ArticleBMC musculoskeletal disorders2025
The association between lower Hounsfield units of the upper instrumented vertebra and proximal junctional failure after limited lumbar fusion for adult spinal deformity.
Article in BMC musculoskeletal disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Letter to the Editor: Clinical Outcomes and Mechanical Complications After Adult Spinal Deformity Surgery in Patients Aged 80 Years or Older: A Propensity Score-Matched Comparative Study.Global spine journal · 2026Article
- The predictive value of the global alignment and proportion (GAP) score for mechanical complications following adult spinal deformity surgery: A systematic review and meta-analysis.North American Spine Society journal · 2025Review
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10 authors.
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Abstract
backgroundLimited lumbar fusion surgery for adult spinal deformity (ASD) increases the risk of proximal junctional failure (PJF) at the thoracolumbar junction due to preserved mobility in this region. The majority of the extant research on PJF focuses on cases where the upper instrumented vertebra (UIV) is in the thoracic spine, whereas the aim of this study was to evaluate the correlation between Hounsfield Unit (HU) values around the thoracolumbar junction and the incidence of PJF following limited lumbar fusion.
methodsA retrospective review identified patients aged ≥ 40 years who underwent fusion surgery spanning ≥ 3 levels with a UIV in the upper lumbar spine (L1-L3) and had a follow-up of at least two years. Demographic data, surgical factors, and spinopelvic parameters were analyzed. HU values were measured at the UIV, UIV + 1, and lower instrumented vertebra and were assessed for their association with PJF.
resultsOf 50 patients, 46 were included after excluding 4 who required reoperation for distal junctional failure. The mean age was 65.9 years, with a mean follow-up of 6.3 years. PJF was observed in 17 patients (36.9%). While most demographic and surgical factors were similar between groups, age was significantly associated with PJF (p = 0.024). Preoperative parameters significantly differed, including PT (p = 0.011), PI-LL (p = 0.010), SVA (p = 0.008), and HU at UIV/UIV + 1 (p = 0.006). Postoperative differences included PT (p = 0.007), PI-LL (p = 0.005), proximal junctional angle (p = 0.021), SVA (p = 0.021), and the global alignment and proportion (GAP) score (p = 0.001). Logistic regression identified low HU at UIV/UIV + 1 as the only independent PJF risk factor (OR: 0.975, 95% CI: 0.950-0.996, p = 0.016), with a cutoff value of 97.8 HU (AUC = 0.745, p = 0.022). PJF rates were 73.3%, 26.7%, and 12.5% for patients with HU < 98, 98-134, and > 134, respectively.
conclusionPreoperative low HU values at UIV/UIV + 1 independently predict PJF risk. HU assessment via preoperative CT imaging offers a critical tool for surgical planning in ASD limited lumbar fusion cases. CLINICAL TRIAL NUMBER: Not applicable.
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