Nakarai Hiroyuki, Kazarian Gregory S, Lovecchio Francis C, Kim Han Jo
Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA.
Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan.
Asian Spine J. 2024 Oct;18(5):719-730. doi: 10.31616/asj.2023.0402. Epub 2024 Oct 22.
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.
本系统评价和荟萃分析的目的是评估现有文献，并确定成人脊柱畸形（ASD）手术后Hounsfield单位（HU）值和椎体质量（VBQ）评分与机械并发症（MCs）之间的关联。尽管骨质量被认为是ASD手术后发生MCs的一个越来越重要的因素，但通过计算机断层扫描评估的HU值和通过磁共振成像评估的VBQ评分的效用仍然未知。我们对PubMed、Embase和Cochrane图书馆数据库进行了系统评价，以查找评估ASD手术后HU值和VBQ评分与MCs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MC结果，并计算标准化平均差和95%置信区间。最终分析共纳入20项研究。19项研究报告了HU值，2项研究报告了VBQ评分。16项研究将近端交界性后凸/失败（PJK/PJF）报告为MC，而6项研究纳入了其他MC。六项研究共纳入506例ASD患者，结果显示PJK/PJF患者上位固定椎体（UIV）和UIV+1的术前HU值显著更低（标准化平均差，-0.74；95%置信区间，-1.09至-0.40）。三项研究表明，HU值约≤120为临界值，合并敏感度为0.77，特异度为0.67，诊断比值比为7.
