Global Spine Journal最新文献

Study DesignRetrospective cohort study.ObjectivesTo investigate the risk factors and clinical impact of progression of thoracic kyphosis (PTK) in who underwent lower thoracic fusion for lumbar flatback deformity (LFBD).MethodsThe study included 170 patients (mean age 70.2 years; 90.6% female) who underwent fusion from the lower thoracic spine (T9 or T10) for LFBD with a minimum follow-up of 2 years. PTK was defined as a final thoracic kyphosis (TK) ≥ 40° and ΔTK ≥10°. Multivariate logistic regression was performed to identify independent risk factors for PTK. Receiver operating characteristic (ROC) curve analysis was used to determine predictive cutoff values.ResultsPTK developed in 55 patients (32.4%) during a mean follow-up of 35.8 months. Patients with PTK exhibited significantly higher final TK (48.2° vs 27.3°), worse sagittal alignment, and lower clinical outcome scores compared to those without PTK. Multivariate analysis identified preoperative TK (odds ratio [OR] = 1.120, P = 0.007) and age (OR = 1.094; P = 0.041) as independent risk factors for PTK. ROC analysis determined a preoperative TK cutoff value of 10.0° (area under the curve [AUC] = 0.834) and an age cutoff of 69.5 years (AUC = 0.661).ConclusionsIn this study, PTK developed in 32.4% of patients following fusion to the lower thoracic spine for LFBD. Advanced age (>70 years) and high baseline TK (>10°) were significant risk factors for PTK. Extending fusion to a more cephalad thoracic spine should be considered for patients at high risk of PTK development.

Study DesignRetrospective cohort study.ObjectivesUnilateral percutaneous kyphoplasty (PKP) is widely used to treat osteoporotic vertebral compression fractures (OVCF) in elderly patients. Cement leakage is the most common complication and may cause serious consequences. Although various techniques have been proposed to reduce leakage, few studies have addressed cases with preexisting anterior vertebral wall defects. This study aims to evaluate whether intraoperative sealing of these defects with gelatin sponge strips pre-soaked in bone cement can reduce leakage and improve surgical outcomes.MethodsA retrospective analysis was conducted on 86 patients who underwent unilateral single-level PKP for thoracolumbar OVCF from December 2021 to October 2024. All patients had preoperative cortical defects in the anterior vertebral wall and were divided into two groups: Group A (n = 43) received conventional PKP, while Group B (n = 43) underwent PKP with defect sealing using pre-soaked gelatin sponge strips. Clinical and radiological assessments were performed preoperatively, immediately postoperatively, at 3 months, and at 12 months.ResultsBoth groups achieved favorable outcomes without severe complications. Cement leakage at the anterior vertebral wall was significantly lower in Group B than in Group A (P = 0.007). Group B also demonstrated better cement diffusion (P = 0.013) and a higher cement injection volume (P = 0.022).ConclusionsIn elderly patients with thoracolumbar OVCF and anterior vertebral cortical defects, unilateral puncture PKP combined with bone cement-soaked gelatin sponge strips effectively reduces anterior vertebral wall cement leakage and improves cement distribution, which may contribute to better procedural safety and stability.

Study DesignRetrospective Study.ObjectivesTo compare the efficacy of pedicle Hounsfield unit (HU) values and pedicle bone quality (PBQ) scores in predicting pedicle screw loosening (PSL) after posterior lumbar interbody fusion (PLIF) in elderly patients and to identify the most discriminative bone mineral density (BMD) assessment indicator.MethodsThis retrospective analysis included 275 consecutive patients who underwent PLIF. L₁ and pedicle HU values were obtained from CT scans, whereas vertebral bone quality (VBQ) and PBQ scores were obtained from MRI. Logistic regression analysis determined factors associated with PSL. Receiver-operating characteristic curve analysis was conducted to assess the predictive value of pedicle HU and PBQ score for PSL and to additionally compare their predictive value with that of L₁ HU value and VBQ score.ResultsThe PSL rate was 20.36% (56/275). The loosening group demonstrated a higher postoperative low-back pain visual analog scale score (P < 0.05), lower L₁ (P < 0.001) and pedicle HU values (P < 0.001) and higher VBQ (P < 0.001) and PBQ scores (P < 0.001) than the non-loosening group. The logistic regression analysis identified L₁ (OR = 0.98, 95% CI = 0.97-0.99, P < 0.001) and pedicle HU values (OR = 0.99, 95% CI = 0.98-0.99, P < 0.001) and VBQ (OR = 2.81, 95% CI = 1.43-5.52, P = 0.003) and PBQ scores (OR = 3.85, 95% CI = 2.03-7.32, P < 0.001) as independent predictors of PSL. The area under the curve for L₁ and pedicle HU values and VBQ and PBQ scores were 0.751, 0.766, 0.684, and 0.702, respectively. The optimal pedicle HU cut-off for predicting PSL was 106.32 (sensitivity: 78.49%; specificity: 75.00%).ConclusionsPedicle HU values exhibited a relatively higher predictive performance for PSL compared with the PBQ score and served as the most discriminative BMD indicator in patients who underwent PLIF. Measuring the pedicle HU value preoperatively help surgeons to select a more appropriate surgical plan and is expected to improve the patient outcomes.