Clinical effect observation of intravenous application of zoledronic acid in patients with cervical spondylosis and osteoporosis after anterior cervical discectomy and fusion: A randomized controlled study

Abstract

Objective: To observe the clinical effect of zoledronic acid (ZA) in patients with cervical spondylosis and osteoporosis after anterior cervical discectomy and fusion (ACDF) surgery. Methods: All selected patients were divided into the study group and the control group according to the sequence of surgery time. In the study group, 5 mg (100 ml) of ZA was applied intravenously as intervention on the 5 day after ACDF surgery. Patients were followed up regularly after surgery. Results: Forty-three cases completed the follow-ups (21/22), the neck disability index (NDI) score significantly decreased at the 3rd month after surgery in both groups, it came to a plateau at the 6th month after surgery, and it had some rise at the 12th month after surgery, but the NDI score was lower in the study group at the 12th month after surgery (p < 0.05). C-telopeptide of type I collagen (CTX) and amino terminal propeptide of type I procollagen of bone turnover markers in the study group showed a downward trend after surgery, among which CTX decreased significantly and no significant changes in the control group. At the 12th month after surgery, the bone mineral density of lumbar spine area in the study group was significantly improved (p < 0.05). During the 3rd and the 6th month follow-up after surgery, 1/2 osteogenesis rate of the study group was significantly higher (p < 0.05). However, all patients in the two groups obtained stable fusion at the 12th month follow-up after surgery. Conclusions: For patients with cervical spondylosis and osteoporosis, intravenous application of ZA after ACDF surgery can shorten the time of cervical osteogenesis, promote local bone graft fusion, and improve the postoperative clinical effect to some extent.

Best Practice Guidelines for Assessment and Management of Osteoporosis in Adult Patients Undergoing Elective Spinal Reconstruction

“…Both alendronate and zoledronate have been well studied and demonstrated mix efficacy in improving fusion and decrease complications compared with no treatment. 15,45,[56][57][58][59][60][61][62][63][64] Denosumab and romosozumab are two other antiresorptive medications that are monoclonal antibodies. Denosumab was studied once specifically in spine surgery where it is combined with teriparatide and found to be more effective than teriparatide alone.…”

“…In seven of the nine studies that compared teriparatide to BP directly, teriparatide demonstrated a significant benefit comparatively (Supplement Table 3, http://links.lww.com/BRS/ B812 Both alendronate and zoledronate have been well studied and demonstrated mix efficacy in improving fusion and decrease complications compared with no treatment. 15,45,[56][57][58][59][60][61][62][63][64] Denosumab and romosozumab are two other antiresorptive medications that are monoclonal antibodies. Romosozumab is a monoclonal antibody that acts as an anabolic agent by inhibiting sclerostin.…”

“…The primary limitation of anabolic medications is their high cost 16,56 . The literature trends towards teriparatide being a superior treatment in spine surgery.…”

“…[52][53][54][55] The primary limitation of anabolic medications is their high cost. 16,56 The literature trends towards teriparatide being a superior treatment in spine surgery. In seven of the nine studies that compared teriparatide to BP directly, teriparatide demonstrated a significant benefit comparatively (Supplement Table 3, http://links.lww.com/BRS/ B812 Both alendronate and zoledronate have been well studied and demonstrated mix efficacy in improving fusion and decrease complications compared with no treatment.…”

Outcomes of cervical degenerative disc disease treated by anterior cervical discectomy and fusion with self-locking fusion cage

“…The visual analogue scale (VAS) was used to assess pain, and the patients were scored on a 0-10 scale. The higher the VAS score, the more severe the pain[ 10 ]. Cervical spine function was assessed using the Japanese Orthopedic Association (JOA) score[ 11 ] and the neck disability index (NDI)[ 12 ].…”