• Cathleen C Kuo, Mohamed A R Soliman, Alexander O Aguirre, Nicco Ruggiero, Marissa Kruk, Asham Khan, Moleca M Ghannam, Neil D Almeida, Patrick K Jowdy, David E Smolar, John Pollina, and Jeffrey P Mullin.
• Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
• Neurosurgery. 2023 May 1; 92 (5): 945954945-954.

BackgroundProximal junctional kyphosis (PJK) and proximal junctional failure (PJF) can be catastrophic complications associated with adult spinal deformity (ASD) surgery. These complications are markedly influenced by osteoporosis, leading to additional vertebral fracture and pedicle screw loosening. The MRI-based vertebral bone quality score (VBQ) is a newly developed tool that can be used to assess bone quality.ObjectiveTo investigate the utility of the VBQ score in predicting PJK and/or PJF (PJF/PJK) after ASD correction.MethodsWe conducted a retrospective chart review to identify patients age ≥50 years who had received ASD surgery of 5 or more thoracolumbar levels. Demographic, spinopelvic parameters, and procedure-related variables were collected. Each patient's VBQ score was calculated using preoperative T1-weighted MRI. Univariate analysis and multivariate logistic regression were performed to determine potential risk factors of PJK/PJF. Receiver operating characteristic analysis and area-under-the-curve values were generated for prediction of PJK/PJF.ResultsA total of 116 patients were included (mean age, 64.1 ± 6.8 years). Among them, 34 patients (29.3%) developed PJK/PJF. Mean VBQ scores were 3.13 ± 0.46 for patients with PJK/PJF and 2.46 ± 0.49 for patients without, which was significantly different between the 2 groups ( P < .001). On multivariate analysis, VBQ score was the only significant predictor of PJK/PJF (odds ratio = 1.745, 95% CI = 1.558-1.953, P < .001), with a predictive accuracy of 94.3%.ConclusionIn patients undergoing ASD correction, higher VBQ was independently associated with PJK/PJF occurrence. Measurement of VBQ score on preoperative MRI may be a useful adjunct to ASD surgery planning.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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