Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
Neurosurgery. 2023 May 1;92(5):945-954. doi: 10.1227/neu.0000000000002291. Epub 2022 Dec 19.
Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) can be catastrophic complications associated with adult spinal deformity (ASD) surgery. These complications are markedly influenced by osteoporosis, leading to additional vertebral fracture and pedicle screw loosening. The MRI-based vertebral bone quality score (VBQ) is a newly developed tool that can be used to assess bone quality.
To investigate the utility of the VBQ score in predicting PJK and/or PJF (PJF/PJK) after ASD correction.
We conducted a retrospective chart review to identify patients age ≥50 years who had received ASD surgery of 5 or more thoracolumbar levels. Demographic, spinopelvic parameters, and procedure-related variables were collected. Each patient's VBQ score was calculated using preoperative T1-weighted MRI. Univariate analysis and multivariate logistic regression were performed to determine potential risk factors of PJK/PJF. Receiver operating characteristic analysis and area-under-the-curve values were generated for prediction of PJK/PJF.
A total of 116 patients were included (mean age, 64.1 ± 6.8 years). Among them, 34 patients (29.3%) developed PJK/PJF. Mean VBQ scores were 3.13 ± 0.46 for patients with PJK/PJF and 2.46 ± 0.49 for patients without, which was significantly different between the 2 groups ( P < .001). On multivariate analysis, VBQ score was the only significant predictor of PJK/PJF (odds ratio = 1.745, 95% CI = 1.558-1.953, P < .001), with a predictive accuracy of 94.3%.
In patients undergoing ASD correction, higher VBQ was independently associated with PJK/PJF occurrence. Measurement of VBQ score on preoperative MRI may be a useful adjunct to ASD surgery planning.
近端交界性后凸（PJK）和近端交界性失败（PJF）是与成人脊柱畸形（ASD）手术相关的灾难性并发症。这些并发症明显受到骨质疏松症的影响，导致额外的椎体骨折和椎弓根螺钉松动。基于 MRI 的椎体骨质量评分（VBQ）是一种新开发的工具，可用于评估骨质量。
研究 VBQ 评分在预测 ASD 矫正后 PJK 和/或 PJF（PJF/PJK）中的作用。
我们进行了回顾性图表审查，以确定年龄≥50 岁且接受了 5 个或更多胸腰椎水平 ASD 手术的患者。收集了人口统计学、脊柱骨盆参数和手术相关变量。使用术前 T1 加权 MRI 计算每位患者的 VBQ 评分。进行单变量分析和多变量逻辑回归以确定 PJK/PJF 的潜在危险因素。生成 ROC 分析和曲线下面积值以预测 PJK/PJF。
共纳入 116 例患者（平均年龄 64.1 ± 6.8 岁）。其中 34 例（29.3%）发生 PJK/PJF。PJK/PJF 患者的平均 VBQ 评分为 3.13 ± 0.46，无 PJK/PJF 患者的平均 VBQ 评分为 2.46 ± 0.49，两组间差异有统计学意义（P <.001）。多变量分析显示，VBQ 评分是 PJK/PJF 的唯一显著预测因素（优势比=1.745，95%CI=1.558-1.953，P <.001），预测准确率为 94.3%。
在接受 ASD 矫正的患者中，较高的 VBQ 与 PJK/PJF 的发生独立相关。术前 MRI 上 VBQ 评分的测量可能是 ASD 手术计划的有用辅助手段。
