Andrew Chung, Jerry Robinson, David Gendelberg, Jose Jimenez, Anita Anand, Arya Rao, Babak Khandehroo, Sheila Kahwaty, Neel Anand

October 2023, Volume 32, Issue 10, pp 3651 - 3658 Original Article Read Full Article 10.1007/s00586-023-07859-2

First Online: 08 August 2023


To delineate whether use of a PTH analogue in the 1-year peri-operative period improves lumbar bone density.


A prospectively collected data registry of 254 patients who underwent CMIS correction of ASD (Cobb angle > 20 or SVA > 50 mm or (PI-LL) > 10) from Jan 2011 to Jan 2020 was analysed. Patients who were placed on PTH analogues for one year in conjunction with surgery were included in the study. Ultimately, 41 patients who had pre- and two-year post-operative CT scans for review were included in this study. Hounsfield units were measured off of the L1–L3 levels for all patients before and after surgery on pre-op and post-op CT scans.


The mean age of patients in this study was 70 (52–84, SD 7). Mean follow-up was 66 (24–132, SD 33) months. Twenty-three patients met criteria for severe deformity (Cobb angle > 50 degrees or SVA > 95 mm or PI/LL mismatch > 20 or PT > 30). Based off 2-year post-op CT scan, there were significant improvements in L1 Hounsfield units when comparing pre-op values (96; SD 55) to post-op values (185 SD 102); p. 


The incidence of PTH analogues failing to increase bone density in our series was low at 12%. This study shows that PTH analogues may be a powerful adjunct for increasing bone density and may help to mitigate the risk of mechanical complications in patients undergoing deformity correction with minimally invasive techniques. Future comparative studies are warranted to confirm these latter findings and to potentially protocolize the ideal peri-operative bone health optimization strategy.

Read Full Article