Asian Spine Journal最新文献

{"title":"Exploring cortical trajectory of the lumbar vertebrae: a morphometric study in dry skeletons: a retrospective study in Thailand.","authors":"Parika Hanarwut, Sitthichai Iamsaard, Permsak Paholpak, Taweechok Wisanuyotin, Yuichi Kasai, Laphatrada Yurasakpong, Athikhun Suwannakhan, Arada Chaiyamoon","doi":"10.31616/asj.2024.0223","DOIUrl":"10.31616/asj.2024.0223","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>This study aimed to explore the morphometry of the Thai lumbar vertebrae.</p><p><strong>Overview of literature: </strong>The cortical bone trajectory (CBT) is a novel approach for vertebral screw fixation aimed at addressing spinal instability associated with spinal disorders. The morphometry of the lumbar vertebrae is crucial in tailoring screw design for each CBT application, given the significant variations in optimal screw sizes, lengths, and angles among populations.</p><p><strong>Methods: </strong>A total of 300 dried lumbar columns were used to measure the pedicle height (PH) and width (PW), length for cortical bone trajectory (LCT), cephalad screw angle (CSA), axial cortical bone trajectory angle (ACA), and possible cortical zones for the CBT.</p><p><strong>Results: </strong>The following average values were calculated: PH in L1, 15.09±1.44 mm; PW in L5, 16.96±2.42 mm; LCT in L3, 35.75±2.61 mm; CSA in L1, 20.85°±2.30°; and ACA in L5, 21.83°±2.49°. Women generally had shorter PH and PW than men, with significant differences across lumbar levels. The LCT was significantly shorter in women and was notably different between the left and right sides. The CSA and ACA varied significantly between sexes and sides, with specific lumbar levels showing wider angles in one sex over the other. The most common cortical zones for screw tips were Z3 and Z10, with high incidences across all lumbar levels.</p><p><strong>Conclusions: </strong>This study presents detailed lumbar vertebral morphometry data specific to the Thai population. The results are essential for CBT application in screw fixation procedures. This information will contribute to the production of optimally designed screws for Thai patients in the future.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"654-662"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456911","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":"Is minimally invasive surgery a game changer in spinal surgery?","authors":"Sang-Min Park, Ho-Joong Kim, Jin S Yeom","doi":"10.31616/asj.2024.0337","DOIUrl":"10.31616/asj.2024.0337","url":null,"abstract":"<p><p>Minimally invasive spine surgery (MISS) has revolutionized the treatment of spinal disorders over the past few decades. This review provides an in-depth analysis of MISS techniques, technologies, outcomes, and future directions. The evolution of MISS techniques-including tubular retractor systems, percutaneous pedicle screw fixation, minimally invasive transforaminal lumbar interbody fusion, lateral lumbar interbody fusion, and endoscopic spine surgery-has expanded the scope of treatable spinal pathologies while minimizing tissue trauma. Technological advancements such as intraoperative navigation, robotics, and augmented reality applications have enhanced precision and capabilities. Clinical evidence supports the efficacy and safety of MISS techniques for various spinal pathologies, demonstrating comparable or superior outcomes to traditional open approaches with reduced tissue trauma, blood loss, and hospital stays. Cost-effectiveness analyses also favor MISS over open techniques. Future directions in MISS include expanding indications, integrating artificial intelligence and machine learning, advancing tissue engineering and biologics, and refining robotic and augmented reality applications. As MISS continues to evolve, it is poised to play an increasingly important role in the treatment of spinal disorders, offering improved patient outcomes with reduced morbidity. However, ongoing rigorous evaluation of new techniques and technologies is crucial to balance potential benefits with associated risks and costs.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"743-752"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456914","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":"Patient-specific mechanical analysis of pedicle screw insertion in simulated osteoporotic spinal bone models derived from medical images.","authors":"Norihiro Nishida, Hidenori Suzuki, Hanvey Tetsu, Yuki Morishita, Yogesh Kumaran, Fei Jiang, Masahiro Funaba, Kazuhiro Fujimoto, Yusuke Ichihara, Takashi Sakai, Junji Ohgi","doi":"10.31616/asj.2024.0121","DOIUrl":"10.31616/asj.2024.0121","url":null,"abstract":"<p><strong>Study design: </strong>Biomechanical study.</p><p><strong>Purpose: </strong>To investigate the mechanical characteristics of bone models created from medical images.</p><p><strong>Overview of literature: </strong>Recent advancements in three-dimensional (3D) printing technology have affected its application in surgery. However, a notable gap exists in the analyses of how patient's dimorphism and variations in vertebral body anatomy influence the maximum insertional torque (MIT) and pullout strength (POS) of pedicle screws (PS) in osteoporotic vertebral bone models derived from medical images.</p><p><strong>Methods: </strong>Male and female patients with computed tomography data were selected. Dimensions of the first thoracic (T1), fourth lumbar (L4), and fifth lumbar (L5) vertebrae were measured, and bone models consisting of the cancellous and cortical bones made from polyurethane foam were created. PS with diameters of 4.5 mm, 5.5 mm, and 6.5 mm were used. T1 PS were 25 mm long, and L4 and L5 PS were 40 mm long. The bone models were secured with cement, and the MIT was measured using a calibrated torque wrench. After MIT testing, the PS head was attached to the machine's crosshead. POS was then calculated at a crosshead speed of 5 mm/min until failure.</p><p><strong>Results: </strong>The L4 and L5 were notably larger in female bone models, whereas the T1 vertebra was larger in male bone models. Consequently, the MIT and POS for L4 and L5 were higher in female bone models across all PS diameters than in male bone models. Conversely, the MIT for T1 was higher in male bone models across all PS; however, no significant differences were observed in the POS values for T1 between sexes.</p><p><strong>Conclusions: </strong>The mechanical properties of the proposed bone models can vary based on the vertebral structure and size. For accurate 3D surgical and mechanical simulations in the creation of custom-made medical devices, bone models must be constructed from patientspecific medical images.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"621-629"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008160","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":"Adjacent segment degeneration at a minimum 2-year follow-up after posterior lumbar interbody fusion: the impact of sagittal spinal proportion: a retrospective case series.","authors":"Xuepeng Wei, Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Shin Oe, Hideyuki Arima, Koichiro Ide, Tomohiro Yamada, Kenta Kurosu, Yukihiro Matsuyama","doi":"10.31616/asj.2024.0108","DOIUrl":"10.31616/asj.2024.0108","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Purpose: </strong>To investigate the sagittal plane configuration of the entire spine and its association with the risk of adjacent segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF).</p><p><strong>Overview of literature: </strong>Although PLIF has demonstrated satisfactory clinical outcomes, it is associated with ASD. However, the geometric mechanical changes that contribute to the occurrence of ASD are not well characterized.</p><p><strong>Methods: </strong>Radiological parameters were extracted from the whole lateral radiographs. Patients were divided into two groups: the ASD group (segmental kyphosis of ≥10º, and/or a ≥50% loss of disc height, and/or ≥3 mm of anteroposterior translation) and the non-ASD group.</p><p><strong>Results: </strong>All 112 included patients underwent PLIF for lumbar degenerative diseases. The minimum follow-up period was 2 years, with an average follow-up time of 63.6 months. Fifty-two patients (46.4%) were classified into the ASD group and of these, 13 required reoperation due to failure of conservative treatment. Patients with ASD exhibited significantly more caudal and posterior inflection vertebrae (IV), while the lumbar apical vertebra was significantly more caudal immediately after surgery. The IV position was identified as a significant risk factor for ASD, and the ASD incidence was significantly higher in the group where IV ≤5 (L1 vertebral body) than in the group where IV ≥5.5 (T12-L1 disc) (69.0% vs. 38.6%).</p><p><strong>Conclusions: </strong>The IV position is a significant risk factor for ASD development. Although it is difficult to control intraoperative IV levels, we note a high risk of ASD in patients with IV lower than T12-L1.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"681-689"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008157","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":"Utility of cervical dynamic magnetic resonance imaging for evaluating patients with cervical myelopathy: a retrospective study.","authors":"Mrugank Narvekar, Bharatkumar Rajendraprasad Dave, Ajay Krishnan, Devanand Degulmadi, Shivanand Mayi, Ravi Ranjan Rai, Mirant Dave, Charde Pranav, Abhijith Anil, Rohan Killekar, Panthackel Mikeson, Kishor Murkute","doi":"10.31616/asj.2024.0176","DOIUrl":"10.31616/asj.2024.0176","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Purpose: </strong>This study aimed to evaluate the utility of cervical dynamic magnetic resonance imaging (dMRI) in the assessment of cervical canal stenosis.</p><p><strong>Overview of literature: </strong>Cervical spondylotic myelopathy has been intricately linked to both static and dynamic narrowing of the cervical spinal canal. Traditional MRI with the neck in a neutral position fails to identify the dynamic changes and may lead to misdiagnosis. Cervical dMRI is a promising tool for evaluating cervical myelopathy, enabling clinicians to assess spinal cord compression, segmental instability, and alterations in range of motion, often missed on conventional imaging.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 369 patients with symptoms of cervical myelopathy assessed using cervical dMRI. After assessing the subaxial cervical spine at each disc level (C3-T1), significant changes in the degree of central canal stenosis were determined. The appearance and extent of hyperintense lesions on T2-weighted sequences were also noted.</p><p><strong>Results: </strong>Overall, 653/1,845 (35.39%) disc levels showed an increase in stenosis grade on extension MRI, with 168/653 (25.72%) and 180/653 (27.56%) disc levels changing from grades 0/1 to grades 2 and 3, respectively. Moreover, 120/369 (32.52%) patients showed a mean increase of 1.55±0.75 levels of compression on extension MRI when compared to neutral MRI. A fresh-appearing hyperintense lesion was observed in 79 (4.28%) disc levels on flexion MRI, which was not visualized on neutral MRI.</p><p><strong>Conclusions: </strong>Cervical dMRI may help surgeons plan for surgery, discuss the prognosis with the patient, and safeguard themselves from medico-legal issues arising from improper or missed diagnosis and treatment.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"647-653"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456899","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":"Evaluating the efficacy of a cost-effective, fully three-dimensional-printed vertebra model for endoscopic spine surgery training for neurosurgical residents.","authors":"Bilal Bahadır Akbulut, Mustafa Serdar Bölük, Hüseyin Biçeroğlu, Taşkın Yurtseven","doi":"10.31616/asj.2024.0288","DOIUrl":"10.31616/asj.2024.0288","url":null,"abstract":"<p><strong>Study design: </strong>A fused deposition modeling three-dimensional (3D)-printed model of the L4-5 vertebra for lumbar discectomy was designed. The model included separately printed dura mater, spinal cord, ligamentum flavum, intervertebral disc (from thermoplastic polyurethane), and bony structures (from polylactic acid), and the material cost approximately US$ 1 per model. A simple plumbing endoscope was used for visualization. Dura mater injury was assessed by painting two layers on the dura mater, which peeled off with trauma.</p><p><strong>Purpose: </strong>Endoscopic spine surgery is a subject of high interest in neurosurgery given its minimally invasive nature; however, it has a steep learning curve. This study evaluated the effectiveness of a cost-efficient 3D-printed model when teaching this technique to neurosurgery residents.</p><p><strong>Overview of literature: </strong>Only a few studies have investigated the efficacy of such a model.</p><p><strong>Methods: </strong>Eight residents with >2 years of training participated. Residents performed the procedure bilaterally and twice at 1-week intervals.</p><p><strong>Results: </strong>From the 32 surgeries, four were excluded because of facet removal (as it widened the surgical corridor), leaving 28 surgeries for analysis. Initial surgeries demonstrated a mean operation time of 21 minutes 18 seconds (standard deviation [SD], 2 minutes 32 seconds), which improved to a mean of 6 minutes 45 seconds (SD, 37 seconds) in the fourth surgery (F(3, 17)=19.18, p <0.0001), demonstrating a significant reduction in surgical time over successive surgeries. The median area with the paint removed decreased, from 161.80 (85.55-217.83) to 95.13 mm2 (12.62-160.54), (F(2.072, Inf)=2.04, p =0.128); however, this was not significant. Resident feedback indicated high satisfaction with the educational value of the model.</p><p><strong>Conclusions: </strong>The developed fully 3D-printed model provides a viable and scalable option for neurosurgical training programs, enhancing the learning experience while maintaining low costs. This model may be an excellent stepping stone for learning lumbar spine endoscopy, acclimating to the two-dimensional view, progressing to cadaver models, and, eventually, independent surgery.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"630-638"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456909","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":"A novel technique for posterior lumbar interbody fusion to obtain a good local lordosis angle: anterior-release posterior lumbar interbody fusion.","authors":"Daisuke Inoue, Hiroaki Matsumori, Hideki Shigematsu, Yurito Ueda, Toshiya Morita, Sachiko Kawasaki, Masaki Ikejiri, Yasuhito Tanaka","doi":"10.31616/asj.2024.0131","DOIUrl":"10.31616/asj.2024.0131","url":null,"abstract":"<p><p>Herein, we describe a novel posterior lumbar interbody fusion (PLIF) technique with annulus fibrosus (AF) release and the use of expandable cages (called \"anterior-release PLIF\" [ARPLIF]). In this technique, posterior column osteotomy (PCO) and AF release provide excellent intervertebral mobility. AF release involves circumferentially peeling off the AF above or below the endplate between the fixed vertebrae under radiographic guidance without cutting the AF and anterior longitudinal ligament. Subsequently, high-angle variable-angle expandable cages are used to simultaneously expand both sides before inserting the percutaneous pedicle screws and correcting to achieve good local lumbar lordosis. PCO and AF release achieve excellent intervertebral mobility. Intervertebral mobility and simultaneous expansion of both cages disperse the force on the endplates, reducing cage subsidence, and the high-angle cages facilitate high intervertebral angle creation. The novel ARPLIF intervertebral manipulation technique can promote good local lumbar lordosis formation.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"706-711"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008156","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":"Current issues in the treatment of adolescent idiopathic scoliosis: a comprehensive narrative review.","authors":"Hyoungmin Kim, Bong-Soon Chang, Sam Yeol Chang","doi":"10.31616/asj.2024.0367","DOIUrl":"10.31616/asj.2024.0367","url":null,"abstract":"<p><p>Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of unknown etiology that commonly affects adolescents, imposing significant socioeconomic burdens. Effective management necessitates a comprehensive approach that takes into account multiple factors, including growth potential and psychological issues. Despite significant advancements in AIS management, several questions regarding optimal treatment strategies persist. Recent technological advancements are transforming the treatment landscape, encompassing advancements in bracing, robotic-assisted deformity corrections, and other interventions. This review explores current issues debated in the literature concerning the treatment of AIS, focusing on contemporary high-level evidence (e.g., meta-analyses and randomized controlled trials). Furthermore, this review explores cutting-edge developments and future directions in AIS management, including the integration of artificial intelligence and augmented reality.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"731-742"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456895","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":"Effect of cannabis use history on postoperative opioid utilization in lumbar fusion patients: an American retrospective study.","authors":"Pranav Mirpuri, Syed Ibad Khalid, Patrick King, Joanna Mary Roy, Aladine Elsamadicy, Ankit Indravadan Mehta, Owoicho Adogwa","doi":"10.31616/asj.2024.0194","DOIUrl":"10.31616/asj.2024.0194","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Purpose: </strong>To examine the effect of cannabis use history on postoperative opioid utilization in patients undergoing one- to three-level lumbar fusion for degenerative spine disease.</p><p><strong>Overview of literature: </strong>Strategies to minimize dosing and chronic opioid use are needed for spine surgery given their widespread prescription for postsurgical pain management.</p><p><strong>Methods: </strong>In this database study, medical coding was used to identify patients who had undergone one- to three-level lumbar fusions between 2012 and 2021. Propensity score matching was used to create two equal cohorts with respect to cannabis use history. Opioid utilization rates (morphine milligram equivalents [MME]/day) and overuse rates at 6 months post-index procedure were assessed. All pvalues <0.05 were considered statistically significant.</p><p><strong>Results: </strong>Following examination of 153,500 patient records, 1,216 patients were matched into cannabis user and non-cannabis user cohorts. Cannabis users had lower rates of opioid utilization compared to non-cannabis users as early as 2 months after fusion (47.7% vs. 41.1%, p <0.05), a relationship which persisted at 6 months (46.2% vs. 37.7%, p <0.01). Additionally, cannabis users had lower rates of high-dose opioid utilization (≥100 MME per day) during the initial 14-30 days following surgery (6.91% vs. 3.79%, p <0.05).</p><p><strong>Conclusions: </strong>Patients with a history of cannabis use were less likely to be using opioids as early as 2 months postoperatively and had lower rates of high-dose opioid utilization in the immediate postoperative period. Physicians operating on these patients should consider their cannabis use patterns to provide appropriate titration of pain medication over time.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"639-646"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456897","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":"Hounsfield units and vertebral bone quality score for predicting mechanical complications after adult spinal deformity surgery: a systematic review and meta-analysis.","authors":"Hiroyuki Nakarai, Gregory S Kazarian, Francis C Lovecchio, Han Jo Kim","doi":"10.31616/asj.2023.0402","DOIUrl":"10.31616/asj.2023.0402","url":null,"abstract":"<p><p>The purpose of this systematic review and meta-analysis is to assess existing literature and determine the association between the Hounsfield unit (HU) value and the vertebral body quality (VBQ) score with mechanical complications (MCs) after adult spinal deformity (ASD) surgery. Although bone quality is considered an increasingly important factor for MCs after ASD surgery, the utility of the HU value assessed by computed tomography and the VBQ score assessed by magnetic resonance imaging remains unknown. A systematic review of PubMed, Embase, and Cochrane Library databases was performed to find studies evaluating the association between the HU value and the VBQ score with MCs after ASD surgery. In the subsequent meta-analysis, MC outcomes were combined using a random-effects model, and the standardized mean difference and 95% confidence interval were calculated. The final analysis included a total of 20 studies. Nineteen studies reported HU values, and two studies reported VBQ scores. Proximal junctional kyphosis/failure (PJK/PJF) was reported as the MC in 16 studies, whereas other MCs were included in 6 studies. Six studies with a pool of 506 patients with ASD revealed that preoperative HU values at the upper instrumented vertebra (UIV) and UIV+1 were significantly lower in patients with PJK/PJF (standardized mean difference, -0.74; 95% confidence interval, -1.09 to -0.40). Three studies suggested an cutoff HU value of approximately ≤120, yielding a pooled sensitivity of 0.77, specificity of 0.67, and diagnostic odds ratio of 7.01. However, two studies reported conflicting results on the relationship between the VBQ score and PJK/PJF. Low HU values predicted the risk of certain MCs, particularly PJK/PJF, after ASD surgery. An HU value of <120 should alert surgeons to be cautious about the postoperative occurrence of PJK/PJF. Future studies are needed to validate the cutoff HU value and evaluate the utility of the VBQ score.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"719-730"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456913","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}