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Yamauchi I, Nakashima H, Ito S, Segi N, Ouchida J, Oishi R, Miyairi Y, Morita Y, Ode Y, Nagatani Y, Okada Y, Morishita K, Takeichi Y, Kagami Y, Tachi H, Ohshima K, Ogura K, Shinjo R, Ohara T, Tsuji T, Kanemura T, Imagama S. Preoperative low Hounsfield units in the lumbar spine are associated with postoperative mechanical complications in adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2824-2831. [PMID: 38695951 DOI: 10.1007/s00586-024-08261-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/23/2024] [Accepted: 04/03/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE To determine the most valid bone health parameter to predict mechanical complications (MCs) following surgery for adult spinal deformity (ASD). METHODS This multicenter study retrospectively examined the records of patients who had undergone fusion of three or more motion segments, including the pelvis, with a minimum two-year follow-up period. Patients with moderate and severe global alignment and proportion scores were included in the study and divided into two groups: those who developed MCs and those who did not. Bone mineral density (BMD) of the lumbar spine and femoral neck was measured using dual-energy X-ray absorptiometry, and Hounsfield units (HUs) were measured in the lumbar spine on computed tomography. Radiographic parameters were evaluated preoperatively, immediately after surgery, and at final follow-up. RESULTS Of 108 patients, 30 (27.8%) developed MCs, including 26 cases of proximal junctional kyphosis/failure, 2 of distal junctional failure, 6 of rod fracture, and 11 reoperations. HUs were significantly lower in patients who experienced MCs (113.7 ± 41.1) than in those who did not (137.0 ± 46.8; P = 0.02). BMD did not differ significantly between the two groups. The preoperative and two-year postoperative global tilt, as well as the immediately postoperative sagittal vertical axis, were significantly greater in patients who developed MCs than in those who did not (P = 0.02, P < 0.01, and P = 0.01, respectively). CONCLUSION Patients who experienced MCs following surgery for ASD had lower HUs than those who did not. HUs may therefore be more useful than BMD for predicting MCs following surgery for ASD.
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Affiliation(s)
- Ippei Yamauchi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Jun Ouchida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Ryotaro Oishi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yuichi Miyairi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yoshinori Morita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yukihito Ode
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yasuhiro Nagatani
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yuya Okada
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Kazuaki Morishita
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Yosuke Takeichi
- Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yujiro Kagami
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Hiroto Tachi
- Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan
| | - Kazuma Ohshima
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Keisuke Ogura
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Ryuichi Shinjo
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Tetsuya Ohara
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | - Taichi Tsuji
- Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
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Crawford AM, Striano BM, Amakiri IC, Williams DL, Lindsey MH, Gong J, Simpson AK, Schoenfeld AJ. The utility of vertebral Hounsfield units as a prognostic indicator of adverse events following treatment of spinal epidural abscess. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 17:100308. [PMID: 38264152 PMCID: PMC10803939 DOI: 10.1016/j.xnsj.2024.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
Background Spinal epidural abscesses (SEAs) are a devastating condition with high levels of associated morbidity and mortality. Hounsfield units (HUs), a marker of radiodensity on CT scans, have previously been correlated with adverse events following spinal interventions. We evaluated whether HUs might also be associated with all-cause complications and/or mortality in this high-risk population. Methods This retrospective cohort study was carried out within an academic health system in the United States. Adults diagnosed with a SEA between 2006 and 2021 and who also had a CT scan characterizing their SEA within 6 months of diagnosis were considered. HUs were abstracted from the 4 vertebral bodies nearest to, but not including, the infected levels. Our primary outcome was the presence of composite 90-day complications and HUs represented the primary predictor. A multivariable logistic regression analysis was conducted adjusting for demographic and disease-specific confounders. In sensitivity testing, separate logistic regression analyses were conducted (1) in patients aged 65 and older and (2) with mortality as the primary outcome. Results Our cohort consisted of 399 patients. The overall incidence of 90-day complications was 61.2% (n=244), with a 7.8% (n=31) 90-day mortality rate. Those experiencing complications were more likely to have undergone surgery to treat their SEA (58.6% vs. 46.5%; p=.018) but otherwise the cohorts were similar. HUs were not associated with composite 90-day complications (Odds ratio [OR] 1.00 [95% CI 1.00-1.00]; p=.842). Similar findings were noted in sensitivity testing. Conclusions While HUs have previously been correlated with adverse events in certain clinical contexts, we found no evidence to suggest that HUs are associated with all-cause complications or mortality in patients with SEAs. Future research hoping to leverage 3-dimensional imaging as a prognostic measure in this patient population should focus on alternative targets. Level of Evidence Level III; Observational Cohort study.
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Affiliation(s)
- Alexander M. Crawford
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA 02115,United States
| | - Brendan M. Striano
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA 02115,United States
| | - Ikechukwu C. Amakiri
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA 02115,United States
| | | | - Matthew H. Lindsey
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA 02115,United States
| | - Jonathan Gong
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115,United States
| | - Andrew K. Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115,United States
| | - Andrew J. Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115,United States
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Pressman E, Monsour M, Liaw D, Screven RD, Kumar JI, Hidalgo AV, Haas AM, Hayman EG, Alikhani P. Three-column osteotomy in long constructs has lower rates of proximal junctional kyphosis and better restoration of lumbar lordosis than anterior column realignment. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:590-598. [PMID: 38224408 DOI: 10.1007/s00586-023-08115-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE Three-column osteotomies (TCOs) and minimally invasive techniques such as anterior column realignment (ACR) are powerful tools used to restore lumbar lordosis and sagittal alignment. We aimed to appraise the differences in construct and global spinal stability between TCOs and ACRs in long constructs. METHODS We identified consecutive patients who underwent a long construct lumbar or thoracolumbar fusion between January 2016 and November 2021. "Long construct" was any construct where the uppermost instrumented vertebra (UIV) was L2 or higher and the lowermost instrumented vertebra (LIV) was in the sacrum or ileum. RESULTS We identified 69 patients; 14 (20.3%) developed PJK throughout follow-up (mean 838 days). Female patients were less likely to suffer PJK (p = 0.009). TCO was more associated with open (versus minimally invasive) screw/rod placement, greater number of levels, higher UIV, greater rate of instrumentation to the ilium, and posterior (versus anterior) L5-S1 interbody placement versus the ACR cohort (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.005, respectively). Patients who developed PJK were more likely to have undergone ACR (12 (32.4%) versus 2 (6.3%, p = 0.007)). The TCO cohort had better improvement of lumbar lordosis despite similar preoperative measurements (ACR: 16.8 ± 3.78°, TCO: 23.0 ± 5.02°, p = 0.046). Pelvic incidence-lumbar lordosis mismatch had greater improvement after TCO (ACR: 14.8 ± 4.02°, TCO: 21.5 ± 5.10°, p = 0.042). By multivariate analysis, ACR increased odds of PJK by 6.1-times (95% confidence interval: 1.20-31.2, p = 0.29). CONCLUSION In patients with long constructs who undergo ACR or TCO, we experienced a 20% rate of PJK. TCO decreased PJK 6.1-times compared to ACR. TCO demonstrated greater improvement of some spinopelvic parameters.
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Affiliation(s)
- Elliot Pressman
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Molly Monsour
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Deborah Liaw
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Ryan D Screven
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Jay I Kumar
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Adolfo Viloria Hidalgo
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Alexander M Haas
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Erik G Hayman
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA
| | - Puya Alikhani
- Division of Spine Surgery, Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA.
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