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Li Q, Fu H, Yang H, Yang X, Wang L, Song Y. Novel MRI-Based Pedicle Bone Quality Score Independently Predicts Pedicle Screw Loosening after Degenerative Lumbar Fusion Surgery. Orthop Surg 2024. [PMID: 38982614 DOI: 10.1111/os.14146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/08/2024] [Accepted: 06/09/2024] [Indexed: 07/11/2024] Open
Abstract
Pedicle screw loosening after posterior lumbar fusion is associated with poor bone quality, which often determines screw pull-out strength, insertion torque, and vertebral body loading characteristics. Magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score were associated with poor bone quality. Current evidence suggests that pedicle bone quality (PBQ) has a greater impact on screw stability. However, the correlation between MRI-based PBQ score and screw loosening has not been reported. PURPOSE To introduce and evaluate an MRI-based PBQ score to determine its effectiveness in predicting pedicle screw loosening following lumbar fusion surgery. METHODS The retrospective study analyzed 244 patients who underwent posterior lumbar interbody fusion (PLIF) with pedicle screws between December 2017 and December 2021, with CT and MRI imaging before surgery. Data collected included patient demographics and preoperative radiological data. Radiographic screw loosening was measured at 12 months postoperatively. Clinical assessments included pain visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. The PBQ score was measured using MRI scans. We use univariate analysis for preliminary screening of the risk factors of screw loosening. Subsequent analysis involved multivariate logistic regression to identify independent predictive factors for screw loosening. We constructed the receiver operating characteristic (ROC) curve to ascertain the discriminative capacity of the PBQ score. The area under the curve (AUC) quantified its predictive accuracy. Additionally, we evaluated the association between PBQ score and screw loosening using Spearman's correlation analysis. RESULTS Overall, 244 patients who underwent PLIF with pedicle screw fixation participated in this study, including 35 in the loosening group and 209 in the non-loosening group. PBQ score in the loosening group was significantly higher than that in the non-loosening group. On multivariate logistic regression, the higher PBQ score (OR = 8.481, 95% CI: 3.158-22.774; p < 0.001) and the lower mean Hounsfield unit (HU) value of L1-4 (OR = 0.967, 95% CI 0.951-0.984; p < 0.001) were the variables that significantly predicted screw loosening. The AUC for the PBQ score and HU value were 0.751 (95% CI: 0.673-0.828) and 0.702 (95% CI: 0.612-0.791). The PBQ score optimal cutoff to differentiate patients with loosening and with non-loosening was calculated as 3.045 with a sensitivity of 85.7% and specificity of 76.9%, while the optimal cutoff of the HU value was 151.5 with a sensitivity of 64.6% and specificity of 89.5%. CONCLUSIONS The association between the PBQ score and the propensity for lumbar pedicle screw loosening was found to be substantial. As a predictive measure, the PBQ score outperformed the HU value in forecasting the likelihood of screw loosening post-posterior lumbar fusion.
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Affiliation(s)
- Qiujiang Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Haiying Fu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Huiliang Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xi Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Lei Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yueming Song
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Agaronnik ND, Giberson-Chen C, Bono CM. Using advanced imaging to measure bone density, compression fracture risk, and risk for construct failure after spine surgery. Spine J 2024; 24:1135-1152. [PMID: 38437918 DOI: 10.1016/j.spinee.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/22/2024] [Accepted: 02/23/2024] [Indexed: 03/06/2024]
Abstract
Low bone mineral density (BMD) can predispose to vertebral body compression fractures and postoperative instrumentation failure. DEXA is considered the gold standard for measurement of BMD, however it is not obtained for all spine surgery patients preoperatively. There is a growing body of evidence suggesting that more routinely acquired spine imaging studies such as computed tomography (CT) and magnetic resonance imaging (MRI) can be opportunistically used to measure BMD. Here we review available studies that assess the validity of opportunistic screening with CT-derived Hounsfield Units (HU) and MRI-derived vertebral vone quality (VBQ) to measure BMD of the spine as well the utility of these measures in predicting postoperative outcomes. Additionally, we provide screening thresholds based on HU and VBQ for prediction of osteopenia/ osteoporosis and postoperative outcomes such as cage subsidence, screw loosening, proximal junctional kyphosis, and implant failure.
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Affiliation(s)
| | - Carew Giberson-Chen
- Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Yawkey Building, Suite 3A, Boston, MA 02114
| | - Christopher M Bono
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115; Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Yawkey Building, Suite 3A, Boston, MA 02114; Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey Building, Suite 3A, Boston, MA 02114.
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Ramos O, Razzouk J, Beauchamp E, Mueller B, Shafa E, Mehbod AA, Cheng W, Danisa O, Carlson BC. Adding Vertebral Bone Quality to the Fusion Risk Score: Does It Improve Predictions of Postoperative Complications? Spine (Phila Pa 1976) 2024; 49:916-922. [PMID: 38419578 DOI: 10.1097/brs.0000000000004974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE The current study evaluates whether the addition of the Vertebral Bone Quality (VBQ) score to the Fusion Risk Score (FRS) improves its ability to predict perioperative outcomes. SUMMARY OF BACKGROUND DATA The FRS was developed to assess preoperative risk in patients undergoing thoracic and lumbar fusions. It includes patient-derived and surgical variables, but it does not include one that directly accounts for bone health. The VBQ score allows assessment of bone quality and has been shown to correlate to DEXA-measured bone mineral density (BMD) scores. METHODS The VBQ score was weighted based on a regression model and then added to the FRS (FRS/VBQ). The ability of the two scores to predict the outcomes was then assessed using the area under the curve (AUC). PATIENT SAMPLE Patients undergoing elective thoracic and lumbar spinal fusion from January 2019 to June 2020 were included. OUTCOME MEASURES The study evaluated various perioperative adverse outcomes, including major and minor adverse events, discharge other than home, extended length of stay, 90-day emergency department visits, 90-day readmission, and 90-day and 2-year reoperation rates. RESULTS A total of 353 met the inclusion and exclusion criteria. The FRS/VBQ demonstrated improved predictive ability compared with the FRS alone when evaluating 90-day reoperation. Both scores showed fair predictive ability for any adverse event, major adverse events, minor adverse events, and 2-year reoperation rates, with AUCs ranging from 0.700 to 0.737. Both had poor predictive ability for the other outcomes. CONCLUSIONS Adding VBQ to the FRS significantly enhances its predictive accuracy for reoperation rate. This updated risk score provides a more comprehensive understanding of a patient's preoperative risk profile, aiding both patients and physicians in assessing surgical risks and optimizing outcomes through preoperative risk stratification. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Omar Ramos
- Twin Cities Spine Center, Minneapolis, MN
| | - Jacob Razzouk
- Loma Linda University Medical Center, Loma Linda, CA
| | | | | | | | | | - Wayne Cheng
- Loma Linda University Medical Center, Loma Linda, CA
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Pennington Z, Mikula AL, Lakomkin N, Martini M, Pinter ZW, Shafi M, Hamouda A, Bydon M, Clarke MJ, Freedman BA, Krauss WE, Nassr AN, Sebastian AS, Fogelson JL, Elder BD. Bone Quality as Measured by Hounsfield Units More Accurately Predicts Proximal Junctional Kyphosis than Vertebral Bone Quality Following Long-Segment Thoracolumbar Fusion. World Neurosurg 2024; 186:e584-e592. [PMID: 38588791 DOI: 10.1016/j.wneu.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To compare the prognostic power of Hounsfield units (HU) and Vertebral Bone Quality (VBQ) score for predicting proximal junctional kyphosis (PJK) following long-segment thoracolumbar fusion to the upper thoracic spine (T1-T6). METHODS Vertebral bone quality around the upper instrumented vertebrae (UIV) was measured using HU on preoperative CT and VBQ on preoperative MRI. Spinopelvic parameters were also categorized according to the Scoliosis Research Society-Schwab classification. Univariable analysis to identify predictors of the occurrence of PJK and survival analyses with Kaplan-Meier method and Cox regression were performed to identify predictors of time to PJK (defined as ≥10° change in Cobb angle of UIV+2 and UIV). Sensitivity analyses showed thresholds of HU < 164 and VBQ > 2.7 to be most predictive for PJK. RESULTS Seventy-six patients (mean age 66.0 ± 7.0 years; 27.6% male) were identified, of whom 15 suffered PJK. Significant predictors of PJK were high postoperative pelvic tilt (P = 0.038), high postoperative T1-pelvic angle (P = 0.041), and high postoperative PI-LL mismatch (P = 0.028). On survival analyses, bone quality, as assessed by the average HU of the UIV and UIV+1 was the only significant predictor of time to PJK (odds ratio [OR] 3.053; 95% CI 1.032-9.032; P = 0.044). VBQ measured using the UIV, UIV+1, UIV+2, and UIV-1 vertebrae approached, but did not reach significance (OR 2.913; 95% CI 0.797-10.646; P = 0.106). CONCLUSIONS In larger cohorts, VBQ may prove to be a significant predictor of PJK following long-segment thoracolumbar fusion. However, Hounsfield units on CT have greater predictive power, suggesting preoperative workup for long-segment thoracolumbar fusion benefits from computed tomography versus magnetic resonance imaging alone to identify those at increased risk of PJK.
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Affiliation(s)
- Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Anthony L Mikula
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nikita Lakomkin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Martini
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Zachariah W Pinter
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mahnoor Shafi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle J Clarke
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - William E Krauss
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmad N Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arjun S Sebastian
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy L Fogelson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Jiang G, Xu L, Ma Y, Guan J, Yang Y, Zhong W, Li W, Zhou S, Song J, Feng N, Qiu Z, Li Z, Zhou Y, Meng L, Qu Y, Yu X. Prediction of Screw Loosening After Dynamic Pedicle Screw Fixation With Lumbar Polyetheretherketone Rods Using Magnetic Resonance Imaging-Based Vertebral Bone Quality Score. Neurospine 2024; 21:712-720. [PMID: 38955540 PMCID: PMC11224750 DOI: 10.14245/ns.2448184.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To investigate the correlation between magnetic resonance imaging-based vertebral bone quality (VBQ) score and screw loosening after dynamic pedicle screw fixation with polyetheretherketone (PEEK) rods, and evaluate its predictive value. METHODS A retrospective analysis was conducted on the patients who underwent dynamic pedicle screw fixation with PEEK rods from March 2017 to June 2022. Data on age, sex, body mass index, hypertension, diabetes, hyperlipidemia history, long-term smoking, alcohol consumption, VBQ score, L1-4 average Hounsfield unit (HU) value, surgical fixation length, and the lowest instrumented vertebra were collected. Logistic regression analysis was employed to assess the relationship between VBQ score and pedicle screw loosening (PSL). RESULTS A total of 24 patients experienced PSL after surgery (20.5%). PSL group and non-PSL group showed statistical differences in age, number of fixed segments, fixation to the sacrum, L1-4 average HU value, and VBQ score (p < 0.05). The VBQ score in the PSL group was higher than that in the non-PSL group (3.56 ± 0.45 vs. 2.77 ± 0.31, p < 0.001). In logistic regression analysis, VBQ score (odds ratio, 3.425; 95% confidence interval, 1.552-8.279) were identified as independent risk factors for screw loosening. The area under the receiver operating characteristic curve for VBQ score predicting PSL was 0.819 (p < 0.05), with the optimal threshold of 3.15 (sensitivity, 83.1%; specificity, 80.5%). CONCLUSION The VBQ score can independently predict postoperative screw loosening in patients undergoing lumbar dynamic pedicle screw fixation with PEEK rods, and its predictive value is comparable to HU value.
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Affiliation(s)
- Guozheng Jiang
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Luchun Xu
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Yukun Ma
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Jianbin Guan
- Department of Neurosurgery, Honghui-Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yongdong Yang
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Wenqing Zhong
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Wenhao Li
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Shibo Zhou
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - JiaWei Song
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Ningning Feng
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Ziye Qiu
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Zeyu Li
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - YiShu Zhou
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Letian Meng
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Yi Qu
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Xing Yu
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
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Xue C, Lu X, Sun G, Wang N, He G, Xu W, Xi Z, Xie L. Opportunistic prediction of osteoporosis in patients with degenerative lumbar diseases: a simplified T12 vertebral bone quality approach. J Orthop Surg Res 2024; 19:296. [PMID: 38750513 PMCID: PMC11094894 DOI: 10.1186/s13018-024-04782-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/05/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Osteoporosis is one of the risk factors for screw loosening after lumbar fusion. However, the probability of preoperative osteoporosis screening in patients with lumbar degenerative disease is low. Therefore, the aim of this study was to investigate whether a simplified vertebral bone quality (VBQ) score based on T12 T1-MRI could opportunistically predict osteoporosis in patients with degenerative lumbar spine diseases. METHODS We retrospectively analyzed cases treated for lumbar degenerative diseases at a single institution between August 2021 and June 2022. The patients were divided into three groups by the lowest T-score: osteoporosis group, osteopenia group, and normal bone mineral density (BMD) group. The signal intensity based on the T12 vertebral body divided by the signal intensity of the cerebrospinal fluid was calculated to obtain the simplified VBQ score, as well as the CT-based T12HU value and the traditional L1-4VBQ score. Various statistical analyses were used to compare VBQ, HU and DEXA, and the optimal T12VBQ threshold for predicting osteoporosis was obtained by plotting the receiver operating curve (ROC) analysis. RESULTS Total of 166 patients were included in this study. There was a statistically significant difference in T12VBQ scores between the three groups (p < 0.001). Pearson correlation showed that there was a moderate correlation between T12VBQ and T-score (r=-0.406, p < 0.001). The AUC value of T12VBQ, which distinguishes between normal and low BMD, was 0.756, and the optimal diagnostic threshold was 2.94. The AUC value of T12VBQ, which distinguishes osteoporosis from non-osteoporosis, was 0.634, and the optimal diagnostic threshold was 3.18. CONCLUSION T12VBQ can be used as an effective opportunistic screening method for osteoporosis in patients with lumbar degenerative diseases. It can be used as a supplement to the evaluation of DEXA and preoperative evaluation. TRIAL REGISTRATION retrospectively registered number:1502-009-644; retrospectively registered number date:27 oct 2022.
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Affiliation(s)
- Congyang Xue
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Xiaopei Lu
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Guangda Sun
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Nan Wang
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Ganshen He
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Wenqiang Xu
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Zhipeng Xi
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Lin Xie
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China.
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Zheng W, Han W, Jin S, Zhu M, Huang Z, Qin T, Shi M, Gao B, Ye W. Application of a Magnetic Resonance Imaging-Based Lumbar Vertebral Bone Quality Scoring System in Patients with Degenerative Lumbar Scoliosis. World Neurosurg 2024; 185:e421-e430. [PMID: 38354770 DOI: 10.1016/j.wneu.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Although dual-energy X-ray absorptiometry is still the gold standard for diagnosing osteoporosis, it can lead to inaccurate bone mineral density measurements due to lumbar degeneration and scoliosis. Many researchers have investigated diagnostic methods for osteoporosis in patients with degenerative lumbar scoliosis (DLS). This study aimed to investigate the differences between conventional vertebral bone quality (VBQ) scores and modified VBQ scores in patients with DLS and the influence of lumbar scoliosis on VBQ scores. METHODS We retrospectively collected the clinical and radiological data of 68 patients with DLS admitted to Sun Yat-sen Memorial Hospital from July 2018 to April 2023. The patients were classified into one of 2 groups based on the T score of the left femoral neck. VBQ scores relative to cerebrospinal fluid at different levels, VBQ scores on different planes and single-level VBQ scores were compared. Receiver operating characteristic analysis was also performed. Different modified VBQ scores were compared between the moderate scoliosis group (10° RESULTS There were no significant differences in VBQ scores relative to cerebrospinal fluid at different levels (P = 0.983), on different planes (P = 0.832) or at single-level (P = 0.996). All the VBQ scores were negatively correlated with the T score of the left femoral neck. There were no significant differences in the modified VBQ scores between the moderate and severe scoliosis groups. CONCLUSIONS Different modified VBQ scores can be used as supplementary methods for diagnosing osteoporosis in patients with DLS. Lumbar scoliosis may not significantly affect the VBQ score.
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Affiliation(s)
- Wanli Zheng
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Weitao Han
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Song Jin
- Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Mingxi Zhu
- Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Zhengqi Huang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tianyu Qin
- Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Ming Shi
- Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Bo Gao
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Ye
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Bernatz JT, Pumford A, Goh BC, Pinter ZW, Mikula AL, Michalopoulos GD, Bydon M, Huddleston P, Nassr AN, Freedman BA, Sebastian AS. MRI Vertebral Bone Quality Correlates With Interbody Cage Subsidence After Anterior Cervical Discectomy and Fusion. Clin Spine Surg 2024; 37:149-154. [PMID: 38706112 DOI: 10.1097/bsd.0000000000001623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/07/2024] [Indexed: 05/07/2024]
Abstract
STUDY DESIGN Retrospective observational study of consecutive patients. OBJECTIVE The purpose of the study was to evaluate VBQ as a predictor of interbody subsidence and to determine threshold values that portend increased risk of subsidence. SUMMARY OF BACKGROUND DATA Many risk factors have been reported for the subsidence of interbody cages in anterior cervical discectomy and fusion (ACDF). MRI Vertebral Bone Quality (VQB) is a relatively new radiographic parameter that can be easily obtained from preoperative MRI and has been shown to correlate with measurements of bone density such as DXA and CT Hounsfield Units. METHODS All patients who underwent 1- to 3-level ACDF using titanium interbodies with anterior plating between the years 2018 and 2020 at our tertiary referral center were included. Subsidence measurements were performed by 2 independent reviewers on CT scans obtained 6 months postoperatively. VBQ was measured on pre-operative sagittal T1 MRI by 2 independent reviewers, and values were averaged. RESULTS Eight-five fusion levels in 44 patients were included in the study. There were 32 levels (38%) with moderate subsidence and 12 levels with severe subsidence (14%). The average VBQ score in those patients with severe subsidence was significantly higher than those without subsidence (3.80 vs. 2.40, P<0.01). A threshold value of 3.2 was determined to be optimal for predicting subsidence (AUC=0.99) and had a sensitivity of 100% and a specificity of 94.1% in predicting subsidence. CONCLUSIONS VBQ strongly correlates with the subsidence of interbody grafts after ACDF. A threshold VBQ score value of 3.2 has excellent sensitivity and specificity for predicting subsidence. Spine surgeons can use VBQ as a readily available screening tool to identify patients at higher risk for subsidence. LEVEL OF EVIDENCE Level-IV.
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Affiliation(s)
| | | | | | | | | | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
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Deng W, Zhou Y, Zhou Q, Yin Y, Song Y, Feng G. Simplified S1 vertebral bone quality score independently predicts proximal junctional kyphosis after surgery for degenerative lumbar scoliosis. J Orthop Surg Res 2024; 19:238. [PMID: 38615068 PMCID: PMC11015578 DOI: 10.1186/s13018-024-04722-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/05/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVE Our study aimed to assess the effectiveness of the simplified S1 vertebral bone quality (VBQ) score in predicting the incidence of proximal junctional kyphosis (PJK) after surgery for degenerative lumbar scoliosis (DLS). METHODS We reviewed 122 patients with DLS who underwent posterior lumbar decompression and long-segment fusion surgery in our hospital from January 2016 to December 2020. The patients were classified into PJK group and non-PJK group. S1 VBQ scores are determined by signal intensity measurements taken from the mid-sagittal plane of T1-weighted non-contrast MRI. Logistic regression analysis was used to identify factors associated with PJK. Receiver-operating characteristic curve (ROC) analysis was used to evaluate the value of S1 VBQ score in predicting pedicle PJK after DLS. RESULTS 122 DLS patients (90 females and 32 males) met the inclusion criteria. In addition, 27 patients (22.13%) had PJK at the time of last follow-up. VBQ was higher in PJK patients than non-PJK patients (3.58 ± 0.67 vs. 3.08 ± 0.54, p < 0.001). Preoperatively, patients in the PJK group had a greater TLK than those in the non-PJK group (20.00 ± 6.22 vs. 16.86 ± 5.38, p = 0.011). After surgery, patients in the PJK group had greater TLK (p < 0.001) and PJA (p < 0.001) compared with the non-PJK group. At final FU, patients in the PJK group had greater TK (p = 0.002), TLK (p < 0.001), SVA (p < 0.001), and PJA (p < 0.001) than patients in the non-PJK group (Table 4). In multivariate logistic regression analysis, higher VBQ score (OR 4.565, 95% CI 1.43-14.568, p = 0.010), advanced age (OR 1.119, 95% CI 1.021-1.227, p = 0.016), and larger TLK (OR 1.191, 95% CI 1.041-1.362, p = 0.011) were significant predictors of postoperative PJK in patients with DLS (Table 6). A statistically significant positive correlation existed between VBQ score and PJA change (r = 0.370, p < 0.001). We created ROC curves for VBQ scores as predictors of PJK with a diagnostic accuracy of 72.1% (95% CI 60.15-82.9%.The ideal limit for the VBQ score was 3.205 (sensitivity: 77.8%, specificity: 81.4%). CONCLUSION To the best of our knowledge, this is the first study to evaluate the effectiveness of the S1 VBQ score in predicting postoperative PJK in DLS. Our study included major risk factors and found that S1 VBQ score was a significant predictor of PJK in patients undergoing DLS surgery. The higher the S1 VBQ score, the higher the probability of PJK.
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Affiliation(s)
- Wei Deng
- Department of Orthopedics Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics, Pidu District People's Hospital/The Third Affiliated Hospital of Chengdu Medical College, Chengdu, 611730, China
| | - Yue Zhou
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qingsong Zhou
- Department of Orthopedics, Pidu District People's Hospital/The Third Affiliated Hospital of Chengdu Medical College, Chengdu, 611730, China
| | - Yong Yin
- Department of Orthopedics, Pidu District People's Hospital/The Third Affiliated Hospital of Chengdu Medical College, Chengdu, 611730, China
| | - Yueming Song
- Department of Orthopedics Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ganjun Feng
- Department of Orthopedics Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Shen S, You X, Ren Y, Ye S. Risk Factors of Cage Subsidence Following Oblique Lumbar Interbody Fusion: A Meta-analysis and Systematic Review. World Neurosurg 2024; 183:180-186. [PMID: 38145652 DOI: 10.1016/j.wneu.2023.12.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES The aim of this systematic review was to evaluate the risk factors for cage subsidence (CS) after oblique lumbar interbody fusion (OLIF). METHODS The cohort and case-control studies which reporting potential risk factors for CS following OLIF were searched in PubMed, Embase, and Web of Science from database inception to June 17, 2023. Two researchers independently screened the literature, extracted data, and evaluated the quality of the literature according to the Newcastle Ottawa Scale. RevMan5.3 software was used for Meta analysis. χ2 statistics and I2 statistics were used to evaluate heterogeneity, and the analysis results were represented by forest plots. RESULTS A total of 8 studies with 280 cases of CS from 832 patients who underwent OLIF met the inclusion criteria. Elderly patients over 60 years old (odds ratio [OR] 2.44, 95% CI 1.38-4.31, P = 0.002), osteoporosis (OR 4.18, 95% CI 2.30-7.61, P = 0.002), end plate injury (OR 5.72, 95% CI 2.32-14.11, P = 0.0002), and overdistraction of intervertebral space (OR 1.67, 95% CI 1.3 2-2.11, P < 0.0001) were potential risk factors, while Hounsfield units value of the vertebral body (OR 0.97, 95% CI 0.95-1.00, P = 0.02) is a protective factor. The number of operative segments did not increase the risk of CS. CONCLUSIONS Older age, osteoporosis, endplate injury, and overdistraction of the intervertebral space may increase the risk of CS after OLIF. Although the incidence rate of CS is low, implementing effective preventions is a priority for clinicians based on these risk factors.
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Affiliation(s)
- Shufeng Shen
- Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang Province, China.
| | - Xinmao You
- Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang Province, China
| | - Yingqing Ren
- Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang Province, China
| | - Senqi Ye
- Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang Province, China
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Jiang L, Liu L, Dong L, Xu Z, Zhang X, Qian L. Comparison of instrumented and stand-alone lateral lumbar interbody fusion for lumbar degenerative disease: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:108. [PMID: 38310205 PMCID: PMC10837938 DOI: 10.1186/s12891-024-07214-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Both instrumented and stand-alone lateral lumbar interbody fusion (LLIF) have been widely used to treat lumbar degenerative disease. However, it remains controversial as whether posterior internal fixation is required when LLIF is performed. This meta-analysis aims to compare the radiographic and clinical results between instrumented and stand-alone LLIF. METHODS PubMed, EMBASE and Cochrane Collaboration Library up to March 2023 were searched for studies that compared instrumented and stand-alone LLIF in the treatment of lumbar degenerative disease. The following outcomes were extracted for comparison: interbody fusion rate, cage subsidence rate, reoperation rate, restoration of disc height, segmental lordosis, lumbar lordosis, visual analog scale (VAS) scores of low-back and leg pain and Oswestry Disability Index (ODI) scores. RESULTS 13 studies involving 1063 patients were included. The pooled results showed that instrumented LLIF had higher fusion rate (OR 2.09; 95% CI 1.16-3.75; P = 0.01), lower cage subsidence (OR 0.50; 95% CI 0.37-0.68; P < 0.001) and reoperation rate (OR 0.28; 95% CI 0.10-0.79; P = 0.02), and more restoration of disc height (MD 0.85; 95% CI 0.18-1.53; P = 0.01) than stand-alone LLIF. The ODI and VAS scores were similar between instrumented and stand-alone LLIF at the last follow-up. CONCLUSIONS Based on this meta-analysis, instrumented LLIF is associated with higher rate of fusion, lower rate of cage subsidence and reoperation, and more restoration of disc height than stand-alone LLIF. For patients with high risk factors of cage subsidence, instrumented LLIF should be applied to reduce postoperative complications.
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Affiliation(s)
- Lianghai Jiang
- Department of Spine Surgery, Qingdao Municipal Hospital, Qingdao, People's Republic of China
| | - Lantao Liu
- Department of Spine Surgery, Qingdao Municipal Hospital, Qingdao, People's Republic of China
| | - Liang Dong
- Department of Orthopedic, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China.
| | - Zhengwei Xu
- Department of Orthopedic, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China
| | - Xiaobo Zhang
- Department of Orthopedic, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China
| | - Lixiong Qian
- Department of Orthopedic, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China
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Wang J, Zhu C, Ding H, Huang Y, Chen Q, Ai Y, Feng G, Liu L, Song Y. Simplified S1 vertebral bone quality (vbq) score to assess proximal junctional kyphosis after Lenke 5 adolescent idiopathic scoliosis surgery. 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; 33:732-738. [PMID: 37889326 DOI: 10.1007/s00586-023-07993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/23/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Proximal junctional kyphosis (PJK) is a common complication following corrective surgery for adolescent idiopathic scoliosis (AIS) with a Lenke 5 curve. Previous studies have suggested that PJK may be associated with osteopenia, which is prevalent in AIS patients. MRI-based vertebral bone quality (VBQ) scores have been proposed as a valuable tool to assess preoperative bone quality. However, accurately measuring VBQ scores in Lenke 5 AIS patients with a structural lumbar curve can be challenging. Recently, a simplified S1 VBQ score has been proposed as an alternative method when the traditional VBQ score is not applicable. This study aims to evaluate the predictive value of the simplified S1 VBQ score in predicting the occurrence of PJK after corrective surgery for Lenke 5 AIS. METHODS We conducted a retrospective analysis of patient data to assess the predictive utility of the S1 VBQ score for PJK in Lenke 5 AIS patients. Demographic, radiographic, and surgical data were collected, and S1 VBQ scores were calculated based on preoperative T1-weighted MRI images. Univariate analysis, linear regression, and multivariate logistic regression were performed to identify potential risk factors for PJK and to assess the correlation between other variables and the S1 VBQ score. Receiver operating characteristic analysis and area under the curve values were used to evaluate the predictive efficiency of the S1 VBQ score for PJK. RESULTS A total of 105 patients (aged 15.50 ± 2.36 years) were included in the analysis, of whom 24 (22.9%) developed PJK. S1 VBQ scores were significantly higher in the PJK group compared to the non-PJK group (2.83 ± 0.44 vs. 2.48 ± 0.30, P < 0.001), and there was a significant positive correlation between the S1 VBQ score and proximal junctional angle (PJA) (r = 0.46, P < 0.0001). Multivariate analysis revealed that the S1 VBQ scores and preoperative thoracic kyphosis (TK) were significant predictors of PJK. CONCLUSION This study provided evidence that higher S1 VBQ scores were independently associated with PJK occurrence following corrective surgery for Lenke 5 AIS. Preoperative measurement of the S1 VBQ score on MRI may serve as a valuable tool in planning surgical correction for Lenke 5 AIS.
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Affiliation(s)
- Juehan Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Ce Zhu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Hong Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Yong Huang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Qian Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Youwei Ai
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Ganjun Feng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China.
| | - Yueming Song
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
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Wang Z, Huang Y, Chen Q, Liu L, Song Y, Feng G. Cervical Vertebral Bone Quality Score Independently Predicts Zero-Profile Cage Subsidence After Single-Level Anterior Cervical Discectomy and Fusion. World Neurosurg 2024; 182:e377-e385. [PMID: 38040332 DOI: 10.1016/j.wneu.2023.11.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE This is the first study to evaluate the predictive value of the cervical vertebral bone quality (VBQ) score on zero-profile cage (ZPC)subsidence after anterior cervical discectomy and fusion (ACDF) using the Hounsfield units (HU) value of computed tomography as the reference. METHODS A total of 89 patients with at least 1 year of follow-up who underwent single-level ACDF with ZPC were retrospectively and consecutively included. VBQ and HU value were determined from preoperative T1-weighted magnetic resonance imaging and computed tomography. Subsidence was defined as ≥2 mm of migration of the cage into the superior or inferior endplate or both using lateral cervical spine radiography. The results were subjected to statistical analysis. RESULTS Subsidence was observed among 16 of the 89 study patients (Subsidence rate: 18.0%). The mean VBQ score was 2.94 ± 0.820 for patients with subsidence and 2.33 ± 0.814 for patients without subsidence. The multivariable analysis demonstrated that only an increased VBQ score (odds ratio: 1.823, 95% confidence interval : 0.918,3.620, P = 0.001) was associated with an increased rate of cage subsidence. There was a significant and moderate correlation between HU and VBQ (r = -0.507, P < 0.001). Using receiver operating characteristic curves, the area under the curve was 0.785, and the most appropriate threshold of VBQ was 2.68 (sensitivity 72.7%, specificity 82.1%). CONCLUSIONS The VBQ score may be a valuable tool for independently predicting ZPC subsidence after single-level ACDF.
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Affiliation(s)
- Zhe Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Orthopaedics and Laboratory of Biological Tissue, Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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