Asian Spine Journal最新文献

{"title":"Biomechanical comparison of multirod constructs for severe thoracolumbar Pott's deformity following posterior vertebral column resection: a finite element study.","authors":"Junlong Zhong, Wen Tan, Shengbiao Ma, Zhifen Yuan, Pihua Wen, Zhenhai Zhou, Jiachao Xiong, Honggui Yu, Kai Cao","doi":"10.31616/asj.2025.0614","DOIUrl":"https://doi.org/10.31616/asj.2025.0614","url":null,"abstract":"<p><strong>Study design: </strong>Finite element study.</p><p><strong>Purpose: </strong>This study aimed to compare the biomechanical performance of three multirod constructs used in posterior vertebral column resection (PVCR) for severe thoracolumbar Pott's deformity.</p><p><strong>Overview of literature: </strong>The optimal configuration of the multirod constructs for spinal deformity correction remains controversial.</p><p><strong>Methods: </strong>A patient-specific three-dimensional spinal model was constructed, and PVCR was simulated using modeling software. Three fixation configurations were evaluated: (A) conventional dual rods with accessory rods bridging the osteotomy site, (B) short-segment fixation adjacent to the osteotomy with long proximal and distal rods, and (C) long rods engaged with staggered screws. A 10-N·m moment was applied to simulate flexion, extension, lateral bending, and axial rotation. Implant stress and vertebral displacement were recorded for each model.</p><p><strong>Results: </strong>Under flexion, the maximum implant stresses of Models A, B, and C were 92, 99, and 131.1 MPa, respectively, occurring at the most cranial screws. Under extension, the corresponding values were 95, 101, and 131.6 MPa, respectively, occurring at the most cranial screws. Under lateral bending, the maximum stresses were 125.9, 118.5, and 155 MPa, respectively, at the cranial rod segments. Under axial rotation, the corresponding values were 213.7, 199, and 214 MPa, respectively, at the most cranial screws. The respective maximum vertebral displacements for Models A, B, and C were 2.4, 2.5, and 2.8 mm in flexion; 2.7, 2.8, and 3.1 mm in extension; 1.3, 1.4, and 2.3 mm in lateral bending; and 1.6, 2.4, and 2.1 mm in rotation.</p><p><strong>Conclusions: </strong>Implant stress in PVCR was predominantly concentrated at the most cranial screws and cranial rod segments. In this finite element analysis, Models A and B demonstrated lower implant stress and construct displacement than Model C under most loading conditions.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute-phase rehabilitation for osteoporotic vertebral fractures: current evidence from scoping review.","authors":"Tomoyoshi Sakaguchi, Masato Tanaka, Ingrid Frances Dizon Ignacio, Tadashi Komatsubara, Ryo Ugawa, Yosuke Yasuda, Kazuhiko Takamatsu, Moeka Ueda, Kaoruko Ishihara, Yuka Hirose","doi":"10.31616/asj.2026.0333","DOIUrl":"10.31616/asj.2026.0333","url":null,"abstract":"<p><strong>Study design: </strong>Scoping review.</p><p><strong>Purpose: </strong>To map and summarize current evidence on acute-phase rehabilitation in patients with osteoporotic vertebral fractures (OVFs), with particular emphasis on intervention characteristics, safety, and clinical effectiveness.</p><p><strong>Overview of literature: </strong>Existing reviews on osteoporotic vertebral compression fractures have predominantly focused on pharmacological or bracing strategies, whereas evidence regarding rehabilitation in the acute phase remains limited.</p><p><strong>Methods: </strong>A literature search was performed using PubMed, Google Scholar, and the Physiotherapy Evidence Database to identify studies published between January 2015 and December 2025. Eligible studies included patients with vertebral compression fractures or OVFs who underwent rehabilitation or exercise-based interventions within 4 weeks of symptom onset. Extracted data were narratively synthesized.</p><p><strong>Results: </strong>This review identified 1,034 records and included seven studies. The included studies were heterogeneous in design and enrolled between 34 and 40,743 participants. In most studies, rehabilitation was initiated within 2 weeks of onset, with several studies reporting initiation within 3 days of admission. Early initiation of rehabilitation within 3 days was associated with greater improvements in the Barthel index (BI) (p <0.001). Longer daily rehabilitation duration was associated with BI gains of 7.28-10.24 points. Provision of rehabilitation through the week, including weekends, was linked to higher BI scores at discharge (B =3.92, p <0.001) and reduced readmission rates (odds ratio, 0.907; p =0.008). No serious adverse events were reported.</p><p><strong>Conclusions: </strong>Acute-phase rehabilitation for patients with OVF appears to be safe and may contribute to improved functional recovery and favorable clinical outcomes, particularly when initiated within 2 weeks of onset and preferably within the first 3 days. Further prospective studies are warranted to establish the optimal rehabilitation program during the acute phase.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"805-816"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the letter to the editor: Dissecting the enigma: insights from a retrospective study from India on congenital craniovertebral junction anomalies.","authors":"Deepika Jain, Tushar Rathod, Yash Prakash Ved, Arjit Vashishtha","doi":"10.31616/asj.2026.0628.r2","DOIUrl":"10.31616/asj.2026.0628.r2","url":null,"abstract":"","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"20 4","pages":"829-831"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropathic pain and sarcopenia based on skeletal muscle mass assessment following lumbar spinal stenosis surgery: a prospective observational study in Japan.","authors":"Kohei Uomi, Yoshihito Sakai, Tsuyoshi Watanabe, Hiroki Matsui, Ryo Sato, Yui Adachi, Yosuke Takeichi, Tatsuhide Tanaka","doi":"10.31616/asj.2026.0244","DOIUrl":"10.31616/asj.2026.0244","url":null,"abstract":"<p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Purpose: </strong>To investigate the relationship between neuropathic pain (NeP) and skeletal muscle mass following lumbar spinal stenosis (LSS) surgery.</p><p><strong>Overview of literature: </strong>Sarcopenia generally worsens clinical outcomes in degenerative diseases. Although a high prevalence of sarcopenia is observed in patients with LSS, it is reported that sarcopenia does not significantly affect the clinical symptoms of lumbar degenerative diseases; thus, its role must be reconsidered in LSS alongside other factors such as spinal alignment and degree of stenosis.</p><p><strong>Methods: </strong>We prospectively evaluated improvements in leg pain and lower limb skeletal muscle mass in 421 patients who underwent surgical treatment for LSS. Bilateral limb muscle mass was compared in 260 patients with unilateral leg pain. The association between postoperative muscle mass increase and improvement in leg pain (Visual Analog Scale [VAS] score <3) was assessed using multivariate logistic regression analysis.</p><p><strong>Results: </strong>Preoperatively, the affected limb exhibited significantly reduced muscle mass compared to the unaffected limb. Postoperatively, the affected side gained muscle mass, which was significantly greater than the unaffected side. Leg pain VAS score <3 and the epidural sac area were significantly associated with increased muscle mass postoperatively. Patients with postoperative improvement in leg pain showed a significant increase in muscle mass compared to those without improvement.</p><p><strong>Conclusions: </strong>In unilateral LSS, the affected limb undergoes significant muscle mass loss, which improves postoperatively with rehabilitation. The increase in muscle mass correlates with improvements in leg pain, indicating a potential relationship between NeP and sarcopenia.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"656-667"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed tomography-derived Hounsfield unit mapping for pedicle screw planning in degenerative lumbar disease: a narrative review.","authors":"Shabir Ahmed Dhar, Reyaz Ahmed Dar, Tarsem Lal Motten, Tahir Ahmad Dar, Sabqat Farooq, Abdul Maajid, Asim Maqbool","doi":"10.31616/asj.2026.0273","DOIUrl":"10.31616/asj.2026.0273","url":null,"abstract":"<p><p>Pedicle screw loosening is a common and clinically significant complication of instrumented lumbar fusion and is reported in 15%-30% of screws in osteoporotic patients. Dual-energy X-ray absorptiometry (DEXA)-based bone mineral density (BMD) has long served as the standard preoperative assessment tool; however, its well-recognized limitations in the degenerative spine and its modest correlations with fixation strength have prompted growing interest in computed tomography (CT)-derived bone quality metrics as complementary alternatives. This study aims to synthesize the current evidence based on CT-derived Hounsfield unit (HU) measurements as preoperative predictors of pedicle screw insertional torque and postoperative screw loosening in degenerative lumbar fusion surgery, with a specific focus on trajectory-specific techniques. A narrative review of studies indexed in PubMed and MEDLINE (1990-2026) was conducted using the following search terms: 'Hounsfield units pedicle screw,' 'CT bone quality lumbar fusion,' 'screw loosening BMD,' 'trajectory HU insertional torque,' and 'vertebral bone quality score.' Studies were included if they reported quantitative bone quality metrics in adult patients undergoing lumbar instrumented fusion with outcomes of insertional torque or radiographic screw loosening. Non-human or cadaveric-only studies were excluded unless they were directly relevant to clinical threshold derivation. Multiple retrospective studies consistently demonstrated that trajectory-specific HU, measured within a cylindrical or single-slice region of interest matched to the planned screw trajectory, outperformed lumbar and femoral DEXA in correlating with insertional torque (r=0.75 vs. r=0.55-0.59) and predicting 12-month screw loosening. Three-dimensional trajectory HU and single-slice measurements both showed clinical utility, with proposed exploratory thresholds of 110-123 HU, although these values were derived from single-center, heterogeneous CT acquisition protocols and were not validated across institutions. The magnetic resonance imaging-based Vertebral Bone Quality score demonstrated comparable performance to vertebral body HU for overall loosening prediction, although trajectory-specific comparisons have not yet been published. The evidence supports an emerging framework for transitioning from systemic DEXA-based BMD to localized, trajectoryspecific CT-HU assessment as a complementary tool for preoperative pedicle screw planning. Prospective validation, standardization of measurement protocols, cross-scanner calibration, and integration into surgical navigation platforms are the critical next steps before clinical translation can be recommended.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"795-804"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical sarcopenia and frailty as complementary predictors of postoperative outcomes after odontoid fracture fixation: a retrospective cohort study in the United States.","authors":"Sapan Patel, Hershil Patel, Rohan Iyer Suresh, Bibhas Amatya, Sourabh Vellala, Mario Sahlani, Anthony Kohler Chiu, Hans Prakash, Evan Honig, Usman Zareef, Ryan Curto, Alexander Padovano, Louis Bivona, Daniel Lee Cavanaugh, Eugene Young Koh, Steven Ludwig, Julio Jose Jauregui","doi":"10.31616/asj.2026.0268","DOIUrl":"10.31616/asj.2026.0268","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>To compare three cervical sarcopenia metrics and frailty as preoperative predictors of unfavorable postoperative outcomes following surgical fixation of odontoid fractures.</p><p><strong>Overview of literature: </strong>Sarcopenia is increasingly recognized as an indicator of physiologic vulnerability in spine surgery and thoracolumbar trauma. However, its prognostic significance in odontoid fractures remains unclear, and no previous study has directly compared cervical sarcopenia measurement sites in this population.</p><p><strong>Methods: </strong>Adult patients who underwent surgical fixation of traumatic odontoid fractures at a single level I trauma center were retrospectively reviewed. Sarcopenia was quantified on perioperative computed tomography using sternocleidomastoid, prevertebral, and paraspinal cross-sectional area normalized to the C3 vertebral body area. Frailty was assessed using the 5-factor modified frailty index (mFI-5), with hypertension status confirmed through a review of prescribed medications. Associations with postoperative outcomes were evaluated using threshold-based analyses, intercorrelation testing, subgroup analysis of combined low-sarcopenia/high-frailty patients, and an exploratory Combined Sarcopenia-Frailty Score.</p><p><strong>Results: </strong>This study included 61 patients (mean age, 61.7 years; 50.8% female). The three sarcopenia metrics were only modestly intercorrelated (Spearman rho, 0.34-0.47), with 46.7%-53.3% overlap among patients in the most sarcopenic quartiles. No individual sarcopenia or mFI-5 threshold independently predicted postoperative outcomes. However, patients in the most sarcopenic quartile on any cervical metric with an mFI-5 ≥2 (n=11) experienced higher rates of mortality, urinary tract infection, pneumonia, and nonunion. In exploratory receiver operating characteristic analysis, the Combined Sarcopenia-Frailty Score exhibited moderate discrimination for significant adverse events, with an area under the curve of 0.73 and an optimal threshold of ≥9.</p><p><strong>Conclusions: </strong>Cervical sarcopenia and frailty were not independently associated with adverse outcomes following odontoid fracture fixation. However, their combination identified patients at substantially higher risk for mortality, complications, and nonunion, supporting a potential role for combined preoperative risk stratification (Level of Evidence: level III).</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"687-697"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: Dissecting the enigma: insights from a retrospective study from India on congenital craniovertebral junction anomalies.","authors":"Sharath Raj, Souvik Das, Vijay G Goni","doi":"10.31616/asj.2026.0628.r1","DOIUrl":"10.31616/asj.2026.0628.r1","url":null,"abstract":"","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"20 4","pages":"827-828"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: Cohort overlap and measurement timing considerations in a study of intraoperative T1 tilt and postoperative shoulder imbalance.","authors":"Sharath Raj, Vijay Goni","doi":"10.31616/asj.2026.0677.r1","DOIUrl":"10.31616/asj.2026.0677.r1","url":null,"abstract":"","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"20 4","pages":"819-820"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcopenia and paraspinal muscle degeneration in adults with spinal deformity surgery: a systematic review and proposal of the Global Alignment and Proportion modification framework.","authors":"Dong-Ju Lim, Joon-Il La","doi":"10.31616/asj.2026.0270","DOIUrl":"10.31616/asj.2026.0270","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review with the proposal of a conceptual sarcopenia-integrated Global Alignment and Proportion modification (GAP-M) for future validation.</p><p><strong>Purpose: </strong>This study aims to synthesize evidence on sarcopenia and paraspinal muscle degeneration in adults with spinal deformity (ASD) and evaluate whether current evidence supports incorporating muscle-related metrics into the Global Alignment and Proportion (GAP) score.</p><p><strong>Overview of literature: </strong>Alignment-based parameters alone cannot account for all mechanical complications following ASD correction. Regional paraspinal muscle degeneration, particularly near the upper instrumented vertebra (UIV), may weaken posterior dynamic support, whereas systemic sarcopenia reflects overall frailty and perioperative risk.</p><p><strong>Methods: </strong>A systematic search of PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and Google Scholar was conducted through May 23, 2026. Eligible studies included adults with ASD, used quantifiable muscle metrics, and reported alignment, mechanical, functional, or perioperative outcomes. Because definitions, measurement levels, and effect estimates varied widely across studies, a quantitative meta-analysis was not performed, and instead a narrative evidence-mapping approach was employed.</p><p><strong>Results: </strong>Of the 507 identified records, 229 were screened, and 50 full-text articles were examined for eligibility; 35 were excluded for documented reasons, leaving 15 primary studies (approximately 1,482 patients). No study directly evaluated whether adding sarcopenia metrics improves GAP score discrimination or reclassification. UIV-adjacent paraspinal muscle quality emerged as the most consistent predictor of proximal junctional kyphosis/failure (five of six studies), while psoas and systemic sarcopenia metrics demonstrated more mixed associations.</p><p><strong>Conclusions: </strong>Paraspinal muscle degeneration appears to be a clinically relevant risk marker in ASD surgery, although current evidence does not yet validate GAP-M for routine clinical use. We therefore propose a provisional 0 to +2-point Muscle-Quality Modifier as a testable framework that requires prospective multicenter validation with standardized UIV-adjacent imaging metrics and direct comparisons of GAP and GAP-M before clinical adoption.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"742-753"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trabecular bone score beyond bone mineral density for identifying osteoporotic vertebral compression fractures: a matched case-control study.","authors":"Rathapoom Suwanaratana, Attaporn Lawanprasert, Nuttawut Chanalithichai","doi":"10.31616/asj.2026.0394","DOIUrl":"10.31616/asj.2026.0394","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective sex- and age-matched case-control study.</p><p><strong>Purpose: </strong>To assess bone mineral density (BMD)-trabecular bone score (TBS) discordance and high-burden abdominal aortic calcification (AAC) in patients with radiographically confirmed osteoporotic vertebral compression fracture (OVCF).</p><p><strong>Overview of literature: </strong>Conventional BMD thresholds may fail to identify all patients with vertebral skeletal fragility, as vertebral fractures can occur despite nonosteoporotic BMD. TBS complements BMD by evaluating trabecular microarchitecture, while AAC may serve as a marker of systemic bone-vascular health associated with skeletal fragility.</p><p><strong>Methods: </strong>This retrospective sex- and age-matched case-control study enrolled patients aged ≥50 years who underwent dual-energy X-ray absorptiometry (DXA) with TBS assessment and vertebral imaging. OVCF was defined as a Genant grade 2 or 3 vertebral fracture. The primary cohort included 47 OVCF patients and 188 matched controls. BMD T-scores at the lumbar spine, femoral neck, total hip, TBS, and AAC-24 were evaluated. Matched conditional logistic regression was used to determine associations with OVCF.</p><p><strong>Results: </strong>More than half of OVCF patients did not demonstrate osteoporotic BMD at any measured DXA site (53.2%). Among those with nonosteoporotic BMD, low TBS was more common in cases than in controls (48.0% vs. 22.7%). Low TBS remained independently associated with OVCF after adjusting for the lowest BMD T-score and high-burden AAC (odds ratio, 2.66; 95% confidence interval, 1.25-5.63; p =0.011). High-burden AAC was more frequent among cases, although its association was attenuated after adjustment.</p><p><strong>Conclusions: </strong>Low TBS may aid in identifying vertebral skeletal fragility in OVCF patients with nonosteoporotic BMD on conventional DXA. High-burden AAC may provide vascular information, although its incremental association beyond BMD and TBS was attenuated.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"676-686"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}