Lower Hounsfield Units at the Planned Lowest Instrumented Vertebra Is an Independent Risk Factor for Complications Following Adult Cervical Deformity Surgery

被引:0
作者
Williamson, Tyler K. [1 ,2 ]
Koslosky, Ezekial J. [2 ]
Lebovic, Jordan [3 ]
Owusu-Sarpong, Stephane [3 ]
Tretiakov, Peter [1 ]
Mir, Jamshaid [1 ]
Dave, Pooja [1 ]
Schoenfeld, Andrew J. [4 ]
Diebo, Bassel G. [5 ]
Koller, Heiko [6 ]
Lafage, Renaud [7 ]
Lafage, Virginie [7 ]
Passias, Peter G. [1 ]
机构
[1] Duke Univ, Med Ctr, Dept Orthopaed Surg, 2301 Erwin Rd, Durham, NC 27710 USA
[2] Univ Texas Hlth San Antonio, Dept Orthopaed Surg, San Antonio, TX USA
[3] NYU, Langone Med Ctr, Dept Orthopaed Surg, New York, NY USA
[4] Harvard Med Ctr, Brigham & Womens Hosp, Dept Orthopaed Surg, Boston, MA USA
[5] Brown Univ, Warren Alpert Med Sch, Dept Orthopaed Surg, Providence, RI USA
[6] Paracelsus Med Univ, Dept Orthopaed Surg, Salzburg, Austria
[7] Northwell Hlth, Lenox Hill Hosp, Dept Orthopaed, New York, NY USA
来源
CLINICAL SPINE SURGERY | 2024年 / 37卷 / 10期
关键词
adult cervical deformity; complications; distal junctional kyphosis; bone mineral density; Hounsfield units; frailty; PROXIMAL JUNCTIONAL KYPHOSIS; BONE-MINERAL DENSITY; SURGICAL-TREATMENT; IMPACT; OSTEOPOROSIS; VALIDATION; ALIGNMENT; OUTCOMES; TOOL;
D O I
10.1097/BSD.0000000000001647
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: The association of Hounsfield units (HU) and junctional pathologies in adult cervical deformity (ACD) surgery has not been elucidated. Objective: Assess if the bone mineral density of the LIV, as assessed by HUs, is prognostic for the risk of complications after ACD surgery. Study Design/Setting: Retrospective cohort study. Methods: HUs were measured on preoperative CT scans. Means comparison test assessed differences in HUs based on the occurrence of complications, linear regression assessed the correlation of HUs with risk factors, and multivariable logistic regression followed by a conditional inference tree derived a threshold for HUs based on the increased likelihood of developing a complication. Results: In all, 107 ACD patients were included. Thirty-one patients (29.0%) developed a complication (18.7% perioperative), with 20.6% developing DJK and 11.2% developing DJF. There was a significant correlation between lower LIVs and lower HUs (r=0.351, P=0.01), as well as age and HUs at the LIV. Age did not correlate with change in the DJK angle (P>0.2). HUs were lower at the LIV for patients who developed a complication and an LIV threshold of 190 HUs was predictive of complications (OR: 4.2, [1.2-7.6]; P=0.009). Conclusions: Low bone mineral density at the lowest instrumented vertebra, as assessed by a threshold lower than 190 Hounsfield units, may be a crucial risk factor for the development of complications after cervical deformity surgery. Preoperative CT scans should be routinely considered in at-risk patients to mitigate this modifiable risk factor during surgical planning.
引用
收藏
页码:E503 / E511
页数:9
相关论文
共 30 条
[1]   Validation of new clinical quantitative analysis software applicable in spine orthopaedic studies [J].
Champain, S. ;
Benchikh, K. ;
Nogier, A. ;
Mazel, C. ;
Guise, J. De. ;
Skalli, W. .
EUROPEAN SPINE JOURNAL, 2006, 15 (06) :982-991
[2]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383
[3]   The Impact of Osteoporosis on 2-Year Outcomes in Patients Undergoing Long Cervical Fusion [J].
Diebo, Bassel G. ;
Scheer, Ryan ;
Rompala, Alexander ;
Veenema, Ryne J. ;
Shah, Neil V. ;
Beyer, George A. ;
Celiker, Pelin ;
Eldib, Hassan ;
Passfall, Lara ;
Krol, Oscar ;
Dubner, Michael G. ;
Lafage, Renaud ;
Challier, Vincent ;
Passias, Peter G. ;
Schwab, Frank J. ;
Lafage, Virginie ;
Daniels, Alan H. ;
Paulino, Carl B. .
JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS, 2023, 31 (01) :E44-E50
[4]   Endplate volumetric bone mineral density is a predictor for cage subsidence following lateral lumbar interbody fusion: a risk factor analysis [J].
Jones, Conor ;
Okano, Ichiro ;
Salzmann, Stephan N. ;
Reisener, Marie-Jacqueline ;
Chiapparelli, Erika ;
Shue, Jennifer ;
Sama, Andrew A. ;
Cammisa, Frank P. ;
Girardi, Federico P. ;
Hughes, Alexander P. .
SPINE JOURNAL, 2021, 21 (10) :1729-1737
[5]   Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity [J].
Kim, Han Jo ;
Virk, Sohrab ;
Elysee, Jonathan ;
Ames, Christopher ;
Passias, Peter ;
Shaffrey, Christopher ;
Mundis, Gregory ;
Protopsaltis, Themistocles ;
Gupta, Munish ;
Klineberg, Eric ;
Hart, Robert ;
Smith, Justin S. ;
Bess, Shay ;
Schwab, Frank ;
Lafage, Renaud ;
Lafage, Virginie .
JOURNAL OF CLINICAL MEDICINE, 2021, 10 (21)
[6]   Bone Density Distribution in the Cervical Spine [J].
Lovecchio, Francis ;
Ang, Bryan ;
Louie, Philip K. ;
Chaudary, Chirag ;
Shah, Sachin P. ;
Punyala, Ananth ;
Yao, Yu-Cheng ;
Steinhaus, Mike ;
McCarthy, Michael H. ;
Huang, Russel ;
Lebl, Darren ;
Lafage, Virginie ;
Albert, Todd J. ;
Iyer, Sravisht ;
Qureshi, Sheeraz ;
Kim, Han Jo .
GLOBAL SPINE JOURNAL, 2024, 14 (01) :169-176
[7]   Regional Hounsfield unit measurement of screw trajectory for predicting pedicle screw fixation using cortical bone trajectory: a retrospective cohort study [J].
Matsukawa, Keitaro ;
Abe, Yuichiro ;
Yanai, Yoshihide ;
Yato, Yoshiyuki .
ACTA NEUROCHIRURGICA, 2018, 160 (02) :405-411
[8]   Clinical considerations for spinal surgery in the osteoporotic patient: A comprehensive review [J].
McCoy, S. ;
Tundo, F. ;
Chidambaram, S. ;
Baaj, A. A. .
CLINICAL NEUROLOGY AND NEUROSURGERY, 2019, 180 :40-47
[9]   Association between lower Hounsfield units and proximal junctional kyphosis and failure at the upper thoracic spine [J].
Mikula, Anthony L. ;
Lakomkin, Nikita ;
Pennington, Zach ;
Pinter, Zachariah W. ;
Nassr, Ahmad ;
Freedman, Brett ;
Sebastian, Arjun S. ;
Abode-Iyamah, Kingsley ;
Bydon, Mohamad ;
Ames, Christopher P. ;
Fogelson, Jeremy L. ;
Elder, Benjamin D. .
JOURNAL OF NEUROSURGERY-SPINE, 2022, 37 (05) :694-702
[10]   Predicting Mechanical Complications After Adult Spinal Deformity Operation Using a Machine Learning Based on Modified Global Alignment and Proportion Scoring With Body Mass Index and Bone Mineral Density [J].
Noh, Sung Hyun ;
Lee, Hye Sun ;
Park, Go Eun ;
Ha, Yoon ;
Park, Jeong Yoon ;
Kuh, Sung Uk ;
Chin, Dong Kyu ;
Kim, Keun Su ;
Cho, Yong Eun ;
Kim, Sang Hyun ;
Kim, Kyung Hyun .
NEUROSPINE, 2023, 20 (01) :265-274