Hiroyuki Nakarai, Gregory S Kazarian, Francis C Lovecchio, Han Jo Kim
{"title":"预测成人脊柱畸形手术后机械并发症的 Hounsfield 单位和椎骨质量评分:系统综述和荟萃分析。","authors":"Hiroyuki Nakarai, Gregory S Kazarian, Francis C Lovecchio, Han Jo Kim","doi":"10.31616/asj.2023.0402","DOIUrl":null,"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":2.3000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538826/pdf/","citationCount":"0","resultStr":"{\"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\":null,\"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\":2.3000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538826/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asian Spine Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.31616/asj.2023.0402\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/22 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Spine Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.31616/asj.2023.0402","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/22 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
本系统综述和荟萃分析的目的是评估现有文献,确定Hounsfield单位(HU)值和椎体质量(VBQ)评分与成人脊柱畸形(ASD)手术后机械并发症(MCs)之间的关联。虽然骨质被认为是影响 ASD 手术后机械并发症的一个日益重要的因素,但计算机断层扫描评估的 HU 值和磁共振成像评估的 VBQ 评分的效用仍不清楚。我们对 PubMed、Embase 和 Cochrane Library 数据库进行了系统性回顾,以找到评估 HU 值和 VBQ 评分与 ASD 手术后 MC 之间关联的研究。在随后的荟萃分析中,使用随机效应模型合并了MC结果,并计算了标准化均值差异和95%置信区间。最终分析共包括 20 项研究。19项研究报告了HU值,2项研究报告了VBQ评分。有 16 项研究将近端交界脊柱后凸/畸形(PJK/PJF)报告为 MC,有 6 项研究将其他 MC 包括在内。六项研究共纳入了 506 名 ASD 患者,结果显示,PJK/PJF 患者术前上器械椎体(UIV)和 UIV+1 的 HU 值显著较低(标准化平均差,-0.74;95% 置信区间,-1.09 至 -0.40)。三项研究建议 HU 临界值约为≤120,汇总灵敏度为 0.77,特异性为 0.67,诊断几率比为 7.01。然而,有两项研究报告的 VBQ 评分与 PJK/PJF 之间的关系结果相互矛盾。低 HU 值可预测 ASD 手术后出现某些 MC(尤其是 PJK/PJF)的风险。HU 值为
Hounsfield units and vertebral bone quality score for predicting mechanical complications after adult spinal deformity surgery: a systematic review and meta-analysis.
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.