scholarly journals Hounsfield unit value on CT as a predictor of cage subsidence following stand-alone oblique lumbar interbody fusion for the treatment of degenerative lumbar diseases

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jing Zhou ◽  
Chao Yuan ◽  
Chao Liu ◽  
Lei Zhou ◽  
Jian Wang
Keyword(s):  
Horizontal Plane ◽  
Sagittal Plane ◽  
Lumbar Vertebrae ◽  
Hounsfield Unit ◽  
Clinical Score ◽  
Lumbar Bone Mineral Density ◽  
Mineral Density ◽  
T Score ◽  
Degenerative Lumbar Diseases ◽  
Cage Subsidence

Abstract Background To investigate the correlation between vertebral Hounsfield unit (HU) values and cage subsidence in patients treated with stand-alone (SA) OLIF. Methods A retrospective review of collected data was performed on 76 patients who underwent SA OLIF. We utilized the HU value for lumbar bone mineral density (BMD) obtained on preoperative CT. The vertebral HU values of patients with subsidence were compared to those without subsidence. The correlation between cage subsidence and clinical score was investigated. Results Sixteen patients (21.1%) had at least radiographic evidence of interbody cage subsidence. The average cage subsidence was 2.5 ± 1.3 mm (range 0.9-4.8 mm). There were no significant differences in sex, BMI, preoperative diagnoses, or fused level (p > 0.05); however, there were significant differences between the cage subsidence group and the nonsubsidence group in age, average of the lowest T-score, and average HU value, including for the L1 vertebrae, L1-L4 horizontal plane, and L1-L4 sagittal plane (p < 0.05). The average HU value of the L1-L4 horizontal plane showed a more predictable AUC of 0.909 (95% CI, 0.834–0.984; P < 0.001) compared with the average of the lowest T-score following an AUC of 0.791 (95% CI, 0.674–0.909; P < 0.001). Based on logistic regression analysis, the average HU value of the L1-L4 horizontal plane (OR, 0.912; 95% CI, 0.861–0.966; P = 0.002) was an independent factor influencing cage subsidence. Conclusions Patients with lower average HU values of the lumbar vertebrae are at a much higher risk of developing cage subsidence after SA OLIF. Measurement of preoperative HU values on preexisting CT scans could be rapid, simple and feasible.

Could Computed Tomography Hounsfield Unit Values of Lumbar Vertebrae Detect Osteoporosis

2021 ◽  
Vol 17 ◽  
Author(s):  
Elif Hocaoglu ◽  
Ercan Inci ◽  
Meltem Vural
Keyword(s):  
Computed Tomography ◽  
Lumbar Vertebrae ◽  
Hounsfield Unit ◽  
Control Group ◽  
Mineral Density ◽  
Lumbar Degenerative Disease ◽  
T Score ◽  
Spinal Osteoporosis ◽  
Spine Degeneration ◽  
Group D

Background: Dual-energy X-ray absorptiometry (DEXA) scanning has several disadvantages determining osteoporosis especially for the degenerative spine. Introduction: To determine spinal osteoporosis in patients suffering from lumbar degenerative disease using computed tomography (CT). Methods: A total of 547 subjects that underwent DEXA and abdominal CT within a period of three months were examined retrospectively and separated into groups based on lumbar degenerative alteration on the CT scan. The subjects that showed degenerative severity at L1–L4, in at least two levels, were graded and placed in the degenerative group (Group D, n=350), while the other subjects constituted the control group (Group C, n=197). The Hounsfield unit (HU) of the vertebral body trabecular bone, the T-score, and bone mineral density (BMD) of L1–L4 and hips were determined from the CT images. CT-HU parameters for osteoporosis acquired from the control group were used to ascertain undiagnosed osteoporosis. Results: The CT-HU was positively correlated with T-score and lumbar BMD for both groups (P<0.001), while the L1–L4 correlation was higher in Group C than in Group D. Based on linear regression, the T-score and CT-HU for L1-L4 osteoporosis were 129, 136, 129 and 120 HU, respectively in Group C. Undiagnosed spinal osteoporosis was greater in Group D compared to the controls (44.2% vs. 9.6%, respectively) based on the CT-HU thresholds. Conclusion: Lumbar spine degeneration can augment BMD and T-score, resulting in the underestimation of lumbar osteoporosis. The osteoporosis threshold determined by CT-HU may be a valuable technique to determine undiagnosed spinal osteoporosis.

scholarly journals BMD status of Postmenopausal Women in relation with BMI: A study with 93 cases

2016 ◽  
Vol 17 (2) ◽  
pp. 138-141
Author(s):  
Samira Sharmin ◽  
Mabubul Haque ◽  
Syedur Rahman Miah ◽  
Md Mahbub Ur Rahman ◽  
Jasmine Ara Haque ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Femoral Neck ◽  
Postmenopausal Women ◽  
Lumbar Vertebrae ◽  
The Body ◽  
Mineral Density ◽  
Cross Sectional ◽  
T Score ◽  
Minimal Trauma ◽  
The Mean

Objectives: Low bone mass is a common disorder in elderly population which predisposes to fracture with minimal trauma. This study was performed to find out the association between the Body Mass Index (BMI) and Bone Mineral Density (BMD) in postmenopausal women.Materials and Methods: This cross sectional study was carried out at Institute of Nuclear Medicine and Allied Sciences Comilla and Mitford, Dhaka over a period of 12 months from January 2013 to December 2013. A total 93 postmenopausal women were enrolled for this study. All postmenopausal women underwent a BMD scan of femoral neck and lumbar vertebrae using a Dual Energy X-ray Absorptiometry (DEXA). Participants were categorized into three groups according to their age and BMI. BMD were expressed base on T-score according to WHO criteria. The relation among BMI, age and BMD were assessed.Results: The results of this study showed that the mean age of the study group was 57.13±7.49 years with range of 46 to 75 years. The most postmenopausal women were in age group 55-65years. The mean BMI of the study subjects were 24.18±5.08 kg/m2 with a range of 15.62 to 36.20 kg/m2. Among 93 subjects osteopenia was greater at lumbar spine (45.2%) with T-score mean±SD-1.83±0.33 and osteoporosis at femoral neck (51.6%) with T-score mean ±SD-3.36±-0.67. Pearson’s correlation coefficient test showed inverse relationship between age and BMD both lumbar spine (r = -0.301, p = 0.003) and femoral neck (r = -0.303, p=0.003) whereas the positive relation between BMI and BMD both at lumbar spine (r=0.338, p=0.001) and femoral neck (r =0.343, p=0.001). These showed that with advancing age, BMD decreases and the risk of osteoporosis increases and with increasing BMI, BMD increases and risk of osteoporosis decreases.Conclusion: The findings of this study portrait that aging and low BMI are risk factors associated with bone loss. So preventive measure should be taken for high risk post menopausal women.Bangladesh J. Nuclear Med. 17(2): 138-141, July 2014

scholarly journals Comparison of osteoporotic fracture risk in surgical and natural menopausal patients

2021 ◽  
Vol 67 (3) ◽  
pp. 322-327
Author(s):  
Ayça Utkan Karasu ◽  
Yetkin Karasu ◽  
Müzeyyen Gülnur Özakşit ◽  
Yusuf Üstün ◽  
Yaprak Üstün Engin
Keyword(s):  
Hip Fracture ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Osteoporotic Fracture ◽  
Assessment Tool ◽  
Lumbar Vertebrae ◽  
Mineral Density ◽  
Natural Menopause ◽  
T Score ◽  
Surgical Menopause

Objectives: This study aims to compare the fracture risk calculated with Fracture Risk Assessment Tool (FRAX®) in patients with natural and surgical menopause. Patients and methods: Between April 2019 and July 2019, 285 postmenopausal patients (mean age 57.3 years; range, 40 to 78 years) who were admitted to the menopause clinic were enrolled in this prospective cross-sectional study. Of these, 220 were in natural menopause and 65 were in surgical menopause. Demographic data, medical history, and International Physical Activity Questionnaire scores were collected through face-to-face interviews with the patients. Femoral neck and lumbar vertebrae (L1-L4) T-scores were evaluated using dual-energy X-ray absorptiometry. Fragility fracture risk was assessed using FRAX®. Results: The groups were similar in terms of age, body mass index, duration of menopause, smoking, alcohol use, and history of fracture (p>0.05). The risk of major osteoporotic fracture and hip fracture calculated without adding bone mineral density (BMD) was similar between groups (p=0.417 and p=0.234). The risk of hip fracture calculated with the addition of BMD was higher in natural menopause patients (p=0.023). Lumbar vertebrae T-scores were similar between two groups regardless of age; femoral neck T-scores were higher in surgical menopause (T-score=-0.8) than natural menopause group (T-score=-1.25) aged under 60 years, whereas this difference disappeared after 60 years of age. Conclusion: In our study, the fracture risk and the severity of osteoporosis were not different in surgical menopausal patients compared to the natural menopausal patients. Hip fracture risk calculated using BMD was lower in patients under 50 years of age in surgical menopausal patients. However, the fracture risks were similar in both groups after 50 years of age.

ASYMMETRY OF BONE MINERAL DENSITY OF THE HIPS IN PATIENTS WITH UNILATERAL KNEE OSTEOARTHRITIS: A CROSS-SECTIONAL STUDY

2011 ◽  
Vol 14 (01) ◽  
pp. 1150005 ◽  
Author(s):  
Alireza Ashraf ◽  
Seyed Mostafa Jazayeri Shooshtari ◽  
Kaynoosh Homayouni ◽  
Sharareh Roshanzamir ◽  
Mohsen Zafarghasempoor ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Knee Osteoarthritis ◽  
Bone Mineral ◽  
Lumbar Vertebrae ◽  
Cross Sectional Study ◽  
Z Score ◽  
Sectional Study ◽  
Mineral Density ◽  
Cross Sectional ◽  
T Score

Background: Osteoarthritis of any joint may exert different effects on bone mineral density that may be the result of several mechanisms including change in the pattern of weight load distribution. In this cross-sectional study we tried to find correlations between unilateral knee osteoarthritis and bone mineral density of hips and lumbar vertebrae. Methods: Forty three patients with knee osteoarthritis (unilateral or more severe in one side) were recruited in this study. The American college of Rheumatology Criteria was followed for the diagnosis of osteoarthritis. Dual X-Ray absorptiometry was used to obtain the T score and the Z score of the hips and lumbar vertebrae. Results: The T score and Z score of the hip and T score of the femoral neck, at the side with ipsilateral knee osteoarthritis was lower than the other side (p < 0.05). The mean Z score and T score of the vertebrae was negative irrespective of the side of osteoarthritis. Conclusions: Bone mineral density of the hip with ipsilateral knee osteoarthritis was lower than the other side, which suggests that BMD may be sensitive to some extent in detecting osteoporosis in these patients; it has also been observed that osteoarthritis might not affect bone mineral density of the hips and lumbar vertebrae in the same manner or to the same extent.

scholarly journals Hounsfield Units on Lumbar Computed Tomography for Predicting Regional Bone Mineral Density

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 545-551 ◽  
Author(s):  
Kyung Joon Kim ◽  
Dong Hwan Kim ◽  
Jae Il Lee ◽  
Byung Kwan Choi ◽  
In Ho Han ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Mineral Density ◽  
Bone Mineral ◽  
Quantitative Computed Tomography ◽  
Lumbar Vertebrae ◽  
Radiation Hazard ◽  
Mineral Density ◽  
Hounsfield Units ◽  
Fusion Surgery ◽  
T Score

AbstractObjectiveBone mineral density (BMD) is a very important factor in spinal fusion surgery using instrumentation. Our aim was to investigate the utility of Hounsfield units (HU) obtained from preoperative lumbar computed tomography (CT) to predict osteoporosis coupling with data of quantitative computed tomography (QCT) and dual X-ray absorptiometry (DEXA).MethodsWe reviewed 180 patients that underwent both QCT and lumbar CT for spine surgery. HU was retrospectively calculated on the lumbar CT of 503 lumbar vertebrae from L1 to L3. Femur DEXA was performed in all patients and spine DEXA was tested in 120 patients (331 vertebrae). BMD was grouped as osteoporosis (QCT<80mg/cm3, DEXA T score≤-2.5) and non-osteoporosis (QCT≥80mg/cm3, DEXA T score>-2.5) for comparison of HU value.ResultsHU value and BMD showed significant correlations. The optima cut-off value based on QCT was higher than that of DEXA scans which had the best correlation for predicting osteoporosis. ROC curve analysis demonstrated that HU value with QCT of 146 has a sensitivity of 94.3% and a specificity of 87.5% for osteoporosis.ConclusionsSignificant correlation was found between HU measurement and BMD value. These findings provide evidence that HU measurement can be established as a means for predicting osteoporosis before spine fusion surgery with reduced radiation hazard.

P0893BONE EFFECTS AND SAFETY OF ONE YEAR DENOSUMAB THERAPY IN A COHORT OF RENAL TRANSPLANTED PATIENTS: AN OBSERVATIONAL MONOCENTRIC STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Carlo Maria Alfieri ◽  
Valentina Binda ◽  
Maria Teresa Gandolfo ◽  
Donata Cresseri ◽  
Maria Rosaria Campise ◽  
...  
Keyword(s):  
Mineral Metabolism ◽  
Graft Loss ◽  
Lumbar Bone Mineral Density ◽  
Bisphosphonate Therapy ◽  
Primary Role ◽  
Mineral Density ◽  
T Score ◽  
Significant Difference ◽  
One Year ◽  
Tract Infections

Abstract Background and aims Bone and mineral metabolism (MM) disorders are relevant problems in renal transplanted patients (RTxp). In our observational monocentric study, we evaluated the effects on femoral and lumbar bone mineral density (BMD) and on MM parameters, and the safety of one year-treatment with Denosumab (DB) in a cohort of RTxp. Method We recorded data about 32 RTxp treated with DB in our Center in the last year. RTxp were evaluated for BMD and T-score (Ts) before the start (T0) and after 12 months (T12) of treatment. Osteopenia was defined, at femoral (F-OPN) and lumbar (L-OPN) sites as Ts:-1&gt;Ts&gt;-2.5 whereas osteoporosis, in the same sites (F-OPS and L-OPS) as Ts&lt;-2.5. X ray evaluation for spontaneous vertebral fractures (sVF) was made at T0 and, in 25 RTxp repeated at T12. MM and renal function parameters (serum creatinine, sCr and daily urinary protein excretion, ProtU) were recorded at T0 and after 1,3,6, and 12 months of therapy. The clinical indications for DB therapy, in the presence of Ca&gt;9.0 mg/dL were the finding at T0 of: 1) F-OPS and/or V-OPS; 2) sVF. During the year of treatment, hypocalcemic (HpCa=Ca&lt;8.0 mg/dL) episodes, infections, graft rejections and loss and RTxp survival were monitored. Results The cohort was composed mainly by females (n=21). The time of RTx was 144[59-232]mths. Steroid therapy was prescribed in 30 RTxp (93%), 22(68%) and in 2 (6%) RTxp were taking 25OHD and 1-25OH. Three RTxp (9%) were receiving Ca supplements. Bisphosphonate therapy was reported in 15 RTxp (46%) in the year before DB start. At T0, 25(78%) and 7 (22%) RTxp had F-OPS and F-OPN. Twenty-three (71%) and 6 (20%) RTxp had L-OPS and L-OPN. In 3 RTxp normal lumbar T-score was found. sVF were present in 17 RTxp (53%). Ca and P were 9.6±0.6 mg/dL and 3.1±0.6 mg/dL whereas PTH, ALP and 25OHD were 64±32 pg/mL, 80±37 U/L and 28±16 mg/dL. SCr and Prot-U were 1,32±0,4 mg/dL and 0,23±0,16 g/24h. At T12, F-Ts increased significantly (T0: -3.0[-3.5/-2.5] vs T12:-2.8[-3.5/-2.4) as like as V-Ts (T0: -3.0[-3.7/-1.9] vs T12:-2.8[-3.0/-1.6) both p&lt;0.0001. A significant increase was found also in BMD: F-BMD +2.4%[-1.1%/+13%] (p&lt;0.0001), V-BMD +2.6%[-3.4%/+12%] (p=0.009). The prevalence of F-OPS reduced from 78% to 73% (p&lt;0.0001) and 4 RTxp ameliorated their Ts category. Prevalence of V-OPS reduced to 53% at T12 from 71% (p&lt;0.001), and 4 RTxp ameliorated their Ts category. In 2 RTxp were found novel sVF. During the treatment no significant modifications of Ca were found, with only a slight but significant difference between T0 and T12 (T12 Ca: 9.22±1.17, p=0.01). PTH and ALP were significantly higher at T3, T6 and T12 respect T0. No differences in 25OH, sCr and ProtU were found. During the year of treatment, in 3 RTxp 25OHD supplementation was started. No one required novel Ca supplementation. DB therapy wasn’t associated to HpCa episodes. Four RTxp had infections during the time of treatment (mean time of DB treatment:114 days). They had positive pathologic anamnesis for urinary tract infections (UTI). Two of them had symptomatic UTI and 2 required hospitalization for sepsis. No biopsy proven graft rejections were observed during the time of treatment and no graft loss or RTxp death were reported. Conclusions The preliminary results presented in our study, limited by the monocentric, not randomized design and by the smallness of the cohort, reported a good bone efficacy of DB in RTxp, especially at lumbar level. The therapy was characterized by a good general safety. Future longer and randomized studies, involving more RTxp might elucidate the possible primary role of DB in the treatment of bone disorders in RTxp.

scholarly journals P0894AEFFECTS OF DENOSUMAB ON BONE MINERAL DENSITY AND LOW ENERGY FRACTURES IN KIDNEY TRANSPLANT PATIENTS: SAFE AND EFFECTIVE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Davide Rolla ◽  
Michela Ardini ◽  
Matteo Trezzi ◽  
Paola Bizzoni ◽  
Francesca Lauria ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Vertebral Fractures ◽  
Human Monoclonal Antibody ◽  
Lumbar Vertebrae ◽  
Low Energy ◽  
High Dose ◽  
Mineral Density ◽  
T Score ◽  
Whole Pth

Abstract Background and Aims Fractures are a disabling clinical outcome after kidney transplantation (KTx), with incidence 5 to 34 times higher expected in males and females, respectively. Denosumab, a fully human monoclonal antibody that binds to RANKL with high affinity and specificity, blocking the interaction of RANKL with RANK, mimicking the endogenous effects of osteoprotegerina, increase bone mineral density; however, its effects to reduce the risk of vertebral fractures and ameliorate BMD remain undefinite in the KTx. Method Thirteen kidney recipients (aged from 50 to 79 yy, 6.2 + 5.5 (SD) yy after KTx), 6 M and 7 F (all postmenopausal) with nearly normal renal function (creat. 1.1+-0.31 mg/dl), affected by low energy vertebral fractures (21 dorsal and 1 lumbar vertebrae), evaluated by morphometric X-ray absorptiometry (Hologic DQR-4500A), were treated with denosumab (four 60-mg doses of denosumab Q6M) over 24 months. Data for vertebral heights and height ratios (P-A), covering 9 vertebral bodies were obtained, besides the data of vertebral, femural and radius BMD.The immunosuppressive regimen consisted of CNI (TAC or CsA), MMF and 8 out of 13 patients were still taking prednisone. Bone mineral metabolism parameters (whole-PTH, 25OHD3 and alcaline phosphatase) were also evaluated. Results No sides effects were observed, and all Patients concluded the study.After two years of denosumab treatment, we observed a significative reduction of vertebral T-score (from -2.12 +- 0.35 (SE) to -1.67+-0.35; p&lt; .02), while T score of femural and radius did not show significative variation (-1.86+-0.21 versus -1.84+- 0.23 and -3.04+-0.42 versus -3.19+-0.45, respectively). The number of low energy vertebral fractures, basal versus two years control, had increased for only two dorsal vertebral fractures. However, to one of two subjects, with new dorsal vertebral fractures, was administered high dose of methylprednison for a severe kidney reject. No variations were observed in whole-PTH (89.31+-19.9 versus 68.38+-9.8 pg/ml), 25OHD3 (24.02+-2.75 versus 26.67+-2.29 ug/dl) and alcaline phosphatase (78.46+-12.73 versus 56.77+-7.14 UI). Conclusion Treatment with denosumab improve BMD at vertebral site in KTx, despite continuous steroid therapy and reduce the risk of new low energy vertebral fractures

scholarly journals The Use of CT Hounsfield Unit Values to Identify The Bone Quality in Patients With Cervical Degenerative Diseases.

2020 ◽  
Author(s):  
Lei He ◽  
Fei Fei Zhou ◽  
Yu Sun ◽  
Wei-Shi Li
Keyword(s):  
Bone Mineral Density ◽  
Bone Quality ◽  
Bone Mineral ◽  
Cervical Vertebrae ◽  
Hounsfield Unit ◽  
Dual Energy ◽  
Degenerative Diseases ◽  
Mineral Density ◽  
X Ray ◽  
T Score

Abstract Background It is well known that osteoporosis may lead to the failure of spinal surgery. As the gold standard, dual-energy X-ray absorptiometry (DXA) is used to evaluate the overall bone mineral density (BMD). Previous studies have used CT (Computed tomography) value to evaluate local bone mineral density. The objective of this study was to investigate the application value of cervical CT value in preoperative bone quality evaluation of cervical degenerative diseases. Methods A total of 939 patients who received surgical treatment for cervical degenerative diseases in our center from January 2015 to December 2017 were retrospectively reviewed. The Hounsfield unit (HU) values were measured in middle transverse CT images of the C2–C7 on the picture archiving and communication system (PACS), and the total bone mineral density T-score of L1–L4 was obtained by dual-energy X-ray absorptiometry. The changes in the HU values of C2–C7 were observed, the correlation between the HU value of C2–C7 and the total BMD T-score of L1–L4 was analyzed, and the HU thresholds of C2–C7 for different T-scores (-2.5 < T-score <-1 or T-score ≤2.5, respectively) were identified. Results The HU values of C2–C7 show a decreasing trend. The mean HU value of C2–C7 was 322.52 ± 89.27 HU. The average BMD T-score of L1-L4 was -0.73. The average HU value of C2–C7 was positively correlated with the average BMD T-score of L1–L4 (r = 0.487, P < 0.001). The HU threshold of C2–C7 was 269 HU when -2.5＜T-score＜-1, and it had a sensitivity of 75.7% and a specificity of 59.8% when used for screening for osteopenia; the HU threshold of C2–C7 was 269H U when T-score ≤-2.5, and it had a sensitivity of 63.8% and a specificity of 80.8% when used for screening for osteoporosis. Conclusions The HU values of cervical vertebrae gradually decrease from C2 to C7 in patients undergoing surgical treatment for cervical degenerative disorders. The CT HU value of cervical vertebrae is positively correlated with the BMD T-score provided by lumbar DXA, which is helpful for clinical evaluation of bone quality before surgery.

scholarly journals Trabecular Bone Score (TBS) in Patients with Early Ankylosing Spondylitis—Limited Utility

2021 ◽  
Vol 10 (22) ◽  
pp. 5373
Author(s):  
Anna Nowakowska-Płaza ◽  
Jakub Wroński ◽  
Iwona Sudoł-Szopińska ◽  
Piotr Głuszko
Keyword(s):  
Ankylosing Spondylitis ◽  
Trabecular Bone ◽  
Clinical Utility ◽  
Trabecular Bone Score ◽  
Bone Microarchitecture ◽  
Lumbar Bone Mineral Density ◽  
Mineral Density ◽  
Cross Sectional ◽  
Additional Information ◽  
T Score

Purpose: Ankylosing spondylitis (AS) not only results in pathological ossification of the spine, but can also be associated with osteoporosis. Due to the presence of syndesmophytes and possible involvement of the hip joints, classical dual X-ray absorptiometry (DXA) is of limited use in patients with advanced stages of AS. Trabecular bone score (TBS) is a method complementary to DXA, providing additional information about bone microarchitecture. There is a growing body of evidence for the usefulness of TBS in AS patients. The aim of this study was to assess the clinical utility of TBS in patients with AS. Methods: Patients with AS underwent DXA with additional TBS assessment. A cross-sectional analysis of the frequency of osteoporosis and bone microarchitecture deterioration and their association with patients’ characteristics was done. Results: A total of 51 male patients, mean age 40.7 years, were enrolled. Osteoporosis was diagnosed in seven patients (13.7%). Lumbar bone mineral density (BMD) was higher (p < 0.001) than femoral BMD, indicating abnormal BMD readings in the spine caused by syndesmophytes. Patients with DXA-diagnosed osteoporosis had lower TBS (p = 0.03) and TBS T-score (p = 0.043) values compared to patients without osteoporosis. However, disturbed bone microarchitecture (TBS < 1.23) was present in only three patients (5.9%). None of the patients had a history of an osteoporotic fracture. A lower TBS T-score (p = 0.032) was demonstrated in patients with sacroiliitis grade 4 than in patients with sacroiliitis grade 2, with no significant differences in BMD and T-score values. Conclusion: Among patients with early AS, the clinical utility of TBS is limited—it does not add value to DXA.

The Role of Hounsfield Unit in Intraoperative Endplate Violation and Delayed Cage Subsidence with Oblique Lateral Interbody Fusion

2021 ◽  
pp. 219256822110525
Author(s):  
Hao Wu ◽  
Jason Pui Yin Cheung ◽  
Teng Zhang ◽  
Zhi Shan ◽  
Xuyang Zhang ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Case Series ◽  
Hounsfield Unit ◽  
Mineral Density ◽  
Lateral Interbody Fusion ◽  
Cage Subsidence ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Study Design Retrospective clinical case series. Objectives To investigate the risk factors for intraoperative endplate violations and delayed cage subsidence after oblique lateral interbody fusion (OLIF) surgery. Secondly, to examine whether low Hounsfield unit (HU) values at different regions of the endplate are associated with intraoperative endplate violation or delayed cage subsidence. Methods 61 patients (aged 65.1 ± 9.5 years; 107 segments) who underwent OLIF with or without posterior instrumentation from May 2015 to April 2019 were retrospectively studied. Intraoperative endplate violation was measured on sagittal reconstructed computerized tomography (CT) images immediate postoperatively, while delayed cage subsidence was evaluated using lateral radiographs and defined at 1-month follow-up or later. Demographic information and clinical parameters such as age, body mass index, bone mineral density, number of surgical levels, cage dimension, disc height restoration, visual analogue scale (VAS), and HU at different regions of the endplate were obtained. Results Total postoperative cage subsidence was identified in 45 surgical levels (42.0%) in 26 patients (42.6%) up till postoperative 1-year follow-up. Low HU value at the ipsilateral epiphyseal ring was an independent risk factor for intraoperative endplate violation ( P = .008) with a cut-off value of 326.21 HUs. Low HU values at the central endplate had a significant correlation with delayed cage subsidence in stand-alone cases ( P = .013) with a cut-off value of 296.42 HUs. VAS scores were not different at 1 week postoperatively in cases with or without intraoperative endplate violation (3.12 ± .73 vs 2.89 ± .72, P = .166) and showed no difference at 1 year with or without delayed cage subsidence (1.95 ± .60 vs 2.26 ± .85, P = .173). Conclusions Intraoperative endplate violation and delayed cage subsidence are not uncommon with OLIF surgery. HUs of the endplate are good predictors for intraoperative endplate violation and cage subsidence since they can represent the regional bone quality of the endplate in contact with the implant. VAS improvements were not affected by intraoperative endplate violation or delayed cage subsidence at 1-year follow-up. Level of Evidence Level III.

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