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Tsung-Hsi Tu, Jau-Ching Wu, Li-Yu Fay, Chin-Chu Ko, Wen-Cheng Huang and Henrich Cheng

splitting and the stability of the artificial disc. Consequently, the patient was put in a Miami-J collar for the next 3 months, in addition to taking subcutaneous injections of Forteo (teriparatide [recombinant human parathyroid hormone 1–34], Eli Lilly) at a dosage of 20 μg per day for 6 months. F ig . 3. Postoperative images obtained 2 days after surgery. A and B: Lateral dynamic flexion (A) and extension (B) radiographs demonstrating preserved segmental motion at the C5–6 level without instability. C: Plain anteroposterior radiograph demonstrating a

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Addisu Mesfin, Mostafa H. El Dafrawy, Amit Jain, Hamid Hassanzadeh, John P. Kostuik, Mesfin A. Lemma and Khaled M. Kebaish

surgeries are invasive. However, no difference in the invasiveness scores of these 2 groups was present, which is indicative of a well-matched cohort. To mitigate the increased risk of complications in spinal deformity surgery for patients with RA, we made certain changes to our presurgical and postsurgical protocols. Because most patients are chronically on steroids and have secondary osteoporosis, we recommend starting them on Teriparatide (Forteo Eli Lilly), an anabolic agent for osteoporosis, preoperatively and having them continue it postoperatively. This protocol

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Luke G. F. Smith, Nguyen Hoang, Ammar Shaikhouni and Stephanus Viljoen

radiographic and clinical trunk shift, we were concerned about her risk of distal junctional failure. Therefore, we decided to include her entire lumbar curve and maximize her correction in both the sagittal and coronal planes. Prior to surgical intervention, she was treated with Forteo (Lilly Medical) to maximize bone quality for hardware implantation. Because of her severe cervicothoracic sagittal deformity and lumbar coronal deformity, it was decided that a C2 to pelvis fusion would be performed. FIG. 3. Case 2. Standing scoliosis radiographs obtained before the initial

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Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes

Presented at the 2019 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Anthony L. Mikula, Ross C. Puffer, Jeffery D. St. Jeor, James T. Bernatz, Jeremy L. Fogelson, A. Noelle Larson, Ahmad Nassr, Arjun S. Sebastian, Brett A. Freedman, Bradford L. Currier, Mohamad Bydon, Michael J. Yaszemski, Paul A. Anderson and Benjamin D. Elder


The authors sought to assess whether Hounsfield units (HU) increase following teriparatide treatment and to compare HU increases with changes in bone mineral density (BMD) as measured by dual-energy x-ray absorptiometry (DEXA).


A retrospective chart review was performed from 1997 to 2018 across all campuses at our institution. The authors identified patients who had been treated with at least 6 months of teriparatide and compared HU and BMD as measured on DEXA scans before and after treatment.


Fifty-two patients were identified for analysis (46 women and 6 men, average age 67 years) who underwent an average of 20.9 ± 6.5 months of teriparatide therapy. The mean ± standard deviation HU increase throughout the lumbar spine (L1–4) was from 109.8 ± 53 to 133.9 ± 61 HU (+22%, 95% CI 1.2–46, p value = 0.039). Based on DEXA results, lumbar spine BMD increased from 0.85 to 0.93 g/cm2 (+9%, p value = 0.044). Lumbar spine T-scores improved from −2.4 ± 1.5 to −1.7 ± 1.5 (p value = 0.03). Average femoral neck T-scores improved from −2.5 ± 1.1 to −2.3 ± 1.0 (p value = 0.31).


Teriparatide treatment increased both HU and BMD on DEXA in the lumbar spine, without a change in femoral BMD. The 22% improvement in HU surpassed the 9% improvement determined with DEXA. These results support some surgeons’ subjective sense that intraoperative bone quality following teriparatide treatment is better than indicated by DEXA results. To the authors’ knowledge, this is the first study demonstrating an increase in HU with teriparatide treatment.