Computed tomography Hounsfield unit–based prediction of pedicle screw loosening after surgery for degenerative lumbar spine disease

View More View Less
  • Department of Orthopedics, Peking University Third Hospital, Beijing, China

OBJECTIVE

The authors investigated the relation between Hounsfield unit (HU) values measured on CT and the risk of pedicle screw loosening in patients who underwent lumbar pedicle screw fixation for degenerative lumbar spine disease.

METHODS

Patients who were treated with lumbar pedicle screw fixation between July 2011 and December 2015 at the authors’ department were reviewed. Age, sex, BMI, smoking and diabetes histories, range of fixation, and fusion method were recorded as the basic patient information. The HU values for lumbar bone mineral density (BMD) for the L1, L2, L3, and L4 vertebra were measured on CT scans. Logistic regression analysis was used to identify the independent influencing factors of pedicle screw loosening.

RESULTS

A total of 503 patients were included in the final analysis. The pedicle screw loosening rate at the 12-month follow-up was 30.0% (151 of 503 patients). There were no significant differences in sex, BMI, or histories of smoking and diabetes between the patients with (loosening group) and those without (nonloosening group) screw loosening (p > 0.05). The mean HU value of L1–4 was lower in the loosening group than the nonloosening group (106.3 ± 33.9 vs 132.6 ± 42.9, p < 0.001). In logistic regression analysis, being male (OR 2.065; 95% CI 1.242–3.433), HU value (OR 0.977; 95% CI 0.970–0.985), length of fixation (OR 3.616; 95% CI 2.617–4.996), and fixation to S1 (OR 1.699; 95% CI 1.039–2.777) were the independent influencing factors for screw loosening.

CONCLUSIONS

HU value measured on CT was an independent predictor for pedicle screw loosening, and lower HU value was significantly correlated with higher risk of screw loosening.

ABBREVIATIONS BMD = bone mineral density; DXA = dual-energy x-ray absorptiometry; HU = Hounsfield units; LIV = lowest instrumented vertebra; ODI = Oswestry Disability Index; PLF = posterolateral lumbar fusion; PLIF = posterior lumbar interbody fusion; ROI = region of interest; VAS = visual analog scale.

Contributor Notes

Correspondence Weishi Li: Peking University Third Hospital, Beijing, China. puh3liweishi@163.com.

INCLUDE WHEN CITING Published online January 3, 2020; DOI: 10.3171/2019.11.SPINE19868.

D.Z. and A.M. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Abul-Kasim K, Ohlin A: Evaluation of implant loosening following segmental pedicle screw fixation in adolescent idiopathic scoliosis: a 2 year follow-up with low-dose CT. Scoliosis 9:13, 2014

    • Search Google Scholar
    • Export Citation
  • 2

    Anderson PA, Polly DW, Binkley NC, Pickhardt PJ: Clinical use of opportunistic computed tomography screening for osteoporosis. J Bone Joint Surg Am 100:20732081, 2018

    • Search Google Scholar
    • Export Citation
  • 3

    Bredow J, Boese CK, Werner CML, Siewe J, Löhrer L, Zarghooni K, : Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery. Arch Orthop Trauma Surg 136:10631067, 2016

    • Search Google Scholar
    • Export Citation
  • 4

    Chen P, Li Z, Hu Y: Prevalence of osteoporosis in China: a meta-analysis and systematic review. BMC Public Health 16:1039, 2016

  • 5

    Chin DK, Park JY, Yoon YS, Kuh SU, Jin BH, Kim KS, : Prevalence of osteoporosis in patients requiring spine surgery: incidence and significance of osteoporosis in spine disease. Osteoporos Int 18:12191224, 2007

    • Search Google Scholar
    • Export Citation
  • 6

    Cotts KG, Cifu AS: Treatment of osteoporosis. JAMA 319:10401041, 2018

  • 7

    El Saman A, Meier S, Sander A, Kelm A, Marzi I, Laurer H: Reduced loosening rate and loss of correction following posterior stabilization with or without PMMA augmentation of pedicle screws in vertebral fractures in the elderly. Eur J Trauma Emerg Surg 39:455460, 2013

    • Search Google Scholar
    • Export Citation
  • 8

    Galbusera F, Volkheimer D, Reitmaier S, Berger-Roscher N, Kienle A, Wilke HJ: Pedicle screw loosening: a clinically relevant complication? Eur Spine J 24:10051016, 2015

    • Search Google Scholar
    • Export Citation
  • 9

    Gazzeri R, Roperto R, Fiore C: Surgical treatment of degenerative and traumatic spinal diseases with expandable screws in patients with osteoporosis: 2-year follow-up clinical study. J Neurosurg Spine 25:610619, 2016

    • Search Google Scholar
    • Export Citation
  • 10

    Goldstein CL, Brodke DS, Choma TJ: Surgical management of spinal conditions in the elderly osteoporotic spine. Neurosurgery 77 (Suppl 4):S98S107, 2015

    • Search Google Scholar
    • Export Citation
  • 11

    Hamdy RC, Petak SM, Lenchik L: Which central dual X-ray absorptiometry skeletal sites and regions of interest should be used to determine the diagnosis of osteoporosis? J Clin Densitom 5 Suppl:S11S18, 2002

    • Search Google Scholar
    • Export Citation
  • 12

    Kim JB, Park SW, Lee YS, Nam TK, Park YS, Kim YB: The effects of spinopelvic parameters and paraspinal muscle degeneration on S1 screw loosening. J Korean Neurosurg Soc 58:357362, 2015

    • Search Google Scholar
    • Export Citation
  • 13

    Lin X, Xiong D, Peng YQ, Sheng ZF, Wu XY, Wu XP, : Epidemiology and management of osteoporosis in the People’s Republic of China: current perspectives. Clin Interv Aging 10:10171033, 2015

    • Search Google Scholar
    • Export Citation
  • 14

    Lorentzon M, Cummings SR: Osteoporosis: the evolution of a diagnosis. J Intern Med 277:650661, 2015

  • 15

    Mo GY, Guo HZ, Guo DQ, Tang YC, Li YX, Yuan K, : Augmented pedicle trajectory applied on the osteoporotic spine with lumbar degenerative disease: mid-term outcome. J Orthop Surg Res 14:170, 2019

    • Search Google Scholar
    • Export Citation
  • 16

    Okuyama K, Abe E, Suzuki T, Tamura Y, Chiba M, Sato K: Influence of bone mineral density on pedicle screw fixation: a study of pedicle screw fixation augmenting posterior lumbar interbody fusion in elderly patients. Spine J 1:402407, 2001

    • Search Google Scholar
    • Export Citation
  • 17

    Orita S, Ohtori S, Eguchi Y, Kamoda H, Arai G, Ishikawa T, : Radiographic evaluation of monocortical versus tricortical purchase approaches in lumbosacral fixation with sacral pedicle screws: a prospective study of ninety consecutive patients. Spine (Phila Pa 1976) 35:E1230E1237, 2010

    • Search Google Scholar
    • Export Citation
  • 18

    Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N: Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 158:588595, 2013

    • Search Google Scholar
    • Export Citation
  • 19

    Pompe E, de Jong PA, de Jong WU, Takx RAP, Eikendal ALM, Willemink MJ, : Inter-observer and inter-examination variability of manual vertebral bone attenuation measurements on computed tomography. Eur Radiol 26:30463053, 2016

    • Search Google Scholar
    • Export Citation
  • 20

    Röllinghoff M, Schlüter-Brust K, Groos D, Sobottke R, Michael JWP, Eysel P, : Mid-range outcomes in 64 consecutive cases of multilevel fusion for degenerative diseases of the lumbar spine. Orthop Rev (Pavia) 2:e3, 2010

    • Search Google Scholar
    • Export Citation
  • 21

    Sandén B, Olerud C, Petrén-Mallmin M, Johansson C, Larsson S: The significance of radiolucent zones surrounding pedicle screws. Definition of screw loosening in spinal instrumentation. J Bone Joint Surg Br 86:457461, 2004

    • Search Google Scholar
    • Export Citation
  • 22

    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 93:10571063, 2011

    • Search Google Scholar
    • Export Citation
  • 23

    Shepherd JA, Schousboe JT, Broy SB, Engelke K, Leslie WD: Executive Summary of the 2015 ISCD Position Development Conference on advanced measures from DXA and QCT: fracture prediction beyond BMD. J Clin Densitom 18:274286, 2015

    • Search Google Scholar
    • Export Citation
  • 24

    Sivasubramaniam V, Patel HC, Ozdemir BA, Papadopoulos MC: Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study. BMJ Open 5:e009011, 2015

    • Search Google Scholar
    • Export Citation
  • 25

    Spirig JM, Sutter R, Götschi T, Farshad-Amacker NA, Farshad M: Value of standard radiographs, computed tomography, and magnetic resonance imaging of the lumbar spine in detection of intraoperatively confirmed pedicle screw loosening—a prospective clinical trial. Spine J 19:461468, 2019

    • Search Google Scholar
    • Export Citation
  • 26

    Tokuhashi Y, Matsuzaki H, Oda H, Uei H: Clinical course and significance of the clear zone around the pedicle screws in the lumbar degenerative disease. Spine (Phila Pa 1976) 33:903908, 2008

    • Search Google Scholar
    • Export Citation
  • 27

    Zaidi Q, Danisa OA, Cheng W: Measurement techniques and utility of Hounsfield unit values for assessment of bone quality prior to spinal instrumentation: a review of current literature. Spine (Phila Pa 1976) 44:E239E244, 2019

    • Search Google Scholar
    • Export Citation
  • 28

    Zou D, Li W, Deng C, Du G, Xu N: The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases. Eur Spine J 28:17581766, 2019

    • Search Google Scholar
    • Export Citation
  • 29

    Zou D, Li W, Xu F, Du G: Use of Hounsfield units of S1 body to diagnose osteoporosis in patients with lumbar degenerative diseases. Neurosurg Focus 46(5):E6, 2019

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 96 96 96
Full Text Views 28 28 28
PDF Downloads 60 60 60
EPUB Downloads 0 0 0