The following is a summary of “Simplified S1 vertebral bone quality score independently predicts proximal junctional kyphosis after surgery for degenerative lumbar scoliosis,” published in the April 2024 issue of Surgery by Deng et al.

The study aimed to evaluate the predictive value of the simplified S1 vertebral bone quality (VBQ) score in determining the incidence of proximal junctional kyphosis (PJK) following surgery for degenerative lumbar scoliosis (DLS). Researchers conducted a retrospective analysis of 122 patients with DLS who underwent posterior lumbar decompression and long-segment fusion surgery at the institution between January 2016 and December 2020. Patients were categorized into PJK and non-PJK groups, and the S1 VBQ scores were determined using signal intensity measurements from mid-sagittal T1-weighted non-contrast MRI images. Logistic regression analysis was employed to identify factors associated with PJK, and receiver-operating characteristic (ROC) curve analysis was conducted to assess the predictive value of the S1 VBQ score for PJK after DLS surgery.

Among the 122 patients in the study, 27 (22.13%) developed PJK during the follow-up period. The VBQ score was significantly higher in patients with PJK than those without PJK (3.58 ± 0.67 vs. 3.08 ± 0.54, p < 0.001). Furthermore, patients in the PJK group exhibited more significant thoracolumbar kyphosis (TLK) both preoperatively (20.00 ± 6.22 vs. 16.86 ± 5.38, p = 0.011) and postoperatively (p < 0.001), as well as greater TLK (p < 0.001), pelvic incidence angle (PI) (p < 0.001), thoracic kyphosis (TK) (p = 0.002), and sagittal vertical axis (SVA) (p < 0.001) at the final follow-up compared to the non-PJK group. 

Multivariate logistic regression analysis revealed that a higher VBQ score (OR 4.565, 95% CI 1.43–14.568, p = 0.010), older age (OR 1.119, 95% CI 1.021–1.227, p = 0.016), and larger TLK (OR 1.191, 95% CI 1.041–1.362, p = 0.011) were significant predictors of postoperative PJK in patients with DLS. Additionally, there was a positive correlation between the VBQ score and PJA change (r = 0.370, p < 0.001). The ROC analysis demonstrated a diagnostic accuracy of 72.1% (95% CI 60.15–82.9%) for VBQ scores in predicting PJK, with an ideal cutoff of 3.205 (sensitivity: 77.8%, specificity: 81.4%).

In conclusion, the study represents the first investigation into the effectiveness of the S1 VBQ score in predicting postoperative PJK in patients with DLS. The study group found that the S1 VBQ score was a significant predictor of PJK following DLS surgery, with higher scores indicating a greater likelihood of PJK occurrence. These findings underscore the potential utility of the S1 VBQ score as a predictive tool in the surgical management of DLS.

Source: josr-online.biomedcentral.com/articles/10.1186/s13018-024-04722-y