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Upper instrumented vertebrae selection criteria for degenerative lumbar scoliosis based on the hounsfield unit asymmetry of the first coronal reverse vertebrae: an observational study – Lumbar Fusion

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This article discusses the importance of selecting the upper instrumented vertebra (UIV) in the surgical treatment of degenerative lumbar scoliosis (DLS) and its impact on postoperative proximal adjacent segment degeneration (pASD). The study, which included 153 patients with DLS, found that selecting a UIV that is not lower than the first coronal reverse vertebra (FCRV) significantly reduced the occurrence of pASD. The study also measured the Hounsfield unit (HU) asymmetry in the vertebrae of these patients to develop more individualized UIV selection criteria. The results showed that patients with a difference in HU between the left and right sides of the FCRV (dF) of ≥5 had a significantly lower rate of pASD when the UIV was not lower than FCRV. Other general, radiological, or operative parameters did not significantly influence the occurrence of pASD. Overall, the study suggests that selecting a UIV ≤ FCRV can effectively reduce the risk of pASD in patients with DLS

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : best recognised spinal facility on Harley Street UK

Published article

S: Selection of UIV ≤ FCRV can significantly reduce the risk of pASD for patients with DLS with dF ≥ 5. Trial Registration Not applicable, since this is an observational study.

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J Orthop Surg Res. 2023 Nov 1;18(1):819. doi: 10.1186/s13018-023-04325-z.ABSTRACTBACKGROUND: Selection of the upper instrumented vertebra (UIV) is crucial for surgical treatment of degenerative lumbar scoliosis (DLS), given the relevance of UIV in postoperative proximal adjacent segment degeneration (pASD). Our previous research found that selection of UIV not lower than (≤) the first coronal reverse vertebra,

J Orthop Surg Res. 2023 Nov 1;18(1):819. doi: 10.1186/s13018-023-04325-z.

ABSTRACT

BACKGROUND: Selection of the upper instrumented vertebra (UIV) is crucial for surgical treatment of degenerative lumbar scoliosis (DLS), given the relevance of UIV in postoperative proximal adjacent segment degeneration (pASD). Our previous research found that selection of UIV not lower than (≤) the first coronal reverse vertebra (FCRV), which marks the turning point of Hounsfield unit (HU) asymmetry, could significantly reduce pASD. However, the degree of HU asymmetry can vary among patients, suggesting a demand for more individualized UIV selection criteria, which we aimed to develop using quantitative HU measurement in the current study.

METHODS: We included 153 consecutive patients with DLS. Quantitative measurement of HU of both sides of the vertebrae of these patients was performed on three planes of CT reconstruction for average values and determination of FCRV. Pre- and postoperative X-ray plain films were examined for radiological measurements and determination of pASD. Further, 35 patients with lumbar disc herniation and without significant scoliosis were also included as the reference group, and their bilateral HU was measured.

RESULTS: In all 153 patients, those with UIV ≤ FCRV had a significantly lower rate of pASD (9.4% vs. 24.6%, P = 0.011). The difference between HU of the left and right sides of the FCRV (dF) could range from close to 0-59.4. The difference between HU of the left and right sides of the vertebrae in the reference group had an average value of 5.21. In 101 dF ≥ 5 DLS patients, those with UIV ≤ FCRV had a significantly lower rate of pASD (7.6% vs. 28.6%, P = 0.005), while this rate was insignificant in the other 52 dF < 5 patients (13.3% vs. 18.2%, P = 0.708). No other general, radiological, or operative parameter was found to have significant influence on the occurrence of pASD.

S: Selection of UIV ≤ FCRV can significantly reduce the risk of pASD for patients with DLS with dF ≥ 5. Trial Registration Not applicable, since this is an observational study.

PMID:37907995 | PMC:PMC10619298 | DOI:10.1186/s13018-023-04325-z

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Upper instrumented vertebrae selection criteria for degenerative lumbar scoliosis based on the hounsfield unit asymmetry of the first coronal reverse vertebrae: an observational study

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J Orthop Surg Res. 2023 Nov 1;18(1):819. doi: 10.1186/s13018-023-04325-z.ABSTRACTBACKGROUND: Selection of the upper instrumented vertebra (UIV) is crucial for surgical treatment of degenerative lumbar scoliosis (DLS), given the relevance of UIV in postoperative proximal adjacent segment degeneration (pASD). Our previous research found that selection of UIV not lower than (≤) the first coronal reverse vertebra

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