Global Spine Journal最新文献

{"title":"Machine Learning Prediction Model and Risk Factor Analysis of Reoperation in Recurrent Lumbar Disc Herniation Patients After Percutaneous Endoscopic Lumbar Discectomy.","authors":"Zheng-Ming Shan, Xue-Song Ren, Hang Shi, Shi-Jie Zheng, Cong Zhang, Su-Yang Zhuang, Xiao-Tao Wu, Xin-Hui Xie","doi":"10.1177/21925682231173353","DOIUrl":"10.1177/21925682231173353","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective, matched case-control study.</p><p><strong>Objective: </strong>To investigate the risk factors of reoperation after percutaneous endoscopic lumbar discectomy (PELD) due to recurrent lumbar disc herniation (rLDH) and to establish a set of individualized prediction models.</p><p><strong>Methods: </strong>Patients who underwent PELD successfully from January 2016 to February 2022 in a single institution were enrolled in this study. Six methods of machine learning (ML) were used to establish an individualized prediction model for reoperation in rLDH patients after PELD, and these models were compared with logistics regression model to select optimal model.</p><p><strong>Results: </strong>A total of 2603 patients were enrolled in this study. 57 patients had repeated operation due to rLDH and 114 patients were selected from the remaining 2546 nonrecurrent patients as matched controls. Multivariate logistic regression analysis showed that disc herniation type (<i>P</i> < .001), Modic changes (type II) (<i>P</i> = .003), sagittal range of motion (sROM) (<i>P</i> = .022), facet orientation (FO) (<i>P</i> = .028) and fat infiltration (FI) (<i>P</i> = .001) were independent risk factors for reoperation in rLDH patients after PELD. The XGBoost AUC was of 90.71%, accuracy was approximately 88.87%, sensitivity was 70.81%, specificity was 97.19%. The traditional logistic regression AUC was 77.4%, accuracy was about 77.73%, sensitivity was 47.15%, specificity was 92.12%.</p><p><strong>Conclusion: </strong>This study showed that disc herniation type (extrusion, sequestration), Modic changes (type II), a large sROM, a large FO and high FI were independent risk factors for reoperation in LDH patients after PELD. The prediction efficiency of XGBoost model was higher than traditional Logistic regression analysis model.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9808992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Sagittal Alignment and Balance Associated With Aging Chinese Adults: A Radiographic Analysis.","authors":"Linyu Jin, Yan Liang, Chen Guo, Bin Zheng, Haiying Liu, Shuai Xu","doi":"10.1177/21925682231172125","DOIUrl":"10.1177/21925682231172125","url":null,"abstract":"<p><strong>Study design: </strong>This was a retrospective cohort radiographic study.</p><p><strong>Objective: </strong>To determine the age- and gender-related normative values and correlation of cervical sagittal parameters in asymptomatic Chinese adults, and to explore the changes and compensating mechanisms across different age groups.</p><p><strong>Methods: </strong>The asymptomatic subjects were divided into 6 groups according to age and then one-way analysis of variance was used to compare the multiple sets of cervical sagittal parameters among the different age groups. Independent t-tests were performed to compare the sagittal parameters among different gender and different cervical spine alignments. Relationships between each parameter were tested by Pearson's correlation. Linear regression analysis based on T1 slope (T1S) and C2 slope (C2S) was used to provide an equation to predict normal cervical alignment.</p><p><strong>Results: </strong>Mean values of each cervical sagittal parameter were presented based on age and gender. There were positive correlations between age and cervical lordosis (CL) (r = -.278, <i>P</i> < .001), T1S (r = .271, <i>P</i> < .001), cervical sagittal vertical axis (cSVA) (r = .218, <i>P</i> < .001), C2-C4 Cobb angle (r = -.283, <i>P</i> < .001), horacic inlet angle (TIA) (r = .443, <i>P</i> < .001), and neck tilt (NT) (r = .354, <i>P</i> < .001). Older groups (aged >50 years) had greater T1 Slope, C2S, and TIA. The C2-C4 Cobb angle maintained a steadily increasing trend and significantly increased in the older adult groups (<i>P</i> < .05), while the C5-C7 Cobb angle was relatively constant. Mean values of parameters were larger in males (<i>P</i> > .05). Linear regression analysis indicated a strong association between T1S and CL (R2 = .551, standard error 1.16°), T1S and C5-7 (R2 = .372; <i>P</i> < .001), and C2S and C2-4 (R2 = .309; <i>P</i> < .001).</p><p><strong>Conclusions: </strong>Normative values of cervical sagittal parameters vary by age and sex. The CL, cSVA, and T1S, C2-4 Cobb angle changed with increasing age, and it can influence the recruitment of compensation mechanism. Normative CL of Chinese adults was predicted by the equation CL = T1S-14.7° ± 1.2°, which could serve as a reference when planning for cervical surgery.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9488007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Separation Operation Followed by Stereotactic Radiotherapy in the Treatment of Spinal Metastasis From Hepatocellular Carcinoma: A Retrospective Cohort Study.","authors":"Bin Liu, Haoliang Chen, Xiangyang Liu, Guoping Wang, Xiongjie Shen","doi":"10.1177/21925682231182332","DOIUrl":"10.1177/21925682231182332","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>Spinal metastasis from hepatocellular carcinoma is rapidly progressive and predisposes to spinal disability, cord compression and further neural injury, leading to poor prognosis. Currently, it is still challenging to look for a treatment strategy that can improve the quality of life of patients and even directly prolong the survival time. This study attempts to evaluate the clinical efficacy of separation operation combined with postoperative stereotactic radiotherapy (SRT/SRS) in the treatment of hepatocellular carcinoma patients developing spinal metastasis and epidural spinal cord compression.</p><p><strong>Methods: </strong>Patients with metastases spinal cord compression from hepatocellular carcinoma were studied retrospectively and divided into two groups, the SO group (who undergo separation operations combined with postoperative SRS, n = 32) and RT group (who received only SRS, n = 28). The visual Analogue Scale (VAS) pain score, Frankel grade, Karnofsky performance score, and Quality of Life (SF-36) score were comparatively analyzed between the two groups.</p><p><strong>Results: </strong>Significantly higher VAS pain scores, Frankel grades, Karnofsky performance scores and Quality of Life (SF-36) scores were demonstrated in patients with combination treatment than in patients with SRS alone.</p><p><strong>Conclusion: </strong>Separation operations are effective surgical procedure for the treatment of spinal metastatic tumor from hepatocellular carcinoma with spinal cord compression. The combination with postoperative SRS can significantly improve the quality of life in this patient population via spinal canal decompression and spinal stability reconstruction.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9951419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-Analysis of Treatment for Adjacent Two-Segment Cervical Spondylotic Myelopathy: A Comparison Between Anterior Cervical Corpectomy and Fusion and Anterior Cervical Discectomy and Fusion.","authors":"Lei Chen, Zhongyi Zhang, Ju Li, Peijian Tong, Taotao Xu","doi":"10.1177/21925682241297586","DOIUrl":"10.1177/21925682241297586","url":null,"abstract":"<p><strong>Study design: </strong>A systematic review and meta-analysis comparing the outcomes of Anterior Cervical Discectomy and Fusion (ACDF) vs Anterior Cervical Corpectomy and Fusion (ACCF) in treating adjacent two-segment cervical spondylotic myelopathy.</p><p><strong>Objective: </strong>To assess the clinical effectiveness and safety of ACDF compared to ACCF.</p><p><strong>Methods: </strong>A literature search was conducted in Cochrane Library, Web of Science, PubMed, and Embase up to December 2023. Studies included were prospective and observational involving ACDF or ACCF for adjacent two-segment cervical spondylotic myelopathy. Data were analyzed using RevMan 5.4 software.</p><p><strong>Results: </strong>Ten studies (nine case-control and one RCT) were included. ACDF showed a shorter hospital stay (SMD = -0.29, 95% CI: -0.53 to -0.04, <i>P</i> < 0.05), better Cobb angle (SMD = 0.52, 95% CI: 0.31 to 0.74, <i>P</i> < 0.01), and improved T1S (SMD = 0.54, 95% CI: 0.28 to 0.80, <i>P</i> < 0.01). No significant differences were found in upper limb VAS, neck VAS, JOA scores, NDI, fusion rates, C2-7 SVA, total complications, blood loss, and operation time.</p><p><strong>Conclusions: </strong>ACDF and ACCF are both effective for adjacent two-segment cervical spondylotic myelopathy, with ACDF offering advantages in hospitalization duration and cervical curvature restoration, making it the preferred surgical approach. Further research is needed to validate these findings.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reevaluating Informed Consent: Integrating Shared Decision-Making into Spinal Surgery for Better Patient Outcomes.","authors":"Jeffrey N Wang, Mohamed A Elhakeem, Matthew J Mesimer, Paul G Mastrokostas, Salman Ahmad, Tim Reed, Brandon Klein, Lucas E Bartlett, Adam D Bitterman, Andrew Megas","doi":"10.1177/21925682241298228","DOIUrl":"10.1177/21925682241298228","url":null,"abstract":"<p><strong>Study design: </strong>Narrative review.</p><p><strong>Objectives: </strong>The objectives of this study were to answer the following questions: (1) What is the quality of informed consent in spine surgery, including both neurosurgery and orthopaedic spine surgery? (2) What limitations impede the ability of surgeons to engage in effective shared decision-making (SDM) and obtain adequate informed consent? (3) What strategies and solutions may improve the quality of informed consent and SDM? (4) What factors decrease the incidence of litigation in spine surgery?</p><p><strong>Methods: </strong>N/A.</p><p><strong>Results: </strong>SDM is a collaborative process where patients are involved in their treatment choices through open communication about risks, alternatives, and postoperative expectations. Informed consent is a vital component of this process, ensuring that patients are fully informed and empowered to make decisions based on their values and preferences. This review highlights the current state of informed consent within the context of SDM in spine surgery and explores how enhancing this process can improve patient outcomes, reduce dissatisfaction, and decrease litigation. By emphasizing patient autonomy and improving the quality of risk communication, SDM fosters better physician-patient relationships and more positive clinical outcomes.</p><p><strong>Conclusions: </strong>Orthopaedic surgery and neurosurgery are highly litigated specialties, with failure to obtain informed consent frequently cited in lawsuits. These legal challenges are costly and time-consuming for both physicians and patients. Integrating SDM into the informed consent process can help mitigate these issues, leading to improved patient satisfaction and fewer legal disputes.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142498911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unsupervised Clustering of Adult Spinal Deformity Patterns Predicts Surgical and Patient-Reported Outcomes.","authors":"Renaud Lafage, Junho Song, Jonathan Elysee, Mitchell S Fourman, Justin S Smith, Christopher Ames, Shay Bess, Alan H Daniels, Munish Gupta, Richard Hostin, Han Jo Kim, Eric Klineberg, Gregory Mundis, Bassel G Diebo, Christopher Shaffrey, Frank Schwab, Virginie Lafage, Douglas Burton","doi":"10.1177/21925682241296481","DOIUrl":"10.1177/21925682241296481","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>To evaluate whether different radiographic clusters of adult spinal deformity identified using artificial intelligence-based clustering are associated with distinct surgical outcomes.</p><p><strong>Methods: </strong>Patients were classified based on the results of a previously conducted analysis that examined clusters of deformity, including Moderate Sagittal (Mod Sag), Severe Sagittal (Sev Sag), Coronal, and Hyper-Thoracic Kyphosis (Hyper-TK). The surgical data, HRQOL, and complication outcomes of these clusters were then compared.</p><p><strong>Results: </strong>The final analysis included 1062 patients. Similar to published results on a different patient sample, Mod Sag and Sev Sag patients were older, more likely to have a history of previous spine surgery, and more disabled. By 2-year, all clusters improved in HRQOL and reached a similar rate of minimal clinically important difference (MCID).The Sev Sag cluster had the highest rate major complications (53% vs 34-40%), and complications leading to reoperation (29% vs 17-23%), implant failures (20% vs 8-11%), and operative complications (27% vs 10-17%). Coronal patients had the highest rate of pulmonary complications (9% vs 3-6%) but the lowest rate of X-ray imbalance (10% vs 19-21%). No significant differences were found in neurological complications, infection rate, gastrointestinal, or cardiac events (all <i>P</i> > .1). Kaplan-Meier survival curves demonstrated a lower time to first complications for the Sev Sag cluster.</p><p><strong>Conclusions: </strong>All clusters of adult spinal deformity benefit similarly from surgery as they all achieved similar rates of MCID. Although the rates of complications varied among the clusters, the types of complications were not significantly different.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142498912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival and Prognostic Factors After Surgery in Single Spinal Metastasis: Comparison of Isolated-Single Spinal Metastasis and Single Spinal Metastasis With Other Metastasis.","authors":"Hyun-Jun Kim, Jin-Sung Park, Se-Jun Park, Dong-Ho Kang, Chong-Suh Lee","doi":"10.1177/21925682241295666","DOIUrl":"10.1177/21925682241295666","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>This study aimed to evaluate the survival period in patients with a single spinal metastasis (SSM), subsequently comparing those with isolated-single spinal metastasis (I-SSM) and single spinal metastasis with other metastasis (O-SSM) after surgery, and to identify prognostic factors affecting their survival.</p><p><strong>Methods: </strong>A total of 135 patients were included, with 24 patients in the I-SSM group and 111 in the O-SSM group. Survival analysis was utilized to assess the survival of SSM patients, followed by a comparison of survival rates between the two groups. Univariate and multivariate analyses were conducted to identify significant prognostic factors for survival.</p><p><strong>Results: </strong>The overall median survival period for patients with single spinal metastasis (SSM) was 10.2 ± 1.8 months. Specifically, the median survival was 15.7 ± 5.7 months in the I-SSM group and 10.2 ± 1.5 months in the O-SSM group. The difference in survival periods between the two groups was not statistically significant (<i>P</i> = 0.345). Significant independent prognostic factors for survival included preoperative Karnofsky Performance Status (KPS) of 50 - 70 (OR 0.51, <i>P</i> = 0.017) and 80 - 100 (OR 0.46, <i>P</i> = 0.012), postoperative ambulatory status (OR 1.19, <i>P</i> = 0.028), and primary malignancy site [Group B (OR 2.67, <i>P</i> = 0.021), Group C (OR 2.90, <i>P</i> = 0.016)].</p><p><strong>Conclusions: </strong>Patients with SSM have a median survival of 10.2 months, with no significant difference in postoperative survival between the I-SSM and O-SSM groups. Significant prognostic factors influencing the survival period after surgery include preoperative KPS, postoperative ambulatory status, and the primary malignancy site.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Machine Learning Algorithms to Predict Postoperative Anterior Bone Loss Following Anterior Cervical Disc Replacement.","authors":"Rui Zong, Can Guo, Jun-Bo He, Ting-Kui Wu, Hao Liu","doi":"10.1177/21925682241293712","DOIUrl":"10.1177/21925682241293712","url":null,"abstract":"<p><strong>Study design: </strong>Machine learning model.</p><p><strong>Objectives: </strong>This study aimed to develop and validate a machine learning (ML) model to predict moderate-severe anterior bone loss (ABL) following anterior cervical disc replacement (ACDR).</p><p><strong>Methods: </strong>A retrospective review of patients undergoing ACDR or Hybrid surgery (HS) at a single center was performed. Patients diagnosed as C3-7 single- or multi-level cervical disc degenerative diseases (CDDD) with more than 2 years of follow-up and complete pre- and postoperative radiological imaging were included. An ML-based algorithm was developed to predict moderate-severe ABL based on perioperative demographic, clinical, and radiographic parameters. Model performance was evaluated in terms of discrimination and overall performance.</p><p><strong>Results: </strong>A total of 339 ACDR segments were included (61.65% female, mean age 45.65 ± 8.03 years). During a follow-up period of 45.65 ± 8.03 months, 103 (30.38%) segments developed moderate-severe ABL. The model demonstrated good discrimination and overall performance according to precision (moderate-severe ABL: 0.71 ± 0.07, none-mild ABL: 0.73 ± 0.08), recall (moderate-severe ABL: 0.69 ± 0.08, none-mild ABL: 0.75 ± 0.07), F1-score (moderate-severe ABL: 0.70 ± 0.08, none-mild ABL: 0.74 ± 0.07), and area under the curve (AUC) (0.74 ± 0.10). The most important predictive features were higher height change, higher post-segmental angle, and longer operation time.</p><p><strong>Conclusions: </strong>Utilizing a ML approach, this study successfully identified risk factors and accurately predicted the development of moderate-severe ABL following ACDR, demonstrating robust discrimination and overall performance. By overcoming the limitations of traditional statistical methods, ML can enhance discovery, clinical decision-making, and intraoperative techniques.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Hounsfield Unit, Vertebral Bone Quality, and Dual-Energy X-Ray Absorptiometry T-Score for Predicting Cage Subsidence After Posterior Lumbar Interbody Fusion.","authors":"Yunsheng Wang, Jiali Zhang, Tong Tong, Dechao Miao, Feng Wang, Linfeng Wang","doi":"10.1177/21925682241293038","DOIUrl":"10.1177/21925682241293038","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>To compare Hounsfield unit (HU), vertebral bone quality (VBQ), and dual-energy X-ray absorptiometry (DEXA) T-score in predicting cage subsidence (CS) after posterior lumbar interbody fusion.</p><p><strong>Methods: </strong>We retrospectively reviewed patients undergoing PLIF and measured L4 HU and VBQ. Baseline characteristics between CS and non-CS groups were compared. Multiple logistic regression analysis was used to identify risk factors for CS. Receiver operating characteristic (ROC) curves were used to explore the predictive value of variables for CS. Subgroup analysis was conducted for patients with available DEXA results.</p><p><strong>Results: </strong>Eighty-four patients were analyzed. The subsidence group was older, with lower L4 HU (92.6 (35.4) vs 130.8 (47.8), <i>P</i> < 0.001) and higher VBQ (3.30 (0.64) vs 2.99 (0.63), <i>P</i> = 0.041) compared to the non-CS group. Low L4 HU (OR 0.979, <i>P</i> = 0.022) was an independent risk factor for subsidence, while VBQ was not. ROC analysis indicated that L4 HU (AUC = 0.733, <i>P</i> < 0.001) exhibited superior predictive performance compared to VBQ (AUC = 0.643, <i>P</i> = 0.032). Subgroup analysis in patients with DEXA showed that the femoral neck T-score (AUC = 0.67, <i>P</i> = 0.037) could differentiate CS, with L4 HU exhibiting the highest predictive ability (AUC = 0.778, <i>P</i> < 0.001), both outperforming VBQ (AUC = 0.645, <i>P</i> = 0.075).</p><p><strong>Conclusions: </strong>Among the three BMD parameters, only low L4 HU could be an independent risk factor for CS. Preoperative HU is mandatory in patients at risk for osteoporosis when undergoing spine surgery.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between Hounsfield Units and Mechanical Failure in ASD Patients.","authors":"Martin Heegaard, Kristin Ingadottir, Lærke Ragborg, Benny Dahl, Lars Valentin Hansen, Søren Ohrt-Nissen, Martin Gehrchen","doi":"10.1177/21925682241291519","DOIUrl":"10.1177/21925682241291519","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study.</p><p><strong>Objectives: </strong>Low bone mineral density (BMD) is a known risk factor for revision surgery in patients with adult spinal deformity (ASD). Hounsfield units (HUs) on CT scans have been suggested as a proxy for assessing BMD. This study aimed to determine HUs in the lumbar region and their association with mechanical failure in patients undergoing ASD surgery.</p><p><strong>Methods: </strong>We included ASD patients undergoing surgery from 2010-2020 with minimum 2-year follow-up. We excluded patients without preoperative CT scans, or a CT scan more than 1 year before surgery. Mechanical failure was defined as proximal junctional failure, pseudarthrosis, or implant failure requiring revision surgery. On preoperative CT scans, HUs were measured on 3 axial slices on each vertebra from L1-L5 and, if available, at UIV and UIV + 1.</p><p><strong>Results: </strong>We included 170 patients, mean age 63 (±12) years, with 108 (64%) females, and 13 [IQR 10-16] instrumented levels. Mechanical failure occurred in 27% (n = 46) of patients at 2-year follow-up. Mean lumbar HUs were 146 (±51) in the mechanical failure group and 135 (±52) in those without revision (<i>P</i> = .232). Area under the curve was 0.58 (95% CI: 0.48-0.68), corresponding to no to low discriminatory power in predicting mechanical failure using lumbar HUs. Univariate logistic regression revealed no significant difference between mechanical failure and lumbar HUs (OR = 1.00, 95% CI: 1.00-1.01, <i>P</i> = .239).</p><p><strong>Conclusions: </strong>We found no association between mechanical failure and HUs on preoperative CT scans in ASD patients. Thus, we cannot recommend using HUs to predict mechanical failure in these patients.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}