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Cervical vertebral Hounsfield units are a better predictor of Zero-P subsidence than the T-score of DXA in patients following single-level anterior cervical discectomy and fusion with zero-profile anchored spacer

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Abstract

Objectives

To determine the predictive effect of Hounsfield unit (HU) values in the cervical vertebral body measured by computed tomography (CT) and T-scores measured by dual-energy X-ray absorptiometry (DXA) on Zero-P subsidence after anterior cervical discectomy and fusion (ACDF)with Zero-P. In addition, we evaluated the most reliable measurement of cervical HU values.

Methods

We reviewed 76 patients who underwent single-level Zero-P fusion for cervical spondylosis. HU values were measured on CT images according to previous studies. Univariate analysis was used to screen the influencing factors of Zero-P subsidence, and then, logistic regression was used to determine the independent risk factors. The area under the receiver operating characteristic curve (AUC) was used to evaluate the ability to predict Zero-P subsidence.

Results

Twelve patients (15.8%) developed Zero-P subsidence. There were significant differences between subsidence group and non-subsidence group in terms of age, axial HU value, and HU value of midsagittal, midcoronal, and midaxial (MSCD), but there were no significant differences in lowest T-score and lowest BMD. The axial HU value (OR = 0.925) and HU value of MSCD (OR = 0.892) were independent risk factors for Zero-P subsidence, and the lowest T-score was not (OR = 1.186). The AUC of predicting Zero-P subsidence was 0.798 for axial HU value, 0.861 for HU value of MSCD, and 0.656 for T-score.

Conclusions

Lower cervical HU value indicates a higher risk of subsidence in patients following Zero-P fusion for single-level cervical spondylosis. HU values were better predictors of Zero-P subsidence than DXA T-scores. In addition, the measurement of HU value in the midsagittal, midcoronal, and midaxial planes of the cervical vertebral body provides an effective method for predicting Zero-P subsidence.

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Availability of data and materials

All data analyzed during this study are included within the manuscript. The datasets used and/or analyzed during this study are available from the first author on reasonable request.

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Acknowledgements

We are grateful to the staff of our department for their support and contribution to this study.

Funding

This study was funded by Research Development Plan of Affiliated Hospital of North Sichuan Medical College (2022JC020).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Fushun People’s Hospital, No. 490, Jixiang Road, Fushi Street, Fushun County, Zigong, 643000, Sichuan Province, China

    Hong-yu Pu, Xun-zhou Song & Bo Wang

  2. Department of Orthopaedic Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China

    Peng Wei & Qian Chen

  3. The Fushun People’s Hospital, Zigong, 643000, Sichuan Province, China

    Rui Zeng

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  1. Hong-yu Pu
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  2. Xun-zhou Song
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  4. Peng Wei
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  5. Rui Zeng
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Contributions

HYP, QC, and PW designed this study. HYP, QC, and PW were responsible for collecting, analyzing and interpreting the data, and writing the manuscript. HYP and QC identified the case, performed the operation, and made contributions to revising the manuscript for crucial intellectual content. HYP, KH, and RZ were responsible for revising the manuscript. The final version of the text has been reviewed and approved by all authors.

Corresponding authors

Correspondence to Rui Zeng or Qian Chen.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

This study was approved by the Institutional Review Board at the Affiliated Hospital of North Sichuan Medical College. All methods were performed in accordance with the relevant guidelines and regulations. Each author certifies that all investigations were conducted in accordance with ethical principles. The participant involved in the study gave their informed consent and signed and an informed consent form.

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Pu, Hy., Song, Xz., Wang, B. et al. Cervical vertebral Hounsfield units are a better predictor of Zero-P subsidence than the T-score of DXA in patients following single-level anterior cervical discectomy and fusion with zero-profile anchored spacer. Eur Spine J 33, 216–223 (2024). https://doi.org/10.1007/s00586-023-07934-8

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  • DOI: https://doi.org/10.1007/s00586-023-07934-8

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