Background: Intraoperative endplate injury (IEI) is a type of fracture and a potential complication during lumbar interbody fusion (LIF). Osteoporosis diagnosed by bone mineral density (BMD) is a well-known risk factor for fracture itself and IEI also. The bone turnover markers (BTMs) are parameters of bone qualities and have some correlations with fractures, but there is no study about the BTMs and intraoperative fractures especially IEI. This study aims to identify the correlation between IEI and BTMs, especially in misTLIF. Methods: We retrospectively reviewed 184 patients (230 spine levels). The IEI was diagnosed as the breakage of the endplate observed on postoperative 1 mm thin-cut CT scans. All surgical and endogenous risk factors of IEI were also checked including the bone resorption marker (serum CTX) and bone formation marker (serum P1NP) of BTMs. Additionally, the ratio (P1NP/CTX) and the subtype groups of BTMs were analyzed. Results: The rate of total IEI was 38%. The sex, osteoporosis, spine BMD, femur BMD, CTX, P1NP/CTX, preoperative disc height, and the discrepancy between preoperative disc height and cage size were risk factors in multivariate logistic regression analyses. The subtypes according to BTMs showed a different rate of IEI, resulting in subtype 2 A (low CTX and P1NP and high P1NP/CTX ratio) having the lowest incidence and statistically significant odds ratios compared to other subtype groups. Conclusion: This study demonstrated that the IEI is related to BTMs regardless of BMD in misTLIF. In addition, the P1NP/CTX ratio or subtypes could be helpful in predicting the risk of IEI due to the parallel dynamics of BTMs.

Background: The degenerative spondylosis can cause the difficulty in maintaining sagittal and coronal alignment of spine, and X-ray parameters are the gold standard to analyze the malalignment. This study aimed to develop a new 3D full body scanner to analyze the spinal balance and compare it to X-ray parameters. Methods: Ninety-seven adult participants who suffer degenerative spondylosis underwent 3D full body scanning, whole spine X-rays, clinical questionnaires and body composition analyses. The 5 inflection points (ear, shoulder, hip, knee, ankle) of the 3D scanner in the sagittal plane were automatically labeled by an AI algorithm. Three concepts are created including “the angle between two points with respect to the plumb line”, “the horizontal distances between two points in the sagittal plane” and “the angle between three points”. For the coronal plane, the shoulder gradient was analyzed. X-ray parameters of cervical, thoracolumbar and whole spine sagittal balance and coronal balances were compared. The body composition data and clinical questionnaire scores were compared to x-ray and 3D scanner parameters. Results: The correlation coefficient (C.C.) of dAB_hor (horizontal distance between ear and shoulder in the sagittal plane) and C2-C7 SVA was 0.478 (p-value < 0.001). The C.C. of aAC_sag (sagittal angle of ear-hip from the plumb line) and ODHA was 0.336 (p < 0.001). About coronal balance, the C.C. of shoulder gradient and clavicle angle from x-ray was 0.373 (p < 0.001). The C.C.s were merely affected by body composition data. But in multiple regression analysis, BMI affected 3D scanner data. Clinical symptoms showed correlations with aBCD(shoulder-hip-knee) and aCDE(hip-knee-ankle angle), which may reflect a compensatory pelvic retroversion and knee flexion for positive sagittal imbalance. Conclusions: This new 3D scanner has some strengths like radiation-free methods, correlation with x-ray parameters and clinical symptoms, independence to body composition data, and possibility of analyzing dynamic spine balance.

Kang TH, et al. J Korean Med Sci. 2025 Dec;41:e28. https://doi.org/10.3346/jkms.2026.41.e28

Summary: This study aimed to identify factors influencing the development of segmental kyphosis development and new compression fractures in Osteoporotic Vertebral Compression Fractures (OVCF)in postmenopause women. We found fatty infiltration (FI) of the multifidus and erector spinae, high BMI, was risk of segmental kyphosis development following OVCF. Background: Paraspinal muscles play a crucial role in maintaining sagittal balance and seem to associated with kyphosis after OVCF. However, there have been few studies investigating the factors associated with the development of segmental kyphosis development after conservative treatment OVCF in postmenopausal women. We aim to identify factors influencing the development of segmental kyphosis development after conservative treatment and the occurrence of new compression fractures. Methods: Postmenopausal women diagnosed with OVCF and managed conservatively at the author's clinic from 2012 to 2022 were retrospectively analyzed. All patients were followed up for more than 1 year and completed imaging studies. In this study, patients were divided into three groups according to the degree of segmental kyphosis development and two groups based on the presence of the newly developed compression fractures. To identify factors associated with the segmental kyphosis development and newly developed compression fractures, by comparing demographic data, radiologic data, MRI assessments, and Koval grades across the groups. Results: A total of 200 postmenopausal women were included, with 87 in Grade 1, 78 in Grade 2, and 35 in Grade 3. Higher body mass index and higher FI in erector spinae and multifidus muscles significantly correlated with segmental kyphosis development (p-value>0.05). No significant differences in newly developed compression fractures. Conclusion: High FI of the multifidus and erector spinae, along with high BMI, is associated with the development of segmental kyphosis development following OVCF.