic mechanism, in the early postoperative period after osteosynthesis or joint replacement. But to the best of our knowledge, the effect of teriparatide on pedicle screw loosening has not been previously reported. We report there on a case of pedicle screw loosening after corrective osteotomy in a patient with ankylosing spondylitis with osteoporosis, which was not improved by teriparatide, and we review the related literature.

Keyword

Teriparatide; Ankylosing spondylitis; Screw loosening

MeSH Terms

Humans
Joints
Osteogenesis
Osteoporosis
Osteotomy
Postoperative Period
Spondylitis, Ankylosing
Teriparatide
Transplants
Teriparatide

Figure

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  Figure 1. The 60 year-old female had a fixed kyphotic deformity with Andersson lesion due to ankylosing spondylitis and osteoporosis (T-score: −2.6). On the radiologic evaluation, the thoracic kyphosis (TK) was 65 o, the lumbar lordosis (LL) was 12 o and the distance between the C7 plumb line and S1 (C7PL) was 59 mm.

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  Figure 2. In the first operation, pedicle subtraction osteotomy at T12 and Smith-Petersen osteotomy at T9-10 were done. In the second operation, anterior corpec-tomy of T9 and anterior interbody fusion with Mesh were done in order to treat the Andersson lesion. The TK was 60 o, the LL was −44 o and the C7PL was 33 mm.

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  Figure 3. The loss of correction with loosening of screws at L1 and L2 (dot arrows) was seen on the computed tomography. We used teriparatide 20μ g once a day to protect against aggravation of the loosening and to achieve early grafted bone union. The grafted bone was not united solidly (solid arrows).

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  Figure 4. The computed tomography after 5 months treatment with the teriparatide demonstrated no specific interval change for the screw loosening (dot arrows). But the grafted bone was united (solid arrows) and there was no additional loss of correction.

Reference

References

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