Back-forward bending CT in simulated surgical position to evaluate the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Wei , CHAI Zihao , CUI Xilong , WANG Kangkang , ZHANG Xu , LI Haijiang , ZHAI Yunlei ,  YU Haiyang

Department of Orthopaedics, Fuyang People’s Hospital, Clinical Research Center for Spine Deformity of Anhui Province, Fuyang Anhui, 236000, P. R. China;

Corresponding author：

YU Haiyang, Email: fy.yhy@163.com

Keywords：

Old thoracolumbar fracture; kyphosis; kyphotic flexibility; osteoporosis; simulated surgical position

DOI：

10.7507/1002-1892.202211107

Video：

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Objective To introduce a scout view scanning technique of back-forward bending CT (BFB-CT) in simulated surgical position for evaluating the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture. Methods A total of 28 patients with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture who met the selection criteria between June 2018 and December 2021 were included in the study. There were 6 males and 22 females with an average age of 69.5 years (range, 56-92 years). The injured vertebra were located at T₁₀-L₂, including 11 cases of single thoracic fracture, 11 cases of single lumbar fracture, and 6 cases of multiple thoracolumbar fractures. The disease duration ranged from 3 weeks to 36 months, with a median of 5 months. All patients received examinations of BFB-CT and standing lateral full-spine X-ray (SLFSX). The thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis of injured vertebra (LKIV), lumbar lordosis (LL), and the sagittal vertical axis (SVA) were measured. Referring to the calculation method of scoliosis flexibility, the kyphosis flexibility of thoracic, thoracolumbar, and injured vertebra were calculated respectively. The sagittal parameters measured by the two methods were compared, and the correlation of the parameters measured by the two methods was analyzed by Pearson correlation. Results Except LL (P>0.05), TK, TLK, LKIV, and SVA measured by BFB-CT were significantly lower than those measured by SLFSX (P<0.05). The flexibilities of thoracic, thoracolumbar, and injured vertebra were 34.1%±18.8%, 36.2%±13.8%, and 39.3%±18.6%, respectively. Correlation analysis showed that the sagittal parameters measured by the two methods were positively correlated (P<0.001), and the correlation coefficients of TK, TLK, LKIV, and SVA were 0.900, 0.730, 0.700, and 0.680, respectively. Conclusion Thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture shows an excellent flexibility and BFB-CT in simulated surgical position can obtain the remaining real angle which need to be corrected surgically.

Citation： ZHANG Wei, CHAI Zihao, CUI Xilong, WANG Kangkang, ZHANG Xu, LI Haijiang, ZHAI Yunlei, YU Haiyang. Back-forward bending CT in simulated surgical position to evaluate the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(4): 457-462. doi: 10.7507/1002-1892.202211107 Copy

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2.	Kawasaki S, Shigematsu H, Tanaka M, et al. Segmental flexibility in adolescent idiopathic scoliosis assessed using the fulcrum-bending radiography method. Clin Spine Surg, 2020, 33(8): E376-E380.
3.	Te Hennepe N, Spruit M, Pouw MH, et al. Supine traction versus prone bending radiographs for assessing the curve flexibility in spinal deformity. Global Spine J, 2022, 12(7): 1345-1351.
4.	Swany LM, Larson AN, Buyuk AF, et al. Comparison of slot-scanning standing, supine, and fulcrum radiographs for assessment of curve flexibility in adolescent idiopathic scoliosis: a pilot study. Spine Deform, 2021, 9(5): 1355-1362.
5.	Cheung JPY, Cheung PWH. Supine flexibility predicts curve progression for patients with adolescent idiopathic scoliosis undergoing underarm bracing. Bone Joint J, 2020, 102-B(2): 254-260.
6.	Bekki H, Harimaya K, Matsumoto Y, et al. Which side-bending X-ray position is better to evaluate the preoperative curve flexibility in adolescent idiopathic scoliosis patients, supine or prone? Asian Spine J, 2018, 12(4): 632-638.
7.	Li QD, Yang JS, He BR, et al. Risk factors for proximal junctional kyphosis after posterior long-segment internal fixation for chronic symptomatic osteoporotic thoracolumbar fractures with kyphosis. BMC Surg, 2022, 22(1): 189. doi: 10.1186/s12893-022-01598-9.
8.	Decker S, Mayer M, Hempfing A, et al. Flexibility of thoracic kyphosis affects postoperative sagittal alignment in adult patients with spinal deformity. Eur Spine J, 2020, 29(4): 813-820.
9.	Lovecchio F, Lafage R, Elysee JC, et al. The utility of supine radiographs in the assessment of thoracic flexibility and risk of proximal junctional kyphosis. J Neurosurg Spine, 2021. doi: 10.3171/2020.11.SPINE201565.
10.	Debnath UK, Quraishi NA, McCarthy MJH, et al. Long-term outcome after surgical treatment of Scheuermann’s Kyphosis (SK). Spine Deform, 2022, 10(2): 387-397.
11.	Park JH, Kim YB, Hyun SJ, et al. Changes in thoracic kyphosis and thoracolumbar kyphosis in asymptomatic Korean male subjects aged >50 years: Do they progress above T₅, T₁₀, T₁₂, or L₂? Asian Spine J, 2020, 14(2): 192-197.
12.	秦杰, 苏保, 王霖邦, 等. 经椎弓根下椎体椎间隙截骨术治疗陈旧性骨质疏松性椎体压缩骨折继发胸腰段后凸畸形. 中国修复重建外科杂志, 2022, 36(3): 305-309.
13.	Prost S, Pesenti S, Fuentes S, et al. Treatment of osteoporotic vertebral fractures. Orthop Traumatol Surg Res, 2021, 107(1S): 102779. doi: 10.1016/j.otsr.2020.102779.
14.	Ma Z, Jiao J, Yang D, et al. Posterior vertebral column resection combined with bone cement augmentation of pedicle screw fixation for treatment of severe vertebral compression fractures with kyphotic deformity: A retrospective case series. Clin Spine Surg, 2020, 33(6): E269-E275.
15.	徐文强, 于海洋, 梁成民, 等. 后路经椎间隙松解打压植骨后柱加压闭合矫形术治疗骨质疏松性脊柱骨折伴中重度后凸畸形. 中国修复重建外科杂志, 2019, 33(11): 1406-1413.
16.	Parreira PCS, Maher CG, Megale RZ, et al. An overview of clinical guidelines for the management of vertebral compression fracture: a systematic review. Spine J, 2017, 17(12): 1932-1938.
17.	Lee GW, Shin H, Chang MC. Deep learning algorithm to evaluate cervical spondylotic myelopathy using lateral cervical spine radiograph. BMC Neurol, 2022, 22(1): 147. doi: 10.1186/s12883-022-02670-w.
18.	Machino M, Nakashima H, Ito K, et al. Age-related degenerative changes and sex-specific differences in osseous anatomy and intervertebral disc height of the thoracolumbar spine. J Clin Neurosci, 2021, 90: 317-324.
19.	Zhou Q, Sun X, Qiu Y, et al. Utility of the decubitus or the supine rather than the extension lateral radiograph in evaluating lumbar segmental instability. Eur Spine J, 2022, 31(4): 851-857.
20.	Putto E, Tallroth K. Extension-flexion radiographs for motion studies of the lumbar spine. A comparison of two methods. Spine (Phila Pa 1976), 1990, 15(2): 107-110.
21.	Ang B, Lafage R, Elysée JC, et al. In the relationship between change in kyphosis and change in lordosis: Which drives which? Global Spine J, 2021, 11(4): 541-548.
22.	Saad E, Semaan K, Kawkabani G, et al. Alteration of the sitting and standing movement in adult spinal deformity. Front Bioeng Biotechnol, 2022, 9: 751193. doi: 10.3389/fbioe.2021.751193.
23.	Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery, 2014, 74(1): 112-120.
24.	Hultman KL, Vaidya R, Malkawi I, et al. Accuracy of low dose computed tomography scanogram for measurement of femoral version after locked intramedullary nailing. Int Orthop, 2016, 40(9): 1955-1960.
25.	Weisz GM, Albury WR, Houang MD, et al. Scanogram for sagittal imbalance of the spine: low dose alternative for a safer diagnosis. Curr Rheumatol Rev, 2014, 10(1): 35-37.
26.	Wu J, Wei F, Ma L, et al. Accuracy and reliability of standing lateral lumbar radiographs for measurements of spinopelvic parameters. Spine (Phila Pa 1976), 2021, 46(15): 1033-1038.
27.	Iwahashi S, Hashida R, Matsuse H, et al. The impact of sarcopenia on low back pain and quality of life in patients with osteoporosis. BMC Musculoskelet Disord, 2022, 23(1): 142. doi: 10.1186/s12891-022-05086-2.
28.	Ohba T, Koji F, Koyama K, et al. Preoperative radiographic evaluation of thoracic flexibility and compensation for adult spinal deformity surgery. How to select optimal upper instrumented vertebra to prevent proximal junctional kyphosis. Spine (Phila Pa 1976), 2022, 47(2): 144-152.
29.	李庆达, 贺宝荣, 杨俊松, 等. 老年陈旧性症状性骨质疏松性胸腰椎骨折后路长节段内固定术后近端交界性后凸的危险因素. 中华创伤杂志, 2022, 38(2): 101-108.

1. He C, Wong MS. Spinal flexibility assessment on the patients with adolescent idiopathic scoliosis: A literature review. Spine (Phila Pa 1976), 2018, 43(4): E250-E258.
2. Kawasaki S, Shigematsu H, Tanaka M, et al. Segmental flexibility in adolescent idiopathic scoliosis assessed using the fulcrum-bending radiography method. Clin Spine Surg, 2020, 33(8): E376-E380.
3. Te Hennepe N, Spruit M, Pouw MH, et al. Supine traction versus prone bending radiographs for assessing the curve flexibility in spinal deformity. Global Spine J, 2022, 12(7): 1345-1351.
4. Swany LM, Larson AN, Buyuk AF, et al. Comparison of slot-scanning standing, supine, and fulcrum radiographs for assessment of curve flexibility in adolescent idiopathic scoliosis: a pilot study. Spine Deform, 2021, 9(5): 1355-1362.
5. Cheung JPY, Cheung PWH. Supine flexibility predicts curve progression for patients with adolescent idiopathic scoliosis undergoing underarm bracing. Bone Joint J, 2020, 102-B(2): 254-260.
6. Bekki H, Harimaya K, Matsumoto Y, et al. Which side-bending X-ray position is better to evaluate the preoperative curve flexibility in adolescent idiopathic scoliosis patients, supine or prone? Asian Spine J, 2018, 12(4): 632-638.
7. Li QD, Yang JS, He BR, et al. Risk factors for proximal junctional kyphosis after posterior long-segment internal fixation for chronic symptomatic osteoporotic thoracolumbar fractures with kyphosis. BMC Surg, 2022, 22(1): 189. doi: 10.1186/s12893-022-01598-9.
8. Decker S, Mayer M, Hempfing A, et al. Flexibility of thoracic kyphosis affects postoperative sagittal alignment in adult patients with spinal deformity. Eur Spine J, 2020, 29(4): 813-820.
9. Lovecchio F, Lafage R, Elysee JC, et al. The utility of supine radiographs in the assessment of thoracic flexibility and risk of proximal junctional kyphosis. J Neurosurg Spine, 2021. doi: 10.3171/2020.11.SPINE201565.
10. Debnath UK, Quraishi NA, McCarthy MJH, et al. Long-term outcome after surgical treatment of Scheuermann’s Kyphosis (SK). Spine Deform, 2022, 10(2): 387-397.
11. Park JH, Kim YB, Hyun SJ, et al. Changes in thoracic kyphosis and thoracolumbar kyphosis in asymptomatic Korean male subjects aged >50 years: Do they progress above T₅, T₁₀, T₁₂, or L₂? Asian Spine J, 2020, 14(2): 192-197.
12. 秦杰, 苏保, 王霖邦, 等. 经椎弓根下椎体椎间隙截骨术治疗陈旧性骨质疏松性椎体压缩骨折继发胸腰段后凸畸形. 中国修复重建外科杂志, 2022, 36(3): 305-309.
13. Prost S, Pesenti S, Fuentes S, et al. Treatment of osteoporotic vertebral fractures. Orthop Traumatol Surg Res, 2021, 107(1S): 102779. doi: 10.1016/j.otsr.2020.102779.
14. Ma Z, Jiao J, Yang D, et al. Posterior vertebral column resection combined with bone cement augmentation of pedicle screw fixation for treatment of severe vertebral compression fractures with kyphotic deformity: A retrospective case series. Clin Spine Surg, 2020, 33(6): E269-E275.
15. 徐文强, 于海洋, 梁成民, 等. 后路经椎间隙松解打压植骨后柱加压闭合矫形术治疗骨质疏松性脊柱骨折伴中重度后凸畸形. 中国修复重建外科杂志, 2019, 33(11): 1406-1413.
16. Parreira PCS, Maher CG, Megale RZ, et al. An overview of clinical guidelines for the management of vertebral compression fracture: a systematic review. Spine J, 2017, 17(12): 1932-1938.
17. Lee GW, Shin H, Chang MC. Deep learning algorithm to evaluate cervical spondylotic myelopathy using lateral cervical spine radiograph. BMC Neurol, 2022, 22(1): 147. doi: 10.1186/s12883-022-02670-w.
18. Machino M, Nakashima H, Ito K, et al. Age-related degenerative changes and sex-specific differences in osseous anatomy and intervertebral disc height of the thoracolumbar spine. J Clin Neurosci, 2021, 90: 317-324.
19. Zhou Q, Sun X, Qiu Y, et al. Utility of the decubitus or the supine rather than the extension lateral radiograph in evaluating lumbar segmental instability. Eur Spine J, 2022, 31(4): 851-857.
20. Putto E, Tallroth K. Extension-flexion radiographs for motion studies of the lumbar spine. A comparison of two methods. Spine (Phila Pa 1976), 1990, 15(2): 107-110.
21. Ang B, Lafage R, Elysée JC, et al. In the relationship between change in kyphosis and change in lordosis: Which drives which? Global Spine J, 2021, 11(4): 541-548.
22. Saad E, Semaan K, Kawkabani G, et al. Alteration of the sitting and standing movement in adult spinal deformity. Front Bioeng Biotechnol, 2022, 9: 751193. doi: 10.3389/fbioe.2021.751193.
23. Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery, 2014, 74(1): 112-120.
24. Hultman KL, Vaidya R, Malkawi I, et al. Accuracy of low dose computed tomography scanogram for measurement of femoral version after locked intramedullary nailing. Int Orthop, 2016, 40(9): 1955-1960.
25. Weisz GM, Albury WR, Houang MD, et al. Scanogram for sagittal imbalance of the spine: low dose alternative for a safer diagnosis. Curr Rheumatol Rev, 2014, 10(1): 35-37.
26. Wu J, Wei F, Ma L, et al. Accuracy and reliability of standing lateral lumbar radiographs for measurements of spinopelvic parameters. Spine (Phila Pa 1976), 2021, 46(15): 1033-1038.
27. Iwahashi S, Hashida R, Matsuse H, et al. The impact of sarcopenia on low back pain and quality of life in patients with osteoporosis. BMC Musculoskelet Disord, 2022, 23(1): 142. doi: 10.1186/s12891-022-05086-2.
28. Ohba T, Koji F, Koyama K, et al. Preoperative radiographic evaluation of thoracic flexibility and compensation for adult spinal deformity surgery. How to select optimal upper instrumented vertebra to prevent proximal junctional kyphosis. Spine (Phila Pa 1976), 2022, 47(2): 144-152.
29. 李庆达, 贺宝荣, 杨俊松, 等. 老年陈旧性症状性骨质疏松性胸腰椎骨折后路长节段内固定术后近端交界性后凸的危险因素. 中华创伤杂志, 2022, 38(2): 101-108.

Chinese Journal of Reparative and Reconstructive Surgery

Back-forward bending CT in simulated surgical position to evaluate the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture

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