Abstract
BackgroundThe asymmetrical distribution of bone mineral density (BMD) in vertebral bodies in adolescent idiopathic scoliosis (AIS) has been reported; however, it is still unknown whether BMD asymmetrical distribution can vary by the mechanical environment around each vertebral body. The purpose of this retrospective study was to investigate changes in the asymmetrical distribution of BMD in each vertebral body up to 1 year after posterior spinal corrective fusion surgery (PSF) in patients with AIS.MethodsWe analyzed 75 vertebrae within the non-instrumented lumbar spines of 27 female AIS patients (median age, 16 years; interquartile range [IQR], 14–19 years) who underwent PSF. The BMDs of the vertebral bodies were calculated from 1-week and 1-year postoperative quantitative computed tomography scans and a laterality index (LI = BMD of right half of vertebral bodies / BMD of left half of vertebral bodies). The disc wedging angle was measured preoperatively and at 1 year postoperatively from plain radiographs, and the disc wedging angle index (DWAI) was calculated as the sum of the disc wedging angles of the upper and lower discs adjacent to each vertebra.ResultsThe median BMDs of both the right and left halves of each vertebral body significantly decreased from 1 week postoperatively to 1 year postoperatively (right, 228.3 mg/cm3 hydroxyapatite [IQR, 201.8–251.0 mg/cm3 hydroxyapatite] to 214.8 mg/cm3 hydroxyapatite [IQR, 186.9–241.0 mg/cm3 hydroxyapatite], P < 0.001; left, 229.6 mg/cm3 hydroxyapatite [IQR, 198.7–244.7 mg/cm3 hydroxyapatite] to 206.3 mg/cm3 hydroxyapatite [IQR, 188.0–231.9 mg/cm3 hydroxyapatite], P < 0.001). The preoperative median DWAI was 5.0 (IQR, −12.0–13.0) and the 1-week postoperative LI was 1.01 (IQR, 0.95–1.08); these measures were positively correlated (ρ = 0.827; P < 0.001). The median perioperative change in DWAI was −4 (IQR, −9–10) and the median postoperative change in LI was 0.01 (IQR, −0.02–0.03); these measures were also positively correlated (ρ = 0.741; P < 0.001).ConclusionsThe laterality of BMD in each vertebral body in AIS patients was a plastic phenomenon, was deemed a secondary change due to external loading, and was related to the amount of disc wedging.