成人脊柱畸形有限腰椎融合术后，上固定椎体较低的亨氏单位与近端交界性失败之间的关联。
The association between lower Hounsfield units of the upper instrumented vertebra and proximal junctional failure after limited lumbar fusion for adult spinal deformity.
作者信息
Moridaira Hiroshi, Inami Satoshi, Takahata Masahiko, Takeuchi Daisaku, Ueda Haruki, Iimura Takuya, Kanto Tomoya, Takada Satoshi, Doi Kazuo, Taneichi Hiroshi
机构信息
Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Shimotuga-gun, Tochigi, 321-0293, Japan.
出版信息
BMC Musculoskelet Disord. 2025 Apr 21;26(1):393. doi: 10.1186/s12891-025-08643-7.
BACKGROUND
Limited lumbar fusion surgery for adult spinal deformity (ASD) increases the risk of proximal junctional failure (PJF) at the thoracolumbar junction due to preserved mobility in this region. The majority of the extant research on PJF focuses on cases where the upper instrumented vertebra (UIV) is in the thoracic spine, whereas the aim of this study was to evaluate the correlation between Hounsfield Unit (HU) values around the thoracolumbar junction and the incidence of PJF following limited lumbar fusion.
METHODS
A retrospective review identified patients aged ≥ 40 years who underwent fusion surgery spanning ≥ 3 levels with a UIV in the upper lumbar spine (L1-L3) and had a follow-up of at least two years. Demographic data, surgical factors, and spinopelvic parameters were analyzed. HU values were measured at the UIV, UIV + 1, and lower instrumented vertebra and were assessed for their association with PJF.
RESULTS
Of 50 patients, 46 were included after excluding 4 who required reoperation for distal junctional failure. The mean age was 65.9 years, with a mean follow-up of 6.3 years. PJF was observed in 17 patients (36.9%). While most demographic and surgical factors were similar between groups, age was significantly associated with PJF (p = 0.024). Preoperative parameters significantly differed, including PT (p = 0.011), PI-LL (p = 0.010), SVA (p = 0.008), and HU at UIV/UIV + 1 (p = 0.006). Postoperative differences included PT (p = 0.007), PI-LL (p = 0.005), proximal junctional angle (p = 0.021), SVA (p = 0.021), and the global alignment and proportion (GAP) score (p = 0.001). Logistic regression identified low HU at UIV/UIV + 1 as the only independent PJF risk factor (OR: 0.975, 95% CI: 0.950-0.996, p = 0.016), with a cutoff value of 97.8 HU (AUC = 0.745, p = 0.022). PJF rates were 73.3%, 26.7%, and 12.5% for patients with HU < 98, 98-134, and > 134, respectively.
CONCLUSION
Preoperative low HU values at UIV/UIV + 1 independently predict PJF risk. HU assessment via preoperative CT imaging offers a critical tool for surgical planning in ASD limited lumbar fusion cases.
CLINICAL TRIAL NUMBER
Not applicable.
背景
成人脊柱畸形（ASD）的有限腰椎融合手术会增加胸腰段交界处近端交界性失败（PJF）的风险，因为该区域保留了活动度。现有的关于PJF的大多数研究都集中在上端固定椎（UIV）位于胸椎的病例，而本研究的目的是评估胸腰段交界处周围的Hounsfield单位（HU）值与有限腰椎融合术后PJF发生率之间的相关性。
方法
一项回顾性研究确定了年龄≥40岁、接受了跨度≥3个节段且UIV位于上腰椎（L1-L3）的融合手术并至少随访两年的患者。分析了人口统计学数据、手术因素和脊柱骨盆参数。在UIV、UIV + 1和下端固定椎测量HU值，并评估其与PJF的相关性。
结果
50例患者中，排除4例因远端交界性失败需要再次手术的患者后，纳入46例。平均年龄为65.9岁，平均随访6.3年。17例患者（36.9%）观察到PJF。虽然两组之间的大多数人口统计学和手术因素相似，但年龄与PJF显著相关（p = 0.024）。术前参数有显著差异，包括骨盆倾斜角（PT）（p = 0.011）、骨盆入射角与腰椎前凸角差值（PI-LL）（p = 0.010）、矢状面垂直轴（SVA）（p = 0.008）以及UIV/UIV + 1处的HU（p = 0.006）。术后差异包括PT（p = 0.007）、PI-LL（p = 0.005）、近端交界角（p = 0.021）、SVA（p = 0.021）以及整体对线和比例（GAP）评分（p = 0.001）。逻辑回归确定UIV/UIV + 1处低HU是唯一独立的PJF危险因素（OR：0.975，95%CI：0.950 - 0.996，p = 0.016），截断值为97.8 HU（AUC = 0.745，p = 0.022）。HU < 98、98 - 134和> 134的患者PJF发生率分别为73.3%、26.7%和12.5%。
结论
术前UIV/UIV + 1处低HU值可独立预测PJF风险。通过术前CT成像进行HU评估为ASD有限腰椎融合病例的手术规划提供了关键工具。临床试验编号：不适用。
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