Journal of Korean Neurosurgical Society

  • 제66권1호
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  • Pages.44-52
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  • 2023
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Clinical Effect of Transverse Process Hook with K-Means Clustering-Based Stratification of Computed Tomography Hounsfield Unit at Upper Instrumented Vertebra Level in Adult Spinal Deformity Patients

  • Jongwon, Cho (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Seungjun, Ryu (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Hyun-Jun, Jang (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Jeong-Yoon, Park (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Yoon, Ha (Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Sung-Uk, Kuh (Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Dong-Kyu, Chin (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Keun-Su, Kim (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Yong-Eun, Cho (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kyung-Hyun, Kim (Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • 투고 : 2022.07.18
  • 심사 : 2022.08.26
  • 발행 : 2023.01.01
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초록

Objective : This study aimed to investigate the efficacy of transverse process (TP) hook system at the upper instrumented vertebra (UIV) for preventing screw pullout in adult spinal deformity surgery using the pedicle Hounsfield unit (HU) stratification based on K-means clustering. Methods : We retrospectively reviewed 74 patients who underwent deformity correction surgery between 2011 and 2020 and were followed up for >12 months. Pre- and post-operative data were used to determine the incidence of screw pullout, UIV TP hook implementation, vertebral body HU, pedicle HU, and patient outcomes. Data was then statistically analyzed for assessment of efficacy and risk prediction using stratified HU at UIV level alongside the effect of the TP hook system. Results : The screw pullout rate was 36.4% (27/74). Perioperative radiographic parameters were not significantly different between the pullout and non-pullout groups. The vertebral body HU and pedicle HU were significantly lower in the pullout group. K-means clustering stratified the vertebral body HU ≥205.3, <137.2, and pedicle HU ≥243.43, <156.03. The pullout rate significantly decreases in patients receiving the hook system when the pedicle HU was from ≥156.03 to < 243.43 (p<0.05), but the difference was not statistically significant in the vertebra HU stratified groups and when pedicle HU was ≥243.43 or <156.03. The postoperative clinical outcomes improved significantly with the implementation of the hook system. Conclusion : The UIV hook provides better clinical outcomes and can be considered a preventative strategy for screw-pullout in the certain pedicle HU range.

키워드

과제정보

This research was supported by Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health & Welfare, Republic of Korea (grant number : HI22C007800).

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