PDF(Pubmed)
Abstract：
METHODS: Prospective cohort study.
OBJECTIVE: This study aimed to identify the optimal preoperative bone health assessment for adult spinal deformity (ASD) surgery through correlation analysis between intraoperative pedicle screw (PS) insertion torque and various bone quality measures, including bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DEXA), Hounsfield unit (HU) by computed tomography (CT), and vertebral bone quality (VBQ) score by magnetic resonance imaging.
BACKGROUND: Existing data on optimal assessment tools for ASD surgery are limited.
METHODS: The study included patients with ASD aged >60 years who underwent spinal corrective fusion surgery from the lower thoracic spine to the pelvis. The intraoperative PS insertion torque was measured using a torque meter. Pearson correlation coefficients were calculated between the PS insertion torque and the BMD, HU, and VBQ score. Preoperative bone quality was compared between the proximal junctional failure (PJF) and non-PJF groups.
RESULTS: Thirty-one patients with 177 PS at T10, T11, and T12 were analyzed. The PS insertion torque showed a moderate positive correlation with lumbar spine BMD (r=0.59-0.69, p<0.01), total hip BMD (0.58-0.62, p<0.01), and HU value (r=0.58-0.66, p<0.01). However, the VBQ score did not show significant correlation (r=-0.28 to -0.23, p >0.05). Notably, a strong correlation was found between the PS insertion torque and the HU value for screws of the same size (r=0.71 and 0.74, p<0.01). The HU value at T12 and the PS insertion torque at T10 were significantly lower in the PJF group than in the non-PJF group.
CONCLUSIONS: This study demonstrates a positive correlation between the PS insertion torque and HU value in the lower thoracic spine and a moderate correlation with BMD but not the VBQ score. Preoperative assessment using DEXA and CT is crucial for optimizing bone health management in ASD surgery.
OBJECTIVE: This study aimed to identify the optimal preoperative bone health assessment for adult spinal deformity (ASD) surgery through correlation analysis between intraoperative pedicle screw (PS) insertion torque and various bone quality measures, including bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DEXA), Hounsfield unit (HU) by computed tomography (CT), and vertebral bone quality (VBQ) score by magnetic resonance imaging.
BACKGROUND: Existing data on optimal assessment tools for ASD surgery are limited.
METHODS: The study included patients with ASD aged >60 years who underwent spinal corrective fusion surgery from the lower thoracic spine to the pelvis. The intraoperative PS insertion torque was measured using a torque meter. Pearson correlation coefficients were calculated between the PS insertion torque and the BMD, HU, and VBQ score. Preoperative bone quality was compared between the proximal junctional failure (PJF) and non-PJF groups.
RESULTS: Thirty-one patients with 177 PS at T10, T11, and T12 were analyzed. The PS insertion torque showed a moderate positive correlation with lumbar spine BMD (r=0.59-0.69, p<0.01), total hip BMD (0.58-0.62, p<0.01), and HU value (r=0.58-0.66, p<0.01). However, the VBQ score did not show significant correlation (r=-0.28 to -0.23, p >0.05). Notably, a strong correlation was found between the PS insertion torque and the HU value for screws of the same size (r=0.71 and 0.74, p<0.01). The HU value at T12 and the PS insertion torque at T10 were significantly lower in the PJF group than in the non-PJF group.
CONCLUSIONS: This study demonstrates a positive correlation between the PS insertion torque and HU value in the lower thoracic spine and a moderate correlation with BMD but not the VBQ score. Preoperative assessment using DEXA and CT is crucial for optimizing bone health management in ASD surgery.
摘要：
■前瞻性队列研究。
■本研究旨在通过术中椎弓根螺钉（PS）插入扭矩与各种骨质量测量值的相关性分析，确定成人脊柱畸形（ASD）手术的最佳术前骨健康评估，包括通过双能X射线骨密度仪（DEXA）评估的骨密度（BMD），Hounsfield单位（HU）通过计算机断层扫描（CT），和磁共振成像的椎骨质量（VBQ）评分。
■关于ASD手术最佳评估工具的现有数据有限。
■该研究包括年龄>60岁的ASD患者，他们接受了从下胸椎到骨盆的脊柱矫正融合手术。使用扭矩计测量术中PS插入扭矩。计算了PS插入扭矩和BMD之间的皮尔逊相关系数，HU,和VBQ得分。比较近端交界失败（PJF）和非PJF组之间的术前骨骼质量。
■分析了31例T10、T11和T12的177PS患者。PS插入扭矩与腰椎BMD呈中度正相关（r=0.59-0.69，p<0.01），总髋部骨密度（0.58-0.62，p<0.01），和HU值(r=0.58-0.66,p<0.01)。然而,VBQ评分无显著相关性(r=-0.28~-0.23,p>0.05)。值得注意的是,对于相同尺寸的螺钉，PS插入扭矩与HU值之间存在很强的相关性（r=0.71和0.74，p<0.01）。PJF组T12时的HU值和T10时的PS插入扭矩明显低于非PJF组。
■这项研究表明，下胸椎的PS插入扭矩与HU值之间呈正相关，与BMD但与VBQ评分无关。使用DEXA和CT进行术前评估对于优化ASD手术中的骨骼健康管理至关重要。
■本研究旨在通过术中椎弓根螺钉（PS）插入扭矩与各种骨质量测量值的相关性分析，确定成人脊柱畸形（ASD）手术的最佳术前骨健康评估，包括通过双能X射线骨密度仪（DEXA）评估的骨密度（BMD），Hounsfield单位（HU）通过计算机断层扫描（CT），和磁共振成像的椎骨质量（VBQ）评分。
■关于ASD手术最佳评估工具的现有数据有限。
■该研究包括年龄>60岁的ASD患者，他们接受了从下胸椎到骨盆的脊柱矫正融合手术。使用扭矩计测量术中PS插入扭矩。计算了PS插入扭矩和BMD之间的皮尔逊相关系数，HU,和VBQ得分。比较近端交界失败（PJF）和非PJF组之间的术前骨骼质量。
■分析了31例T10、T11和T12的177PS患者。PS插入扭矩与腰椎BMD呈中度正相关（r=0.59-0.69，p<0.01），总髋部骨密度（0.58-0.62，p<0.01），和HU值(r=0.58-0.66,p<0.01)。然而,VBQ评分无显著相关性(r=-0.28~-0.23,p>0.05)。值得注意的是,对于相同尺寸的螺钉，PS插入扭矩与HU值之间存在很强的相关性（r=0.71和0.74，p<0.01）。PJF组T12时的HU值和T10时的PS插入扭矩明显低于非PJF组。
■这项研究表明，下胸椎的PS插入扭矩与HU值之间呈正相关，与BMD但与VBQ评分无关。使用DEXA和CT进行术前评估对于优化ASD手术中的骨骼健康管理至关重要。
