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Which Bone Mineral Density Measure Offers a More Reliable Prediction of Mechanical Complications in Adult Spinal Deformity Surgery: Hounsfield Units or DEXA Scan? – Lumbar Fusion

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The article presents a retrospective cohort study that aimed to determine the relationship between bone mineral density (BMD), t-scores, and Hounsfield units (HU) in patients undergoing adult spinal deformity (ASD) surgery. The study also compared the ability of these measurements to predict mechanical complications and reoperations. The results showed poor correlation between the three BMD modalities, but DEXA-measured BMD was found to be superior to t-scores and HU in predicting proximal junctional kyphosis (PJK) among patients with osteopenia. The study suggests a threshold of BMD <0.82g/cm2 as a predictor for PJK. Overall, the findings highlight the importance of BMD measurements in assessing and managing spine surgery outcomes Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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CONCLUSION: Poor correlation was found between the three BMD modalities. DEXA-measured BMD may be superior to t-scores and HU in predicting PJK among patients with osteopenia with a threshold of BMD<0.82g/cm2. Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
World Neurosurg. 2023 Aug 3:S1878-8750(23)01088-4. doi: 10.1016/j.wneu.2023.07.140. Online ahead of print.ABSTRACTOBJECTIVE: In patients undergoing adult spinal deformity (ASD) surgery, we sought to:1) determine the relationship between Dual-energy X-ray absorptiometry (DEXA)-measured bone mineral density(BMD), t-scores, and Hounsfield units(HU), and 2) compare the ability of DEXA-measured BMD, t-scores, and HU to predict mechanical complications and reoperations.METHODS: A,

World Neurosurg. 2023 Aug 3:S1878-8750(23)01088-4. doi: 10.1016/j.wneu.2023.07.140. Online ahead of print.

ABSTRACT

OBJECTIVE: In patients undergoing adult spinal deformity (ASD) surgery, we sought to:1) determine the relationship between Dual-energy X-ray absorptiometry (DEXA)-measured bone mineral density(BMD), t-scores, and Hounsfield units(HU), and 2) compare the ability of DEXA-measured BMD, t-scores, and HU to predict mechanical complications and reoperations.

METHODS: A single-institution retrospective cohort study was undertaken from 2013-17.

INCLUSION CRITERIA: ≥5-level-fusion, sagittal/coronal deformity, and 2-year follow-up. Multivariable regression controlled for age, BMI, receiving anabolic medications, and postoperative sagittal vertical axis (SVA) and pelvic-incidence lumbar-lordosis mismatch (PI-LL). A sub-analysis was performed for osteopenic patients (-1

RESULTS: Of 145 patients undergoing ASD surgery, 72(49.6%) had both preoperative DEXA and CT scans. Mean DEXA-measured BMD was 0.91±0.52g/cm2, mean t-score was -1.61±1.03, and mean HU was 153.5±52.8. While no correlation was found between DEXA-measured BMD and HU(r=0.17,p=0.144), t-score and HU had a weakly positive correlation(r=0.31,p=0.007). Mechanical complications occurred in 48(66.7%) patients, including 27(37.5%) proximal junctional kyphosis (PJK), 1(1.4%) distal junctional kyphosis (DJK), 5(6.9%) implant failure, 30(41.7%) rod fracture/pseudarthrosis, 42(58.3%) reoperations, and 16(22.2%) reoperations due to PJK. No association was found between DEXA-measured BMD or t-scores with mechanical complications or reoperations. While univariate regression showed a significant association between lower HU and PJK(OR=0.98,95%CI=0.97-0.99,p=0.011), the significance was lost after multivariable analysis. When considering osteopenic patients(N=37), only DEXA-measured BMD was an independent risk factor for PJK(OR=0.01,95%CI=0.00-0.09,p=0.017), with a threshold of 0.82g/cm2(AUC=0.70,95%CI=0.53-0.84,p=0.019).

CONCLUSION: Poor correlation was found between the three BMD modalities. DEXA-measured BMD may be superior to t-scores and HU in predicting PJK among patients with osteopenia with a threshold of BMD<0.82g/cm2.

PMID:37543204 | DOI:10.1016/j.wneu.2023.07.140

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Which Bone Mineral Density Measure Offers a More Reliable Prediction of Mechanical Complications in Adult Spinal Deformity Surgery: Hounsfield Units or DEXA Scan?

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World Neurosurg. 2023 Aug 3:S1878-8750(23)01088-4. doi: 10.1016/j.wneu.2023.07.140. Online ahead of print.ABSTRACTOBJECTIVE: In patients undergoing adult spinal deformity (ASD) surgery, we sought to:1) determine the relationship between Dual-energy X-ray absorptiometry (DEXA)-measured bone mineral density(BMD), t-scores, and Hounsfield units(HU), and 2) compare the ability of DEXA-measured BMD, t-scores, and HU to predict mechanical complications and reoperations.METHODS: A

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