Dynamic Bone Metabolism and Inflammatory-Immune Markers for Postoperative Outcome Assessment in Thoracolumbar Burst Fractures.

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2025-09-24 DOI:10.1016/j.wneu.2025.124510

Guanyou Li

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Abstract

Background: Postoperative failure after thoracolumbar burst-fracture fixation is difficult to anticipate using imaging alone. We tested whether early inflammatory biomarkers and bone-formation markers improve risk stratification.

Methods: Prospective cohort of consecutive adults undergoing fixation for T10-L2 burst fractures with 24-month follow-up. The primary endpoint was treatment failure. Secondary endpoints were ≥10% vertebral height loss and ≥10° kyphosis progression. Biomarkers (C-reactive protein (CRP), interleukin-6 (IL-6), bone-specific alkaline phosphatase, osteocalcin, ESR) were measured serially. Primary analyses used the posterior-only cohort; full-cohort models adjusting for approach served as sensitivity checks. Forced-entry multivariable logistic regression quantified associations; performance was assessed with AUC and calibration. Prespecified sensitivities adjusted for infections ≤3 months and NSAID/steroid exposure near the two-week draw.

Results: Of 196 screened, 174 were analyzed (posterior-only n=138); 50/174 (28.7%) met the primary endpoint. In posterior-only patients, two-week CRP (7.8 vs 4.1 mg/L; p=0.006) and IL-6 (16.8 vs 12.5 pg/mL; p=0.028) were higher in failures. Adjusted models showed TLICS ≥ 5 (OR 2.35, 95% CI 1.02-5.42), CRP ≥ 5 mg/L (OR 2.12, 1.22-3.70), and IL-6 ≥ 7 pg/mL (OR 1.63, 1.01-2.67) predicted failure; AUC = 0.75 (optimism-corrected 0.73) with good calibration. Two-week CRP/IL-6 provided peak discrimination (AUCs 0.73/0.70) and increased a baseline clinical AUC from 0.66 to 0.75. Associations persisted after infection and medication adjustments. Radiographic progression was more frequent in failures and associated with TLICS and, for height loss, CRP.

Conclusions: Two-week CRP and IL-6, combined with TLICS, identify patients at risk of postoperative treatment failure after thoracolumbar burst-fracture fixation and support biomarker-guided surveillance.

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动态骨代谢和炎症免疫标志物对胸腰椎爆裂骨折术后预后的评估。

背景：仅凭影像学很难预测胸腰椎爆裂骨折内固定术后的失败。我们测试了早期炎症生物标志物和骨形成标志物是否能改善风险分层。方法：连续接受T10-L2爆裂骨折固定治疗的成人前瞻性队列，随访24个月。主要终点是治疗失败。次要终点为≥10%椎体高度损失和≥10°后凸进展。连续测定生物标志物（c反应蛋白（CRP）、白细胞介素-6 （IL-6）、骨特异性碱性磷酸酶、骨钙素、ESR）。初步分析采用纯后验队列；调整方法的全队列模型作为敏感性检查。强行进入多变量logistic回归定量关联；用AUC和校准法评估其性能。根据感染≤3个月和接近两周的非甾体抗炎药/类固醇暴露调整预先指定的敏感性。结果：在筛选的196例中，分析了174例（仅后验n=138）；50/174（28.7%）达到了主要终点。在单纯术后患者中，两周CRP （7.8 vs 4.1 mg/L, p=0.006）和IL-6 （16.8 vs 12.5 pg/mL, p=0.028）在失败患者中较高。调整后的模型显示，TLICS≥5 （OR 2.35, 95% CI 1.02-5.42）、CRP≥5 mg/L （OR 2.12, 1.22-3.70）和IL-6≥7 pg/mL （OR 1.63, 1.01-2.67）预测失败；AUC = 0.75（乐观校正0.73），校准良好。两周CRP/IL-6提供了峰值识别（AUC 0.73/0.70），并将基线临床AUC从0.66增加到0.75。这种关联在感染和药物调整后仍然存在。x线摄影进展在失败中更常见，与TLICS相关，对于身高下降，与CRP相关。结论：两周CRP和IL-6联合TLICS可识别胸腰椎爆裂骨折固定术后治疗失败风险患者，并支持生物标志物引导监测。

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

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS