Utility of the vertebral bone quality score to predict complications after spine surgery: a systematic review.

IF 3.1 2区 医学 Q2 CLINICAL NEUROLOGY
Jacob D Greisman, Esteban Quiceno, Mohamed A R Soliman, Raphael Bastianon Santiago, Asham Khan, Jeffrey P Mullin, John Pollina
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引用次数: 0

Abstract

Objective: The MRI-based vertebral bone quality (VBQ) score has emerged as a safe, convenient alternative to dual energy x-ray absorptiometry (DEXA) and CT for preoperative bone health assessment, which correlates with the outcomes of spine surgery. In this study, the authors aimed to systematically review the literature characterizing the utility of the VBQ score in predicting postoperative complications to inform operative planning and patient management.

Methods: This systematic review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration no. CRD42024542755) and adhered to PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched for all original research published between January 1, 2020, and May 20, 2024, that had analyzed the VBQ score as a predictor of postoperative complications following spine surgery including pedicle screw loosening (PSL), cage subsidence (CS), adjacent segment disease (ASD), proximal junctional kyphosis (PJK) or proximal junctional failure (PJF), distal junctional kyphosis (DJK) or distal junctional failure (DJF), vertebral refracture, and need for reoperation. Applications of the VBQ score and its derivatives were characterized across methods, demographics, and outcomes. The Newcastle-Ottawa Scale was used for study quality assessment.

Results: Twenty-seven studies comprising 4068 patients, 60.5% of whom were female, with a mean age of 58.5 ± 17.0 years were eligible for study inclusion. Sixteen studies used the traditional VBQ score calculation (L1-4/L3); alternatives included C3-6/C2 (5 studies), C3-6/C5 (1 study), L1-5/L3 (1 study), L4-5/L3 (1 study), and S1/L3 (3 studies). The VBQ score significantly predicted PSL (ranges: thresholds 2.9-3.175, areas under the curve [AUCs] 0.72-0.77, ORs 1.02-5.778), CS (thresholds 2.68-4.10, AUCs 0.785-0.99, ORs 1.513-23.158), ASD (thresholds 2.91-2.95, AUCs 0.934-0.963, ORs 1.509-1.601), PJK or PJF (thresholds 2.715-3.205, AUCs 0.721-0.943, ORs 1.745-26.49), DJK or DJF (threshold 2.66, AUC 0.935, OR 1.46), refracture (combined T1- and T2-weighted VBQ nomogram threshold 0.73, and ratio of adjacent to injured vertebral levels VBQ score < 1.4; AUCs 0.753-0.838, ORs 0.32-2.239), and reoperation (threshold 2.6 to > 3, AUCs 0.702-0.808, ORs 1.569-2.096).

Conclusions: The data suggested that the VBQ score serves as a safe, convenient measure to predict complications after spine surgery. The lowest thresholds reported across all complications were 2.66 in the cervical spine and 2.6 in the lumbar spine, which may serve as rough cutoffs for prompting further patient testing. However, methodological heterogeneity limits guideline development. Future research with consistent methodology is necessary. Systematic review registration no.: CRD42024542755 (www.crd.york.ac.uk/prospero).

椎体骨质量评分在预测脊柱手术后并发症中的应用:一项系统综述。
目的:基于mri的椎体骨质量(VBQ)评分已成为一种安全、方便的替代双能x线吸收仪(DEXA)和CT的术前骨健康评估方法,它与脊柱手术的结果相关。在这项研究中,作者旨在系统地回顾描述VBQ评分在预测术后并发症方面的应用的文献,为手术计划和患者管理提供信息。方法:本系统评价在国际前瞻性系统评价登记册(PROSPERO)前瞻性注册,注册号为:CRD42024542755),并遵守PRISMA指南。PubMed, Embase和Cochrane数据库检索了2020年1月1日至2024年5月20日期间发表的所有原始研究,这些研究分析了VBQ评分作为脊柱手术术后并发症的预测因子,包括椎弓根螺钉松动(PSL),笼沉降(CS),邻近节段疾病(ASD),近端结缔组织后凸(PJK)或近端结缔组织衰竭(PJF),远端结缔组织后凸(DJK)或远端结缔组织衰竭(DJF),椎体再骨折,需要再手术。VBQ评分及其衍生品的应用在方法、人口统计和结果方面具有特点。纽卡斯尔-渥太华量表用于研究质量评估。结果:27项研究纳入4068例患者,其中60.5%为女性,平均年龄为58.5±17.0岁。16项研究采用传统的VBQ评分计算方法(L1-4/L3);备选方案包括C3-6/C2(5项研究)、C3-6/C5(1项研究)、L1-5/L3(1项研究)、L4-5/L3(1项研究)和S1/L3(3项研究)。VBQ得分显著预测PSL(范围:阈值为2.8 ~ 3.175,曲线下面积[aus] 0.72 ~ 0.77, or 1.02 ~ 5.778)、CS(阈值2.68 ~ 4.10,aus 0.785 ~ 0.99, or 1.513 ~ 23.158)、ASD(阈值2.91 ~ 2.95,aus 0.934 ~ 0.963, or 1.509 ~ 1.601)、PJK或PJF(阈值2.715 ~ 3.205,aus 0.721 ~ 0.943, or 1.745 ~ 26.49)、DJK或DJF(阈值2.66,AUC 0.935, or 1.46)、再骨折(T1、t2加权联合VBQ图阈值0.73,与损伤椎段比值VBQ评分< 1.4;auc为0.753 ~ 0.838,or为0.32 ~ 2.239),再手术(阈值为2.6 ~ bb0.3, auc为0.702 ~ 0.808,or为1.569 ~ 2.096)。结论:数据提示VBQ评分是一种安全、方便的预测脊柱术后并发症的方法。在所有并发症中报道的最低阈值为颈椎2.66和腰椎2.6,这可以作为提示进一步患者检测的粗略临界值。然而,方法的异质性限制了指南的制定。未来有必要采用一致的方法进行研究。系统评审注册号:: CRD42024542755 (www.crd.york.ac.uk/prospero)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
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