Ji Chenqing, Wang Xiayan, Weng Yuanzhi, Ma Chi, Li Shihuai, Zhang Hongda, Li Ruiyan, Tang Xiongfeng, Xie Zhuoting, Qu Wenrui, Xu Hao, Lu William W, Guo Deming, Qin Yanguo
Jilin University, Jilin Province, 130041, Changchun, China.
Orthopaedic Medical Center, The Second Norman Bethune Hospital of Jilin University, Jilin Province, 130041, Changchun, China.
Eur Spine J. 2025 Aug 2. doi: 10.1007/s00586-025-09215-y.
This study aimed to investigate the asymmetric distribution of vertebral bone microstructure in adult spinal deformity (ASD) patients with coronal plane deformities using phantom-less quantitative CT (PL-QCT). Specifically, we sought to quantify vertebral 'bone void' (BMD < 40 mg/cm³) to analyze spatial heterogeneity of bone mass and structure, and examine its correlation with deformity characteristics, gender, age, and BMD.
A retrospective cross-sectional study included 167 ASD patients (49 males, 118 females) with ASD. Vertebral BMD and bone void volume were measured using PL-QCT. The apex vertebra and its adjacent levels (Apex-1, Apex, Apex + 1) were analyzed. Each vertebra was divided into 8 regional sections (convex vs. concave sides) to assess bone void distribution.
The key findings revealed significant spatial heterogeneity and asymmetry in bone void distribution. Bone voids were predominantly concentrated in the posterior-inferior region of the concave side (CC). Normalized bone void volume was significantly higher on the CC side compared to the convex side (CV) at all vertebral levels. Notably, female patients had significantly higher normalized bone void volume than males.
PL-QCT revealed significant asymmetric spatial heterogeneity in vertebral bone microstructure in ASD, characterized by preferential 'bone void' accumulation on the concave side, particularly in posterior-inferior regions. This asymmetry, influenced by vertebral level, female gender, and advancing age, likely reflects abnormal biomechanical loading and remodeling imbalances. Quantifying bone void distribution provides a crucial multidimensional assessment for understanding ASD progression and developing targeted interventions focused on reinforcing the biomechanically vulnerable concave side.
本研究旨在使用无体模定量CT（PL-QCT）研究患有冠状面畸形的成人脊柱畸形（ASD）患者椎骨微结构的不对称分布。具体而言，我们试图量化椎骨“骨空隙”（骨密度<40mg/cm³），以分析骨量和结构的空间异质性，并检查其与畸形特征、性别、年龄和骨密度的相关性。
一项回顾性横断面研究纳入了167例患有ASD的患者（49例男性，118例女性）。使用PL-QCT测量椎骨骨密度和骨空隙体积。分析顶椎及其相邻节段（顶椎-1、顶椎、顶椎+1）。每个椎骨分为8个区域切片（凸侧与凹侧）以评估骨空隙分布。
主要研究结果显示骨空隙分布存在显著的空间异质性和不对称性。骨空隙主要集中在凹侧（CC）的后下部区域。在所有椎骨水平，CC侧的标准化骨空隙体积均显著高于凸侧（CV）。值得注意的是，女性患者的标准化骨空隙体积显著高于男性。
PL-QCT显示ASD患者椎骨微结构存在显著的不对称空间异质性，其特征是凹侧尤其是后下部区域优先积累“骨空隙”。这种不对称性受椎骨水平、女性性别和年龄增长的影响，可能反映了异常的生物力学负荷和重塑失衡。量化骨空隙分布为理解ASD进展和制定针对加强生物力学易损凹侧的靶向干预措施提供了关键的多维度评估。
