Zhonghua Yi Xue Za Zhi. 2026 Mar 10;106(9):834-840. doi: 10.3760/cma.j.cn112137-20250722-01813.
ABSTRACT
Objective: To investigate the distribution patterns of vertebral bone density in degenerative lumbar scoliosis (DLS) patients with different coronal imbalance classifications. Methods: A retrospective study was conducted on 154 patients with DLS who underwent long-segment spinal fusion surgery at Nanjing Drum Tower Hospital between January 2017 and December 2022. The patients were classified according to the Nanjing Drum Tower coronal imbalance classification of DLS: Type A, coronal balance distance (CBD) <3 cm; Type B, CBD ≥3 cm and C7 plumb line (C7PL) located on the concave side; Type C, CBD ≥3 cm and C7PL located on the convex side. The major curve Cobb angle and CBD were measured on preoperative standing full-spine radiographs. Preoperative assessments also included L1-4 T-scores and femoral neck T-scores obtained from dual-energy X-ray absorptiometry (DXA). Additionally, overall vertebral body bone density and Hounsfield unit (HU) values on the concave and convex sides were measured using preoperative CT scans. The patients with L1 HU value <110 were diagnosed with osteoporosis (OP). Comparative analyses included OP prevalence and coronal plane bone mass distribution patterns among the different coronal classifications. Results: A total of 154 patients were included in this study, comprising 21 males and 133 females, with an average age of (62.9±6.6) years. Among them, 99 patients were classified as Type A, 30 as Type B, and 25 as Type C. The prevalence of OP was 48.7% (75/154), with the prevalence in Type C (72.0%, 18/25) patients being higher than that in Types A (44.4%, 44/99) and B (43.3%, 13/30) (both P<0.05). The mean HU value of the S1 vertebra for all patients was 140.8±63.1, it was the lowest in Type C patients (108.2±53.4), which was statistically significantly lower than that in Types A and B patients (150.2±66.0 and 137.1±52.0, respectively, both P<0.05). For all the patients, the HU values on the concave side of the main curve were all greater than those on the convex side (all P<0.005), with the greatest asymmetry observed at the apex vertebra. The asymmetry ratios of the concave to convex sides of the S1 vertebra in Type B and Type C patients were higher than those in Type A patients (1.25±0.24, 1.23±0.24, and 1.11±0.22, respectively; P<0.01). Conclusions: Patients with DLS exhibit a high prevalence of OP, with Type C patients showing the highest OP prevalence and the lowest bone density at the S1 vertebral body. Based on these findings, it is recommended that, for type C patients, distal internal fixation be performed using iliac screws or S2 sacroiliac screws to reduce the risk of internal fixation failure.
PMID:41796006 | DOI:10.3760/cma.j.cn112137-20250722-01813
