Assessing the effects of lumbar posterior stabilization and fusion to vertebral bone density in stabilized and adjacent segments by using Hounsfield unit

Demir, Özgür; Öksüz, Erol; Deniz, Fatih Ersay; Demir, Osman

doi:10.21037/jss.2017.09.05

Cited by 20 publications

(20 citation statements)

References 26 publications

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“…In the USA, by age 60 years, half of Caucasian women have osteopenia . The current standard of BMD assessment, DXA, is based on a person's BMD T‐score at the hip and lumbar spine, according to the World Health Organization diagnostic classification . Fundamental differences exist between DXA and CT vertebral densitometry.…”

Section: Discussionmentioning

confidence: 99%

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Loss of bone mineral density following sepsis using Hounsfield units by computed tomography

Hongo

Kotake

Muramatsu

et al. 2019

Acute Medicine & Surgery

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Aim To examine the change in vertebral bone mineral density (BMD) using abdominal computed tomography in patients treated for sepsis. Methods A single‐center, retrospective, observational study was undertaken to evaluate BMD after critical care at Okayama Saiseikai General Hospital (Okayama, Japan) from January 2016 to April 2018. Sepsis was defined as an absolute increase of ≥2 in Sequential Organ Failure Assessment score in the intensive care unit or high care unit. Bone mineral density was evaluated in Hounsfield units (HU) by computed tomography. Patients were divided into groups based on the presence or absence of osteoporosis, which was defined as average vertebral body HU <110. Paired t‐tests were used to compare the mean BMD of each vertebra between before and after critical care. We also analyzed accidental bone fracture events after discharge. The survival rate was analyzed as an outcome using the Kaplan–Meier method. Results Fifty‐two of 188 patients met the inclusion criteria. We found significant differences between admission and follow‐up vertebral BMD values in the spine at the thoracic 12, lumbar 1–5, and sacrum 1 levels (P < 0.05), especially in the non‐osteoporosis groups. No difference in mortality was observed between patients with osteoporosis and those without. Two of 19 patients with osteoporosis developed a bone fracture. Conclusion We found that sepsis was associated with loss in BMD following critical care.

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Section: Discussionmentioning

confidence: 99%

“…The CT software reported the average CT attenuation of the ROI in HU. These methods have been evaluated and shown to produce reliable results . We measured thoracic vertebra (Th) 12, lumbar vertebrae (L) 1–5, and sacrum vertebra (S) 1.…”

Section: Methodsmentioning

confidence: 99%

Loss of bone mineral density following sepsis using Hounsfield units by computed tomography

Hongo

Kotake

Muramatsu

et al. 2019

Acute Medicine & Surgery

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“…Hounsfield units (HUs) on CT as a proxy for BMD have been shown to correlate with DXA values. 18,[22][23][24] Studies have demonstrated a correlation between HUs and DXA scores when comparing osteoporotic and non-osteoporotic patients, 23,25 with a positive correlation between the T-score on DXA and the HU value on spinal CT. 18,25 However, these studies have focused on degenerative conditions of the lumbar spine, and it is unclear if HUs reliably reflect the BMD of the LT vertebrae, the often-chosen UIV level in ASD surgery. We evaluated whether the HU values at the UIV, UIV+1, and UIV+2 (2 levels above the UIV) were associated with PJK in ASD patients over 50 years old.…”

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confidence: 99%

“…6,21 BMD is normally evaluated using dual-energy x-ray absorptiometry (DXA). 18,22 However, DXA scans in the lumbar spine may not always be accurate given the amount of degeneration obscuring the true values, and spinal instrumentation can obfuscate interpretation. 18,22 Moreover, not all patients obtain a preoperative DXA scan.…”

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The association between lower Hounsfield units of the upper instrumented vertebra and proximal junctional kyphosis in adult spinal deformity surgery with a minimum 2-year follow-up

Duan

Mummaneni²,

Rivera³

et al. 2020

Neurosurgical Focus

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OBJECTIVEPatients undergoing long-segment fusions from the lower thoracic (LT) spine to the sacrum for adult spinal deformity (ASD) correction are at risk for proximal junctional kyphosis (PJK). One mechanism of PJK is fracture of the upper instrumented vertebra (UIV) or higher (UIV+1), which may be related to bone mineral density (BMD). Because Hounsfield units (HUs) on CT correlate with BMD, the authors evaluated whether HU values were correlated with PJK after long fusions for ASD.METHODSThe authors performed a retrospective study of patients older than 50 years who had undergone ASD correction from the LT spine to the sacrum in the period from October 2007 to January 2018 and had a minimum 2-year follow-up. Demographic and spinopelvic parameters were measured. HU values were measured on preoperative CT at the UIV, UIV+1, and UIV+2 (2 levels above the UIV) levels and were assessed for correlations with PJK.RESULTSThe records of 127 patients were reviewed. Fifty-four patients (19 males and 35 females) with a mean age of 64.91 years and mean follow-up of 3.19 years met the study inclusion criteria; there were 29 patients with PJK and 25 patients without. There was no statistically significant difference in demographics or follow-up between these two groups. Neither was there a difference between the groups with regard to postoperative pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), PI minus LL (PI-LL), thoracic kyphosis (TK), or sagittal vertical axis (SVA; all p > 0.05). Postoperative pelvic tilt (p = 0.003) and T1 pelvic angle (p = 0.014) were significantly higher in patients with PJK than in those without. Preoperative HUs at UIV, UIV+1, and UIV+2 were 120.41, 124.52, and 129.28 in the patients with PJK, respectively, and 152.80, 155.96, and 160.00 in the patients without PJK, respectively (p = 0.011, 0.02, and 0.018). Three receiver operating characteristic (ROC) curves for preoperative HU values at the UIV, UIV+1, and UIV+2 as a predictor for PJK were established, with areas under the ROC curve of 0.710 (95% CI 0.574–0.847), 0.679 (95% CI 0.536–0.821), and 0.681 (95% CI 0.539–0.824), respectively. The optimal HU value by Youden index was 104 HU at the UIV (sensitivity 0.840, specificity 0.517), 113 HU at the UIV+1 (sensitivity 0.720, specificity 0.517), and 110 HU at the UIV+2 (sensitivity 0.880, specificity 0.448).CONCLUSIONSIn patients undergoing long-segment fusions from the LT spine to the sacrum for ASD, PJK was associated with lower HU values on CT at the UIV, UIV+1, and UIV+2. The measurement of HU values on preoperative CTs may be a useful adjunct for ASD surgery planning.

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The cervical spine demonstrates less postoperative bone loss than the lumbar spine

Salzmann

Okano

Miller

et al. 2021

Journal Orthopaedic Research

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The objective of this study is to determine the bone mineral density (BMD) changes in adjacent vertebra following anterior cervical discectomy and fusion (ACDF).Consecutive patients undergoing ACDF with available preoperative and postoperative computed tomography (CT) imaging were included. Quantitative CT measurements of screw-free cervical and first thoracic vertebra were performed.Comparisons between pre-and postoperative BMD in the vertebrae one or two levels above the upper instrumented vertebra (UIV + 1, UIV + 2) and one level below the lowest instrumented vertebra (LIV + 1) were assessed. Seventy-two patients (men, 66.7%) met the inclusion criteria. The patient population was 91.7% Caucasian with a mean age of 55.0 years. The mean interval (±SD) between surgery and secondary CT was 157 ± 23 days. Preoperative BMD (±SD) in UIV + 1 was 300.6 ± 66.2 mg/cm 3 . There was a significant BMD loss of 1.5% at UIV + 1 after surgery, resulting in a postoperative BMD of 296.2 ± 64.8 mg/cm 3 (p = .029). At UIV + 2 and LIV + 1, no significant differences between pre-and postoperative BMD (304.7 ± 75.7 mg/cm 3 vs. 299.8 ± 74.3 mg/cm 3 , 197.3 ± 50.4 mg/cm 3 vs. 200.8 ± 48.7 mg/cm 3 , p = .113 and p = .078, respectively) were observed.

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Assessing the effects of lumbar posterior stabilization and fusion to vertebral bone density in stabilized and adjacent segments by using Hounsfield unit

Abstract: Decrease in the bone density of the adjacent segment vertebral bodies may be one of the major predisposing factors for adjacent segment disease (ASD).

Cited by 20 publications

References 26 publications

Loss of bone mineral density following sepsis using Hounsfield units by computed tomography

Loss of bone mineral density following sepsis using Hounsfield units by computed tomography

The association between lower Hounsfield units of the upper instrumented vertebra and proximal junctional kyphosis in adult spinal deformity surgery with a minimum 2-year follow-up

The cervical spine demonstrates less postoperative bone loss than the lumbar spine

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