Perioperative Change in Bone Quality Following Posterior Cervical Fusion and Its Effects on Postoperative Outcomes.

IF 1.7 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2025-09-25 DOI:10.1097/BSD.0000000000001922

Hannah A Levy, Caden Messer, Tissiana Vallecillo, Zachariah W Pinter, Tyler Allen, Harold I Salmons, Sarah Townsley, Karim Nathani, Mohamad Bydon, Jeremy L Fogelson, Benjamin D Elder, Bradford Currier, Ahmad N Nassr, Brett A Freedman, Brian A Karamian, Arjun S Sebastian

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引用次数: 0

Abstract

Study design: Retrospective cohort analysis.

Objective: To determine the effect of long-segment posterior cervical decompression and fusion (PCDF) on perioperative changes in vertebral Hounsfield Units (HUs) and the impact of these changes on radiographic outcomes and fusion status.

Summary of background data: Low preoperative CT HUs have been associated with adverse outcomes after spinal fusion, including hardware complications and reoperation. No existing studies have investigated the preoperative to postoperative change in HUs after cervical spinal fusion. Stress shielding may decrease bone quality within the fusion construct. Whereas, altered junctional loading and increased segmental mobility may precipitate bony hypertrophy in the terminal and adjacent levels.

Methods: All adult patients who underwent C2-T2 PCDF for myelopathy/ myeloradiculopathy at an academic center between 2013 and 2020 were retrospectively identified. Preoperative and postoperative HUs were assessed on axial CT images in the cranial, middle, and caudal C2, C6, T2, and T3 vertebral bodies, outside of the region of instrumentation and artifact by 2 independent reviewers. Paired t test compared preoperative to postoperative changes in HUs. Preoperative and long-term postoperative cervical alignment, fusion, and revision rates were assessed. Univariate and regression analysis compared patient factors and outcomes between groups with perioperative increase versus decrease in vertebral HUs.

Results: One hundred patients were included. The average preoperative to postoperative change in HUs in the C2, C6, T2, and T3 vertebral bodies were -19.80 (P=0.008), -52.63 (P<0.001), 15.15 (P=0.014), and 9.41 (P=0.346), respectively. Perioperative increase in C2 HUs was predictive of increased postoperative distal junctional angle (β=3.41, P=0.048) and increased T1-T4 kyphosis (β=6.50, P=0.003). Perioperative increase in C6 HU predicted pseudoarthrosis (fusion odds ratio: 0.19, P=0.007).

Conclusions: Significant perioperative decreases in C6 HUs within a long-fused construct may demonstrate stress shielding. The significant association between greater distal kyphosis and an increase in C2 HUs may be attributed to a stress riser effect.

Level of evidence: Level III.

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颈椎后路融合术围手术期骨质量的变化及其对术后预后的影响。

研究设计：回顾性队列分析。目的：探讨长节段颈椎后路减压融合术（PCDF）对围手术期椎体霍斯菲尔德单位（HUs）变化的影响及这些变化对影像学结果和融合状态的影响。背景资料总结：术前CT低hu与脊柱融合后的不良结果相关，包括硬体并发症和再手术。目前尚无研究调查颈椎融合术后HUs术前至术后的变化。应力屏蔽可能降低融合结构内的骨质量。然而，关节负荷的改变和节段性活动度的增加可能导致末梢和邻近节段骨肥大。方法：回顾性分析2013年至2020年间在某学术中心因脊髓病/髓根病接受C2-T2 PCDF治疗的所有成年患者。术前和术后的hu由2名独立的审稿人通过轴向CT图像评估颅内、中部和尾侧C2、C6、T2和T3椎体，在器械和假体区域之外。配对t检验比较术前和术后HUs的变化。评估术前和术后长期颈椎对准、融合和翻修率。单因素和回归分析比较围手术期椎体HUs增加和减少组之间的患者因素和结果。结果：纳入100例患者。C2、C6、T2和T3椎体的hu术前至术后平均变化分别为-19.80 （P=0.008）、-52.63 (P)。结论：长融合椎体C6 hu围手术期显著降低可能证明了应力屏蔽。较大的远端后凸和C2 HUs增加之间的显著关联可能归因于应力上升效应。证据等级：三级。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.