Department of Orthopaedics, Peking University Third Hospital, Haidian District, No 49. North Garden Road, Beijing, 100191, China.
Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
J Orthop Surg Res. 2023 Nov 1;18(1):819. doi: 10.1186/s13018-023-04325-z.
Selection of the upper instrumented vertebra (UIV) is crucial for surgical treatment of degenerative lumbar scoliosis (DLS), given the relevance of UIV in postoperative proximal adjacent segment degeneration (pASD). Our previous research found that selection of UIV not lower than (≤) the first coronal reverse vertebra (FCRV), which marks the turning point of Hounsfield unit (HU) asymmetry, could significantly reduce pASD. However, the degree of HU asymmetry can vary among patients, suggesting a demand for more individualized UIV selection criteria, which we aimed to develop using quantitative HU measurement in the current study.
We included 153 consecutive patients with DLS. Quantitative measurement of HU of both sides of the vertebrae of these patients was performed on three planes of CT reconstruction for average values and determination of FCRV. Pre- and postoperative X-ray plain films were examined for radiological measurements and determination of pASD. Further, 35 patients with lumbar disc herniation and without significant scoliosis were also included as the reference group, and their bilateral HU was measured.
In all 153 patients, those with UIV ≤ FCRV had a significantly lower rate of pASD (9.4% vs. 24.6%, P = 0.011). The difference between HU of the left and right sides of the FCRV (dF) could range from close to 0-59.4. The difference between HU of the left and right sides of the vertebrae in the reference group had an average value of 5.21. In 101 dF ≥ 5 DLS patients, those with UIV ≤ FCRV had a significantly lower rate of pASD (7.6% vs. 28.6%, P = 0.005), while this rate was insignificant in the other 52 dF < 5 patients (13.3% vs. 18.2%, P = 0.708). No other general, radiological, or operative parameter was found to have significant influence on the occurrence of pASD.
Selection of UIV ≤ FCRV can significantly reduce the risk of pASD for patients with DLS with dF ≥ 5. Trial Registration Not applicable, since this is an observational study.
在上位器械椎（UIV）的选择对于退行性腰椎侧凸（DLS）的手术治疗至关重要，因为 UIV 与术后近端相邻节段退变（pASD）有关。我们之前的研究发现，选择 UIV 不低于（≤）第一个冠状反转椎（FCRV），这标志着 Hounsfield 单位（HU）不对称的转折点，可以显著降低 pASD。然而，HU 不对称的程度在不同患者之间可能有所不同，这表明需要更个体化的 UIV 选择标准，我们旨在使用当前研究中的定量 HU 测量来开发这些标准。
我们纳入了 153 例连续的 DLS 患者。对这些患者的 CT 重建的三个平面进行 HU 的双侧定量测量，以获得平均值和 FCRV 的确定。术前和术后 X 线平片用于放射学测量和 pASD 的确定。此外，还纳入了 35 例腰椎间盘突出症且无明显侧凸的患者作为参考组，并对其双侧 HU 进行了测量。
在所有 153 例患者中，UIV≤FCRV 的患者 pASD 发生率明显较低（9.4% vs. 24.6%，P=0.011）。FCRV 左右 HU 差值（dF）可在接近 0-59.4 之间变化。参考组左右 HU 差值的平均值为 5.21。在 101 例 dF≥5 的 DLS 患者中，UIV≤FCRV 的患者 pASD 发生率明显较低（7.6% vs. 28.6%，P=0.005），而在其他 52 例 dF<5 的患者中，这一发生率无显著差异（13.3% vs. 18.2%，P=0.708）。没有其他一般、放射学或手术参数被发现对 pASD 的发生有显著影响。
对于 dF≥5 的 DLS 患者，选择 UIV≤FCRV 可以显著降低 pASD 的风险。
不适用，因为这是一项观察性研究。
