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

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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.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Not applicable.

Funding

This study was supported in part by the Projects of the Science & Technology Department of Sichuan Province (2022ZDZX0029 and 2021YFS0218), the National Natural Science Foundation of China (81871772; 82172495; 82072434 and 82272546), and the 1·3·5 project for disciplines of excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University (2021HXFH003).

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Author notes

  1. Juehan Wang and Qian Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China

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

  2. Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China

    Qian Chen

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  1. Juehan Wang
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Correspondence to Limin Liu.

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This study was approved by the Ethics Committee of the West China Hospital. The participant consent was written and was performed in accordance with the ethical standards of the Declaration of Helsinki.

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Wang, J., Chen, Q., Ai, Y. et al. Vertebral bone quality score as a novel predictor of proximal junctional kyphosis after thoracic adolescent idiopathic scoliosis surgery. Eur Spine J 32, 3996–4002 (2023). https://doi.org/10.1007/s00586-023-07894-z

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  • DOI: https://doi.org/10.1007/s00586-023-07894-z

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