The association between lower Hounsfield units of the upper instrumented vertebra and proximal junctional kyphosis in adult spinal deformity surgery with a minimum 2-year follow-up

Duan, Ping‐Guo; Mummaneni, Praveen V.; Rivera, Joshua; Guinn, Jeremy; Wang, Minghao; Xi, Zhuo; Li, Bo; Wu, Hao-Hua; Ames, Christopher P.; Burch, Shane; Berven, Sigurd; Chou, Dean

doi:10.3171/2020.5.focus20192

Cited by 43 publications

(31 citation statements)

References 39 publications

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“…In the lumbar region, a few studies have shown a correlation between lower HU values and screw loosening 13 , 14 . According to a previous study by Duan et al 18 , lower HU values were associated with proximal junctional kyphosis in patients who underwent long-segmental fusions involving the lower thoracic spine. Our results also demonstrated a difference in HU values between the loosening and control groups at the lower thoracic level.…”

Section: Discussionmentioning

confidence: 86%

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Value of computed tomography Hounsfield units in predicting pedicle screw loosening in the thoracic spine

Lee

2022

Sci Rep

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We evaluated the feasibility of using the Hounsfield unit (HU) value of the vertebral body to predict screw loosening in the thoracic spine. Consecutive patients who underwent thoracic spinal fusion surgery (from 2014 to 2020) were retrospectively identified. Patients with pedicle screw loosening in the upper instrumented vertebra (UIV) on postoperative computed tomography were included in the “loosening” group. The control group comprised an equal number of age-, sex-, and UIV-matched patients without screw loosening. Preoperative HU values at the UIV and lumbar T-scores were compared between the groups; receiver operating characteristic curves were constructed for HU values and T-scores to predict screw loosening, and the best cutoff values were determined. The same statistical analyses were performed for each subgroup, i.e., upper (T1–T4) and lower (T9–T12) thoracic levels. Forty-six patients each were included in the loosening and control groups. A significant between-group difference of HU values was noted for the lower thoracic UIV (loosening = 99.3, control = 126.3; p = 0.02) but not for the upper thoracic UIV (loosening = 171.8, control = 146.0, p = 0.70). T-scores did not differ between the groups for the lower (p = 0.14) and upper (p = 0.56) thoracic UIV. For the lower thoracic UIV, the area under the receiver operating characteristic curve was 0.660 for HUs (p = 0.01; 95% confidence interval [CI] 0.541–0.766) and 0.601 (p = 0.13; 95% CI 0.480–0.713) for T-scores. The optimal cutoff value for HUs was 126.3. Using this cutoff, HU values showed a better positive predictive value, negative predictive value, and accuracy compared to T-scores in predicting screw loosening.

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Section: Discussionmentioning

confidence: 86%

“…Duan et al 18 suggested a cutoff value of 104 HU for predicting the risk of proximal junctional kyphosis in the lower thoracic spine (T9–T12). A higher cutoff value of 126 HU was derived from our study.…”

Section: Discussionmentioning

confidence: 99%

Value of computed tomography Hounsfield units in predicting pedicle screw loosening in the thoracic spine

Lee

2022

Sci Rep

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“…35 Poor bone quality, Parkinson disease, infection, smoking are well known risk factors for proximal junctional failure in spine surgery, but an unbalanced or hyper corrected spine is now considered as one of the main reasons for implant and junctional failure. 36,37 Our study has some limitations. First, this is a retrospective analysis from electronic medical records of 8 institutions in Latin America and selection bias could be present as there could be patients not properly included in the analysis due to its retrospective nature.…”

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Unplanned Readmission Following Early Postoperative Complications After Fusion Surgery in Adult Spine Deformity: A Multicentric Study

Camino-Willhuber

Guiroy

Servidio

et al. 2021

Global Spine Journal

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Study Design: Multicentric retrospective study, Level of evidence III. Objective: The objective of this multicentric study was to analyze the prevalence and risk factors of early postoperative complications in adult spinal deformity patients treated with fusion. Additionally, we studied the impact of complications on unplanned readmission and hospital length of stay. Methods: Eight spine centers from 6 countries in Latin America were involved in this study. Patients with adult spinal deformity treated with fusion surgery from 2017 to 2019 were included. Baseline and surgical characteristics such as age, sex, comorbidities, smoking, number of levels fused, number of surgical approaches were analyzed. Postoperative complications at 30 days were recorded according to Clavien-Dindo and Glassman classifications. Results: 172 patients (120 females/52 males, mean age 59.4 ± 17.6) were included in our study. 78 patients suffered complications (45%) at 30 days, 43% of these complications were considered major. Unplanned readmission was observed in 35 patients (20,3%). Risk factors for complications were: Smoking, previous comorbidities, number of levels fused, two or more surgical approaches and excessive bleeding. Hospital length of stay in patients without and with complications was of 7.8 ± 13.7 and 17 ± 31.1 days, respectively ( P 0.0001). Conclusion: The prevalence of early postoperative complications in adult spinal deformity patients treated with fusion was of 45% in our study with 20% of unplanned readmissions at 30 days. Presence of complications significantly increased hospital length of stay.

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“…Xu 23 (2020) 143 UH, values of the vertebral body and pedicle as predictors of post-surgical pedicular screw loosening.…”

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confidence: 99%

Hounsfield Units Use in Spinal Surgery Planning: Systematic Review and Meta-Analysis

et al. 2022

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Bone mineral density is a crucial factor in the success or failure of osteosynthesis in spine surgery; it shows the onset of osteoporosis and related complications. Its evaluation is verified by dual-energy X-ray absorptiometry (DEXA) and Hounsfield Unit (HU) measurement by CT scan. Objective: Determine the use of HU in surgical planning; compare utility in diagnosing osteoporosis by DEXA; and evaluate sensitivity in predicting complications. Method: A systemic literature review was conducted on PubMed, in line with PRISMA methodology. Including those who justified the use of pre-surgical planning, compared HU/DEXA, and assessed complications. For the statistical analysis, the χ2 was used. Results: 57 articles were identified by selecting nine that met the inclusion criteria. In patients undergoing spinal surgery for fixation and fusion for degenerative pathology, HU measurement showed a prevalence of osteoporosis of 58.5% (sensitivity 93.26%; specificity 90.22%), osteoporosis-associated complications of 24.5%, proper diagnosis of 71.98%, and screw release rate of 82.31%. Conclusions: UH measurement for the diagnosis of osteoporosis turns out to be more sensitive, specific, and predictive compared to DEXA, especially in elderly patients; it represents a useful tool in planning spinal surgery, minimizing the risk of complications such as screw release, fractures, pseudoarthrosis, subsidence of intersomatic devices, and kyphosis of the proximal junction. Level of evidence II; Study Design: Systematic Review and meta-analysis.

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The association between lower Hounsfield units of the upper instrumented vertebra and proximal junctional kyphosis in adult spinal deformity surgery with a minimum 2-year follow-up

Cited by 43 publications

References 39 publications

Value of computed tomography Hounsfield units in predicting pedicle screw loosening in the thoracic spine

Value of computed tomography Hounsfield units in predicting pedicle screw loosening in the thoracic spine

Unplanned Readmission Following Early Postoperative Complications After Fusion Surgery in Adult Spine Deformity: A Multicentric Study

Hounsfield Units Use in Spinal Surgery Planning: Systematic Review and Meta-Analysis

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