160 demonstrated significant reduction in risk of osteoporosis, whereas HU values < 110 were significantly correlated with osteoporosis. CONCLUSIONS Osteoporosis is increasingly recognized as a significant risk factor for complications after spinal fusion surgery. Consequently, preoperative assessment of BMD is a critical factor to consider in planning surgical treatment. Although DEXA has been the gold standard for BMD measurement, other imaging modalities, including MRI, oCT, and qCT, appear to be viable alternatives and may offer cost and time savings." name="description">
Osteoporosis has significant implications in spine fusion surgery, for which reduced spinal bone mineral density (BMD) can result in complications and poorer outcomes. Currently, dual-energy x-ray absorptiometry (DEXA) is the gold standard for radiographic diagnosis of osteoporosis, although DEXA accuracy may be limited by the presence of degenerative spinal pathology. In recent years, there has been an evolving interest in using alternative imaging, including CT and MRI, to assess BMD. In this systematic review of the literature, the authors assessed the use and effectiveness of MRI, opportunistic CT (oCT), and quantitative CT (qCT) to measure BMD.
In accordance with the PRISMA guidelines, the authors conducted a systematic search for articles posted on PubMed between the years 2000 and 2022 by using the keywords "opportunistic CT, quantitative CT, MRI" AND "bone density" AND "spine." Inclusion criteria consisted of articles written in English that reported studies pertaining to human or cadaveric subjects, and studies including a measure of spinal BMD. Articles not related to spinal BMD, osteoporosis, or spinal surgery or reports of studies that did not include the use of spinal MRI or CT were excluded. Key study outcomes were extracted from included articles, and qualitative analysis was subsequently performed.
The literature search yielded 302 articles. Forty-two articles reported studies that met the final inclusion criteria. Eighteen studies utilized MRI protocols to correlate spinal BMD with vertebral bone quality scores, M-scores, and quantitative perfusion markers. Eight studies correlated oCT with spinal BMD, and 16 studies correlated qCT with spinal BMD. With oCT and qCT imaging, there was consensus that Hounsfield unit (HU) values > 160 demonstrated significant reduction in risk of osteoporosis, whereas HU values < 110 were significantly correlated with osteoporosis.
Osteoporosis is increasingly recognized as a significant risk factor for complications after spinal fusion surgery. Consequently, preoperative assessment of BMD is a critical factor to consider in planning surgical treatment. Although DEXA has been the gold standard for BMD measurement, other imaging modalities, including MRI, oCT, and qCT, appear to be viable alternatives and may offer cost and time savings.
插图从Akinduroet al. (pp 481–493). Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved.
INCLUDE WHEN CITINGPublished online January 6, 2023; DOI: 10.3171/2022.11.SPINE22875.
DisclosuresDr. Passias reported receiving personal fees outside the submitted work from Medtronic, Globus, Cerapedics, and Royal Biologics and being a consultant for Medtronic. Dr. LaBagnara reported being a consultant for Medtronic. Dr. Park reported receiving personal fees from Globus, NuVasive, Accelus, LifeNet, and DePuy Synthes and grants from DePuy Sunthes, royalties from Globus, travel and lodging for a meeting from Medtronic, and grants from Cerapedics, ISSG, and SI Bone outside the submitted work.
SalariN,GhasemiH,MohammadiL,et al.The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis.J Orthop Surg Res.2021;16(1):609.
Föger-SamwaldU,DovjakP,Azizi-SemradU,Kerschan-SchindlK,PietschmannP.Osteoporosis: pathophysiology and therapeutic options.EXCLI J.2020;19:1017- - - - - -1037.
RandT,SeidlG,KainbergerF,et al.Impact of spinal degenerative changes on the evaluation of bone mineral density with dual energy X-ray absorptiometry (DXA).Calcif Tissue Int.1997;60(5):430- - - - - -433.
PappouIP,GirardiFP,SandhuHS,et al.Discordantly high spinal bone mineral density values in patients with adult lumbar scoliosis.Spine (Phila Pa 1976).2006;31(14):1614- - - - - -1620.
OkuyamaK,AbeE,SuzukiT,TamuraY,ChibaM,SatoK.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.2001;1(6):402- - - - - -407.
ChoiMK,KimSM,LimJK.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 DEXA scan and Hounsfield units from CT.Acta Neurochir (Wien).2016;158(7):1421- - - - - -1427.
ZouD,LiW,DengC,DuG,XuN.The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases.Eur Spine J.2019;28(8):1758- - - - - -1766.
AynaszyanS,DeviaLG,UdoeyoIF,BadveSA,DelSoleEM.Patient physiology influences the MRI-based vertebral bone quality score.Spine J.2022;22(11):1866- - - - - -1874.
BandiraliM,Di LeoG,PapiniGD,et al.A new diagnostic score to detect osteoporosis in patients undergoing lumbar spine MRI.Eur Radiol.2015;25(10):2951- - - - - -2959.
ChangHK,HsuTW,KuJ,et al.Simple parameters of synthetic MRI for assessment of bone density in patients with spinal degenerative disease.J Neurosurg Spine.2022;36(3):414- - - - - -421.
EhresmanJ,PenningtonZ,SchillingA,et al.Novel MRI-based score for assessment of bone density in operative spine patients.Spine J.2020;20(4):556- - - - - -562.
GokalpG,MutluFS,YaziciZ,YildirimN.Evaluation of vertebral bone marrow fat content by chemical-shift MRI in osteoporosis.Skeletal Radiol.2011;40(5):577- - - - - -585.
HeJ,FangH,Na LiX.椎骨髓扩散系数在正常的成年人with varying bone densities at 3T diffusion-weighted imaging.Acta Radiol.2018;59(1):89- - - - - -96.
HeL,LiuZ,LiuC,et al.Radiomics based on lumbar spine magnetic resonance imaging to detect osteoporosis.Acad Radiol.2021;28(6):e165- - - - - -e171.
HuYH,YehYC,NiuCC,et al.Novel MRI-based vertebral bone quality score as a predictor of cage subsidence following transforaminal lumbar interbody fusion.J Neurosurg Spine.2022;37(5):654- - - - - -662.
HuangZ,LinQ,WangJ,ZhanZ,TuX.Relationship between quantitative parameters of lumbar vertebral perfusion and bone mineral density (BMD) in postmenopausal women.Adv Clin Exp Med.2019;28(8):1005- - - - - -1011.
KaleH,YadavS.Can routine MRI spine T1 sequences be used for prediction of decreased bone density?Acta Radiol.Published online January 6, 2022. doi:10.1177/02841851211063008
KühnJP,HernandoD,MeffertPJ,et al.Proton-density fat fraction and simultaneous R2* estimation as an MRI tool for assessment of osteoporosis.Eur Radiol.2013;23(12):3432- - - - - -3439.
LeonhardtY,GassertFT,FeuerriegelG,et al.Vertebral bone marrow T2* mapping using chemical shift encoding-based water-fat separation in the quantitative analysis of lumbar osteoporosis and osteoporotic fractures.Quant Imaging Med Surg.2021;11(8):3715- - - - - -3725.
MarisTG,DamilakisJ,SideriL,et al.Assessment of the skeletal status by MR relaxometry techniques of the lumbar spine: comparison with dual X-ray absorptiometry.Eur J Radiol.2004;50(3):245- - - - - -256.
MomeniM,AsadzadehM,MowlaK,HanafiMG,GharibvandMM,SahraeizadehA.Sensitivity and specificity assessment of DWI and ADC for the diagnosis of osteoporosis in postmenopausal patients.Radiol Med (Torino).2020;125(1):68- - - - - -74.
SalzmannSN,OkanoI,JonesC,et al.Preoperative MRI-based vertebral bone quality (VBQ) score assessment in patients undergoing lumbar spinal fusion.Spine J.2022;22(8):1301- - - - - -1308.
ShayganfarA,KhodayiM,EbrahimianS,TabriziZ.Quantitative diagnosis of osteoporosis using lumbar spine signal intensity in magnetic resonance imaging.Br J Radiol.2019;92(1097):20180774.
TangGY,LvZW,TangRB,et al.Evaluation of MR spectroscopy and diffusion-weighted MRI in detecting bone marrow changes in postmenopausal women with osteoporosis.Clin Radiol.2010;65(5):377- - - - - -381.
ZhaoY,HuangM,Serrano SosaM,et al.Fatty infiltration of paraspinal muscles is associated with bone mineral density of the lumbar spine.Arch Osteoporos.2019;14(1):99.
ShahLM,HanrahanCJ.MRI of spinal bone marrow: part I, techniques and normal age-related appearances.AJR Am J Roentgenol.2011;197(6):1298- - - - - -1308.
BandaruS,HareK,KruegerD,BinkleyN.Do patients that fracture with normal DXA-measured BMD have normal bone?Arch Osteoporos.2020;15(1):70.
BettagC,AbboudT,von der BrelieC,MelichP,RohdeV,SchatloB.Do we underdiagnose osteoporosis in patients with pyogenic spondylodiscitis?Neurosurg Focus.2020;49(2):E16.
CohenA,FoldesAJ,HillerN,SimanovskyN,SzalatA.Opportunistic screening for osteoporosis and osteopenia by routine computed tomography scan: a heterogeneous, multiethnic, middle-eastern population validation study.Eur J Radiol.2021;136:109568.
EmohareO,CaganA,MorganR,et al.计算机断层扫描的使用eval衰减uate osteoporosis following acute fractures of the thoracic and lumbar vertebra.Geriatr Orthop Surg Rehabil.2014;5(2):50- - - - - -55.
EmohareO,DittmerA,MorganRA,SwitzerJA,PollyDWJr.Osteoporosis in acute fractures of the cervical spine: the role of opportunistic CT screening.J Neurosurg Spine.2015;23(1):1- - - - - -7.
LeeSJ,BinkleyN,LubnerMG,BruceRJ,ZiemlewiczTJ,PickhardtPJ.Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density.Osteoporos Int.2016;27(3):1131- - - - - -1136.
MichalskiAS,BeslerBA,BurtLA,BoydSK.Opportunistic CT screening predicts individuals at risk of major osteoporotic fracture.Osteoporos Int.2021;32(8):1639- - - - - -1649.
XiZ,MummaneniPV,WangM,et al.The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion.Neurosurg Focus.2020;49(2):E8.
CarlsonBB,SalzmannSN,ShirahataT,et al.Prevalence of osteoporosis and osteopenia diagnosed using quantitative CT in 296 consecutive lumbar fusion patients.Neurosurg Focus.2020;49(2):E5.
ChengX,LiK,ZhangY,et al.The accurate relationship between spine bone density and bone marrow in humans.Bone.2020;134:115312.
CzyzM,KapinasA,HoltonJ,PyzikR,BoszczykBM,QuraishiNA.The computed tomography-based fractal analysis of trabecular bone structure may help in detecting decreased quality of bone before urgent spinal procedures.Spine J.2017;17(8):1156- - - - - -1162.
FuerdererS,VonhoegenJ,CoenenO,MichaelJ,KoebkeJ,EyselP.In vitro comparison of the pullout strength of 3 anterior double-screw fixation techniques with different screw angulations.J Neurosurg Spine.2011;14(3):367- - - - - -371.
GiambiniH,Salman RoghaniR,ThoresonAR,MeltonLJIII,AnKN,GayRE.Lumbar trabecular bone mineral density distribution in patients with and without vertebral fractures: a case-control study.Eur Spine J.2014;23(6):1346- - - - - -1353.
KayFU,HoV,DosunmuEB,et al.Quantitative CT detects undiagnosed low bone mineral density in oncologic patients imaged with 18F-FDG PET/CT.Clin Nucl Med.2021;46(1):8- - - - - -15.
KimK,SongSH,KimIJ,JeonYK.Is dual-energy absorptiometry accurate in the assessment of bone status of patients with chronic kidney disease?Osteoporos Int.2021;32(9):1859- - - - - -1868.
KinsellaS,MurphyK,BreenM,et al.比较单一的CT扫描评估骨mineral density, vascular calcification and fat mass with standard clinical measurements in renal transplant subjects: the ABC HeART study.BMC Nephrol.2015;16:188.
LöfflerMT,JacobA,ScharrA,et al.Automatic opportunistic osteoporosis screening in routine CT: improved prediction of patients with prevalent vertebral fractures compared to DXA.Eur Radiol.2021;31(8):6069- - - - - -6077.
LöfflerMT,JacobA,ValentinitschA,et al.Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA.Eur Radiol.2019;29(9):4980- - - - - -4989.
NarlochJ,GlinkowskiW.Software-assisted morphometry and volumetry of the lumbar spine.Neurol Neurochir Pol.2016;50(3):143- - - - - -150.
OkanoI,SalzmannSN,JonesC,et al.The impact of degenerative disc disease on regional volumetric bone mineral density (vBMD) measured by quantitative computed tomography.Spine J.2020;20(2):181- - - - - -190.
PaxinosO,TsitsopoulosPP,ZindrickMR,et al.Evaluation of pullout strength and failure mechanism of posterior instrumentation in normal and osteopenic thoracic vertebrae.J Neurosurg Spine.2010;13(4):469- - - - - -476.
SmithA,KhanM,VarneyE,et al.Opportunistic bone density screening for the abdominal radiologist using colored CT images: a pilot retrospective study.Abdom Radiol (NY).2019;44(2):775- - - - - -782.
TherkildsenJ,WintherS,NissenL,et al.Feasibility of opportunistic screening for low thoracic bone mineral density in patients referred for routine cardiac CT.J Clin Densitom.2020;23(1):117- - - - - -127.
UllrichBW,SchwarzF,McLeanAL,et al.Inter-rater reliability of Hounsfield units as a measure of bone density: applications in the treatment of thoracolumbar fractures.World Neurosurg.2022;158:e711- - - - - -e716.
WagnerSC,FormbyPM,HelgesonMD,KangDG.Diagnosing the undiagnosed: osteoporosis in patients undergoing lumbar fusion.Spine (Phila Pa 1976).2016;41(21):E1279- - - - - -E1283.
ACR-SPR-SSR Practice Parameter for the Performance of Musculoskeletal Quantitative Computed Tomography (QCT). American College of Radiology.Accessed November 23, 2022.https://www.acr.org/-/media/ACR/Files/Practice-Parameters/QCT.pdf
NishiyamaKK,ItoM,HaradaA,BoydSK.Classification of women with and without hip fracture based on quantitative computed tomography and finite element analysis.Osteoporos Int.2014;25(2):619- - - - - -626.
GoelH,LibberJ,BorchardtG,KruegerD,BinkleyN.A pilot study comparing daily teriparatide with monthly cycles of teriparatide and raloxifene.Arch Osteoporos.2021;16(1):70.
All Time | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 1642 | 1642 | 481 |
Full Text Views | 486 | 486 | 77 |
PDF Downloads | 292 | 292 | 38 |
EPUB Downloads | 0 | 0 | 0 |