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European Spine Journal

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22-08-2023 | Scoliosis | Original Article

Vertebral bone quality score as a novel predictor of proximal junctional kyphosis after thoracic adolescent idiopathic scoliosis surgery

Authors: Juehan Wang, Qian Chen, Youwei Ai, Yong Huang, Ce Zhu, Hong Ding, Ganjun Feng, Limin Liu, Yueming Song

Published in: European Spine Journal | Issue 11/2023

Abstract

Introduction

Proximal junctional kyphosis (PJK) is one of the most common complications after thoracic AIS surgery. Previous studies reported that the etiology of PJK was associated with osteopenia and meanwhile the AIS patients were found osteopenia which could persist into adulthood. Recently, an MRI-based vertebral bone quality score (VBQ) was reported to be a promising tool which can assess preoperative bone quality.

Objective

This study aims to evaluate the utility of VBQ score in predicting PJK after corrective surgery for thoracic AIS (Lenke 1 and 2).

Methods

We conducted a retrospective study to identify the predictive efficiency of VBQ score for PJK in thoracic AIS patients. Demographic, radiographic parameters, and surgical variables were collected. VBQ score was calculated using preoperative T1-weighted MRI. Univariate analysis, linear regression, and multivariate logistic regression were performed to determine potential risk factors of PJK and correlation between other parameters and VBQ score. Receiver operating characteristic analysis and area under the curve values were utilized to evaluate the predictive efficiency of VBQ score for PJK.

Results

A total of 206 patients (aged 14.4 ± 2.3 years) were included, of which 33 (16.0%) developed PJK. VBQ scores were significantly different between the PJK and non-PJK groups (2.8 ± 0.2 vs 2.5 ± 0.2, P < 0.01). A significant positive correlation was found between VBQ score and PJA (R² = 0.1728, P < 0.01).On multivariate analysis, VBQ score was the only significant predictor of PJK (odds ratio = 2.178, 95% CI = 1.644–2.885, P < 0.001), with a predictive accuracy of 83%.

Conclusion

Higher VBQ scores were independently associated with PJK occurrence after corrective surgery for thoracic AIS. Preoperative measurement of VBQ score on MRI may serve as a valuable tool in planning thoracic AIS surgery.

Al-Mohrej OA, Aldakhil SS, Al-Rabiah MA, Al-Rabiah AM (2012) Surgical treatment of adolescent idiopathic scoliosis: complications. Annal Med Surg 2020(52):19–23. https://doi.org/10.1016/j.amsu.2020.02.004CrossRef

Cerpa M, Sardar Z, Lenke L (2020) Revision surgery in proximal junctional kyphosis. Eur Spine J 29(Suppl 1):78–85. https://doi.org/10.1007/s00586-020-06320-yCrossRefPubMed

Kuo CC, Soliman MAR, Aguirre AO, Ruggiero N, Kruk M, Khan A et al (2022) Vertebral bone quality score independently predicts proximal junctional kyphosis and/or failure after adult spinal deformity surgery. Neurosurgery. https://doi.org/10.1227/neu.0000000000002291CrossRefPubMed

Yu WS, Chan KY, Yu FW, Yeung HY, Ng BK, Lee KM et al (2013) Abnormal bone quality versus low bone mineral density in adolescent idiopathic scoliosis: a case-control study with in vivo high-resolution peripheral quantitative computed tomography. Spine J 13(11):1493–1499. https://doi.org/10.1016/j.spinee.2013.05.018CrossRefPubMed

Lam TP, Yang G, Pang H, Yip B, Lee W, Hung A et al (2021) A six years longitudinal cohort study on the changes in bone density and bone quality up to peak bone mass in adolescent idiopathic scoliosis (AIS) with and without 2 years of Calcium and Vit-D supplementation. Stud Health Technol Inf 280:31–34. https://doi.org/10.3233/shti210429CrossRef

Kono H, Machida M, Saito M, Nishiwaki Y, Kato H, Hosogane N et al (2011) Mechanism of osteoporosis in adolescent idiopathic scoliosis: experimental scoliosis in pinealectomized chickens. J Pineal Res 51(4):387–393. https://doi.org/10.1111/j.1600-079X.2011.00901.xCrossRefPubMed

Sawicki P, Tałałaj M, Życińska K, Zgliczyński WS, Wierzba W (2021) Current applications and selected technical details of dual-energy X-Ray absorptiometry. Med Sci Monitor 27:e930839. https://doi.org/10.12659/msm.930839CrossRef

Tang GY, Lv ZW, Tang RB, Liu Y, Peng YF, Li W et al (2010) Evaluation of MR spectroscopy and diffusion-weighted MRI in detecting bone marrow changes in postmenopausal women with osteoporosis. Clin Rad 65(5):377–381. https://doi.org/10.1016/j.crad.2009.12.011CrossRef

Shen W, Chen J, Punyanitya M, Shapses S, Heshka S, Heymsfield SB (2007) MRI-measured bone marrow adipose tissue is inversely related to DXA-measured bone mineral in Caucasian women. Osteoporosis Int 18(5):641–647. https://doi.org/10.1007/s00198-006-0285-9CrossRef

10.

Shen W, Scherzer R, Gantz M, Chen J, Punyanitya M, Lewis CE et al (2012) Relationship between MRI-measured bone marrow adipose tissue and hip and spine bone mineral density in AfricanAmerican and Caucasian participants: the CARDIA study. J Clinl Endocrinol Metabol 97(4):1337–1346. https://doi.org/10.1210/jc.2011-2605CrossRef

11.

Ehresman J, Pennington Z, Schilling A, Lubelski D, Ahmed AK, Cottrill E et al (2020) Novel MRI-based score for assessment of bone density in operative spine patients. Spine J 20(4):556–562. https://doi.org/10.1016/j.spinee.2019.10.018CrossRefPubMed

12.

Zhong J, Cao K, Wang B, Li H, Zhou X, Xu X et al (2019) Incidence and risk factors for proximal junctional kyphosis in adolescent idiopathic scoliosis after correction surgery: a meta-analysis. World Neurosurgery 125:e326–e335. https://doi.org/10.1016/j.wneu.2019.01.072CrossRefPubMed

13.

Ferrero E, Bocahut N, Lefevre Y, Roussouly P, Pesenti S, Lakhal W et al (2018) Proximal junctional kyphosis in thoracic adolescent idiopathic scoliosis: risk factors and compensatory mechanisms in a multicenter national cohort. Eur Spine J 27(9):2241–2250. https://doi.org/10.1007/s00586-018-5640-yCrossRefPubMed

14.

Boeckenfoerde K, Schulze Boevingloh A, Gosheger G, Bockholt S, Lampe LP, Lange T (2022) Risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis-the spinous processes and proximal rod contouring. J Clin Med 11(20):11206098. https://doi.org/10.3390/jcm11206098CrossRef

15.

Lee J, Park YS (2016) Proximal junctional kyphosis: diagnosis, pathogenesis, and treatment. Asian Spine J 10(3):593–600. https://doi.org/10.4184/asj.2016.10.3.593CrossRefPubMedPubMedCentral

16.

Lonner BS, Ren Y, Newton PO, Shah SA, Samdani AF, Shufflebarger HL et al (2017) Risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis-the pelvis and other considerations. Spine Deformity 5(3):181–188. https://doi.org/10.1016/j.jspd.2016.10.003CrossRefPubMed

17.

Tambe AD, Panikkar SJ, Millner PA, Tsirikos AI (2018) Current concepts in the surgical management of adolescent idiopathic scoliosis. Bone Joint J 100b(4):415–424. https://doi.org/10.1302/0301-620x.100b4.Bjj-2017-0846.R2CrossRef

18.

Pahys JM, Vivas AC, Samdani AF, Cunn G, Betz RR, Newton PO et al (2018) Assessment of proximal junctional kyphosis and shoulder balance with proximal screws versus hooks in posterior spinal fusion for adolescent idiopathic scoliosis. Spine 43(22):e1322–e1328. https://doi.org/10.1097/brs.0000000000002700CrossRefPubMed

19.

Tamai K, Terai H, Suzuki A, Nakamura H, Watanabe K, Katsumi K et al (2019) Risk factors for proximal junctional fracture following fusion surgery for osteoporotic vertebral collapse with delayed neurological deficits: a retrospective cohort study of 403 patients. Spine Surg Related Res 3(2):171–177. https://doi.org/10.22603/ssrr.2018-0068CrossRef

20.

Mikula AL, Lakomkin N, Pennington Z, Pinter ZW, Nassr A, Freedman B et al (2022) Association between lower Hounsfield units and proximal junctional kyphosis and failure at the upper thoracic spine. J Neurosurg Spine 2022:1–9. https://doi.org/10.3171/2022.3.Spine22197CrossRef

21.

Razzouk J, Ramos O, Ouro-Rodrigues E, Samayoa C, Wycliffe N, Cheng W et al (2023) Comparison of cervical, thoracic, and lumbar vertebral bone quality scores for increased utility of bone mineral density screening. Eur Spine J 32(1):20–26. https://doi.org/10.1007/s00586-022-07484-5CrossRefPubMed

22.

Kuo CC, Soliman MAR, Aguirre AO, Ruggiero N, Kruk M, Khan A et al (2023) Vertebral bone quality score independently predicts proximal junctional kyphosis and/or failure after adult spinal deformity surgery. Neurosurgery 92(5):945–954. https://doi.org/10.1227/neu.0000000000002291CrossRefPubMed

23.

Clément JL, Pesenti S, Ilharreborde B, Morin C, Charles YP, Parent HF et al (2021) Proximal junctional kyphosis is a rebalancing spinal phenomenon due to insufficient postoperative thoracic kyphosis after adolescent idiopathic scoliosis surgery. Eur Spine J 30(7):1988–1997. https://doi.org/10.1007/s00586-021-06875-4CrossRefPubMed

24.

Shariatzadeh H, Modaghegh BS, Mirzaei A (2017) the effect of dynamic hyperextension brace on osteoporosis and hyperkyphosis reduction in postmenopausal osteoporotic women. Arch Bone Joint Surg 5(3):181–185PubMedPubMedCentral

Title: Vertebral bone quality score as a novel predictor of proximal junctional kyphosis after thoracic adolescent idiopathic scoliosis surgery
Authors: Juehan Wang
Qian Chen
Youwei Ai
Yong Huang
Ce Zhu
Hong Ding
Ganjun Feng
Limin Liu
Yueming Song
Publication date: 22-08-2023
Publisher: Springer Berlin Heidelberg
Keywords: Scoliosis
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Adolescent Idiopathic Scoliosis
Published in: European Spine Journal / Issue 11/2023
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-023-07894-z

2024 ASCO Annual Meeting

Springer Medicine

Vertebral bone quality score as a novel predictor of proximal junctional kyphosis after thoracic adolescent idiopathic scoliosis surgery

Abstract

Introduction

Objective

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Introduction

Objective

Methods

Results

Conclusion

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