Assessing underlying bone quality in spine surgery patients: a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives

Pennington, Zach; Ehresman, Jeff; Lubelski, Daniel; Cottrill, Ethan; Schilling, Andrew; Ahmed, Ali; Feghali, James; Witham, Timothy F.; Sciubba, Daniel M.

doi:10.1016/j.spinee.2020.08.020

Cited by 48 publications

(28 citation statements)

References 84 publications

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“…Alternative means of preoperative bone quality assessment have been investigated for patients being considered for spinal fusion. 21,22 Since 2011, the vertebral Hounsfield units (HU) value derived from clinical computed tomography (CT) has been regarded as a useful tool to determine BMD and osteoporosis. 17 It is less affected by lumbar degenerative conditions than DXA by avoiding cortical bone, vascular calcification, and degenerative structures.…”

Section: Discussionmentioning

confidence: 99%

Assessment of vertebral bone mineral density and stand-alone oblique lumbar interbody fusion for adjacent segment disease and primary lumbar degenerative diseases

Zhou

Yuan

Liu

et al. 2022

J Orthop Surg (Hong Kong)

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Purpose To evaluate the vertebral bone mineral density and the value of stand-alone oblique lumbar interbody fusion (SA OLIF) for the management of single-level adjacent segment disease (ASD) and primary lumbar degenerative diseases. Patients and methods Seventy-eight patients undergoing single-level SA OLIF was divided into index surgery group ( n = 36) or revision surgery group ( n = 42) at single center. The vertebral body Hounsfield units (HU) value was measured to assess bone mineral density of operated level by the preoperative CT. The following data were retrospectively collected and compared between the two groups: demographic, surgical data, clinical results, and complications. Results No differences were found between the two groups in surgical data. The fusion segment HU values in the revision group were significantly higher than that in the index group (147.4 ± 35.3 vs 129.2 ± 38.4 p = .033). There were significant differences while comparing fusion segment HU values to L1–L4 horizontal plane (147.4 ± 35.3 vs 126.1 ± 28.4, p = .000) and L1 (147.4 ± 35.3 vs 126.8 ± 26.2, p = .000) in revision group, meanwhile, no statistically significant difference was observed in index group ( p > .05). The cage subsidence was observed in the revision group ( n = 2) and index group ( n = 9) ( p = .045). The patients with cage subsidence had significantly lower vertebral HU values. Conclusion SA OLIF is valid alternative to the traditional posterior approach in the management of ASD with good clinical outcomes at short-term follow-up. Increased HU values of fusion segment may play a role in the management of ASD by SA OLIF.

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Section: Discussionmentioning

confidence: 99%

Assessment of vertebral bone mineral density and stand-alone oblique lumbar interbody fusion for adjacent segment disease and primary lumbar degenerative diseases

Zhou

Yuan

Liu

et al. 2022

J Orthop Surg (Hong Kong)

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“…However, a growing body of research literature has suggested that in vivo assessments of BMD using DXA are inaccurate and imperfect. Alternative means of preoperative bone quality assessment have been investigated for patients being considered for spinal fusion [9,15,16]. The HU value is less affected by lumbar degenerative conditions than DXA by avoiding cortical bone, vascular calcification, and degenerative structures.…”

Section: Discussionmentioning

confidence: 99%

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

Zhou

Yuan

Liu

et al. 2021

BMC Musculoskelet Disord

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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.

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“…Representing the number of standard deviations from average BMD in a young healthy population, a T score between À1.0 and À2.5 is diagnostic for osteopenia, whereas a T score less than À2.5 is considered osteoporosis. 139 However, some investigators have questioned the accuracy of DXA-derived BMD, [141][142][143] and 1 study found that most women with hip fracture had T scores more than À2.5, showing the low sensitivity of this technique. 144 Rather than BMD, bone turnover can be used to evaluate patients for osteoporosis.…”

Section: Metabolic Bone Diseasesmentioning

confidence: 99%

Novel Musculoskeletal and Orthopedic Applications of 18F-Sodium Fluoride PET

et al. 2021

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The bone-seeking properties of 18 F-sodium fluoride (NaF) were first described in 1962 by Blau and colleagues, 1 who used this positron-emitting radiotracer in skeletal scintigraphy. Both high uptake by bone and rapid plasma clearance of NaF were determined to be advantages in imaging skeletal metabolism. 2 The mechanism of NaF uptake relies on the exchange of OH À for 18 F À , converting hydroxyapatite on the surface of the bone matrix to fluorapatite. 2,3 One hour after NaF is administered intravenously, only 10% remains in the plasma compartment because of a first-pass Conflict of interest: The authors have declared no conflicts of interest.

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Assessing underlying bone quality in spine surgery patients: a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives

Cited by 48 publications

References 84 publications

Assessment of vertebral bone mineral density and stand-alone oblique lumbar interbody fusion for adjacent segment disease and primary lumbar degenerative diseases

Assessment of vertebral bone mineral density and stand-alone oblique lumbar interbody fusion for adjacent segment disease and primary lumbar degenerative diseases

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

Novel Musculoskeletal and Orthopedic Applications of 18F-Sodium Fluoride PET

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