Determination of Osteopenic and Osteoporotic Spine with Hounsfield Unit in Spinal Fusion Surgery

Öz

Aim: Bone mineral density (BMD) is vital in spinal fusion surgery. Dual X-ray absorptiometry (DEXA) is the gold standard for evaluating BMD. In this study, we aim to assess the bone density of the patients using Hounsfield units (HU) who underwent spinal surgery with instrumentation. Material and Method: Computed tomography (CT) and DEXA results of 99 cases of 40 years of age or older who had posterolateral fusion operation between 2014 and 2017 were evaluated retrospectively. The HU values of the vertebral body obtained from the lumbar CT, which is routinely used in surgical planning, were measured with the image archiving and communication system (PACS; Maroview, Infinitt Healthcare). Three measurements were taken from each vertebra. Hounsfield unit values were determined according to age groups. These results were compared with the L1–4 DEXA results acquired before the operation and/ or within six months. Results: HU values of patients obtained from CT were classified between four age groups. Hounsfield unit values of each vertebral level were compared with the T score obtained with DEXA. The correlations of the HU value with the T score were significant (p <0.001). The mean HU values of the compared levels decreased consistently over the ten years. The differences were statistically significant. There was no significant difference between HU values in age groups. Conclusion: Estimating the osteopenic/ osteoporotic spine by measuring the HU values from CT is a simple, cost-effective method that helps surgical planning at instrumentation.

Anahtar Kelimeler

• Hounsfield unit
• lumbar vertebrae
• instrumentation
• posterolateral fusion; osteoporosis; spine

Kaynakça

1. 1. Bulut G, Aytar MH, Güngör A. Surgıcal prıncıples ın posterıor transpedıcular screw fıxatıon and fusıon for treatment of spondylolısthesıs: Retrospectıve evaluatıon of 77 cases. The J of Turkish Spinal Surg. 2019;30:111–6.
2. 2. Ebbesen EN, Thomsen JS, Beck-Nielsen H, Nepper-Rasmussen HJ, Mosekilde L. Lumbar vertebral body compressive strength evaluated by dual-energy X-ray absorptiometry, quantitative computed tomography, and ashing. Bone. 1999;25:713–24.
3. 3. Masud T, Langley S, Wiltshire P, Doyle DV, Spector TD. Effect of spinal osteophytosis on bone mineral density measurements in vertebral osteoporosis. BMJ. 1993;307:172–3.
4. 4. Prevention and management of osteoporosis World Health Organ Tech Rep Ser. 2003;921:1–164.
5. 5. Adams JE. Quantitative computed tomography. Eur J Radiol. 2009;71:415–24.
6. 6. Link TM, Koppers BB, Licht T, Bauer J, Lu Y, Rummeny EJ. In vitro and in vivo spiral CT to determine bone mineral density: initial experience in patients at risk for osteoporosis. Radiology. 2004;231:805–11.
7. 7. Papadakis AE, Karantanas AH, Papadokostakis G, Petinellis E, Damilakis J. Can abdominal multi-detector CT diagnose spinal osteoporosis? Eur Radiol. 2009;19:172–6.
8. 8. Tay WL, Chui CK, Ong SH, Ng AC. Osteoporosis screening using areal bone mineral density estimation from diagnostic CT images. Acad Radiol. 2012;19:1273–82.

9. 9. Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93:1057–63.
10. 10. Foul F, Erdfelder E, Lang AG, Buchner A. Using G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007;39, 175–191.
11. 11. Choi MK, Kim SM, Lim JK. Diagnostic efficacy of Hounsfield units in spine CT for the assessment of real bone mineral density of degenerative spine: correlation study between T-scores determined by DXA scan and Hounsfield units from CT. Acta Neurochir (Wien) 2016;158:1421–7.
12. 12. Kim JK, Kim DH, Lee JI, Choi BK, Han IH, Nam KH. Hounsfield Units on Lumbar Computed Tomography for Predicting Regional Bone Mineral Density. Open Med (Wars) 2019;14:545–51.
13. 13. Cauley JA, Lui LY, Ensrud KE, Zmuda JM, Stone KL, Hochberg MC. Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA. 2005;293:2102–8.
14. 14. Damilakis J, Maris TG, Karantanas AH. An update on the assessment of osteoporosis using radiologic techniques. Eur Radiol. 2007;17:1591–602.
15. 15. Lochmuller EM, Burklein D, Kuhn V, Glaser C, Muller R, Gluer CC. Mechanical strength of the thoracolumbar spine in the elderly: prediction from in situ dual-energy X-ray absorptiometry, quantitative computed tomography (QCT), upper and lower limb peripheral QCT, and quantitative ultrasound. Bone. 2002;31:77–84.
16. 16. Nguyen ND, Eisman JA, Center JR, Nguyen TV. Risk factors for fracture in nonosteoporotic men and women. J Clin Endocrinol Metab. 2007;92:955–62.
17. 17. Yu EW, Thomas BJ, Brown JK, Finkelstein JS. Simulated increases in body fat and errors in bone mineral density measurements by DXA and QCT. J Bone Miner Res. 2012;27:119–24.
18. 18. Genant HK, Block JE, Steiger P, Glueer CC, Smith R. Quantitative computed tomography in assessment of osteoporosis. Semin Nucl Med. 1987;17:316–33.
19. 19. Liu CC, Theodorou DJ, Theodorou SJ, Andre MP, Sartoris DJ, Szollar SM. Quantitative computed tomography in the evaluation of spinal osteoporosis following spinal cord injury. Osteoporos Int. 2000;11:889–96.
20. 20. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of postmenopausal osteoporosis Endocr Pract 16(Suppl 3);2010.
21. 21. Turkyilmaz I, Aksoy U, McGlumphy EA. Two alternative surgical techniques for enhancing primary implant stability in the posterior maxilla: a clinical study including bone density, insertion torque, and resonance frequency analysis data. Clin Implant Dent Relat Res. 2008;10:231–7.
22. 22. Turkyilmaz I, Sennerby L, McGlumphy EA, Tozum TF. Biomechanical aspects of primary implant stability: a human cadaver study. Clin Implant Dent Relat Res. 2009;11:113–9.
23. 23. Zou D, Muheremu A, Sun Z, Zhong W, Jiang S, Li W. Computed tomography Hounsfield unit-based prediction of pedicle screw loosening after surgery for degenerative lumbar spine disease. J Neurosurg Spine. 2020;1–6.
24. 24. Bredow J, Boese CK, Werner CML, Siewe J, Löhrer L, Zarghooni K, et al. Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery. Arch Orthop Trauma Surg. 2016;136:1063–7.
25. 25. Schwaiger BJ, Gersing AS, Baum T, Noël PB, Zimmer C, Bauer JS. Bone mineral density values derived from routine lumbar spine multidetector row CT predict osteoporotic vertebral fractures and screw loosening. AJNR Am J Neuroradiol. 2014;35:1628–33.
26. 26. Schreiber JJ, Hughes AP, Taher F, Girardi FP. An association can be found between Hounsfield units and success of lumbar spine fusion. HSS J. 2014;10:25–9