Sasagawa Takeshi
Department of Orthopedic Surgery, Toyama Prefectural Central Hospital, Toyama City, Japan.
J Spine Surg. 2024 Dec 20;10(4):635-641. doi: 10.21037/jss-24-69. Epub 2024 Nov 8.
There is no consensus on the association between final local kyphosis and residual back pain (RBP) after traumatic vertebral fracture. The aim of this study was to investigate whether there is an association between the final local kyphosis angle and RBP in patients with traumatic vertebral fractures at the thoracolumbar junction who underwent single posterior surgery with percutaneous pedicle screws and implant removal after fracture healing. A second goal was to determine the optimal cut-off value for the final local kyphosis angle with and without RBP.
Twenty-five patients were included in the study. Age, gender, Injury severity score, level of fracture, AO classification, the McCormack Load sharing classification, and range of stabilization were collected. In addition, imaging assessment was performed to evaluate vertebral kyphosis angle, local kyphosis angle (Cobb angle), and the percentage of anterior, middle and posterior vertebral body compression at the time of injury and at the final follow-up after implant removal. The patients were divided into two groups, with and without RBP [Group RBP (+) and Group RBP (-), respectively]. Each variable was compared between groups. Cut-off values were calculated using the Youden index with receiver operating characteristic (ROC) curves.
There were 12 patients in the RBP (+) group and 13 in the RBP (-) group. The two groups were significantly different only for the final local kyphosis angle, with no significant differences for the other variables. The ROC curve of the final local kyphosis angle for RBP had an area under the curve (AUC) of 0.88 (P<0.01). The optimal cut-off value for the final local kyphosis angle for RBP calculated from the Youden index was 15.85°.
There is an association between the final local kyphosis angle and RBP. The optimal cut-off value of the final local kyphosis angle for RBP was approximately 16°.
创伤性椎体骨折后最终局部后凸畸形与残留背痛（RBP）之间的关联尚无定论。本研究的目的是调查在胸腰段交界处发生创伤性椎体骨折且接受了经皮椎弓根螺钉单后路手术并在骨折愈合后取出内固定装置的患者中，最终局部后凸角与RBP之间是否存在关联。第二个目标是确定有无RBP情况下最终局部后凸角的最佳截断值。
本研究纳入了25例患者。收集了年龄、性别、损伤严重程度评分、骨折节段、AO分类、麦科马克负荷分担分类以及固定范围。此外，进行影像学评估以评估损伤时及取出内固定装置后的最终随访时的椎体后凸角、局部后凸角（Cobb角）以及椎体前、中、后柱压缩百分比。患者被分为两组，分别为有RBP组和无RBP组[分别为RBP（+）组和RBP（-）组]。对两组间的每个变量进行比较。使用约登指数和受试者工作特征（ROC）曲线计算截断值。
RBP（+）组有12例患者，RBP（-）组有13例患者。两组仅在最终局部后凸角方面存在显著差异，其他变量无显著差异。RBP的最终局部后凸角的ROC曲线下面积（AUC）为0.88（P<0.01）。根据约登指数计算出的RBP的最终局部后凸角的最佳截断值为15.85°。
最终局部后凸角与RBP之间存在关联。RBP的最终局部后凸角的最佳截断值约为16°。
