Skip to main content

Advertisement

SpringerLink
Log in

Advances in Hounsfield units value for predicting cage subsidence on spinal interbody fusion surgery

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

A growing number of studies have demonstrated that Hounsfield units (HU) value can effectively assess bone quality and predict cage subsidence (CS) after spinal surgery. The purpose of this review is to provide an overview of the utility of the HU value for predicting CS after spinal surgery and to raise some of the unresolved questions in this field.

Methods

We searched on PubMed, EMBASE, MEDLINE, and Cochrane Library for studies correlating HU value to CS.

Results

Thirty-seven studies were included in this review. We found that HU value can predicted the risk of CS effectively after spinal surgery. Moreover, the HU value of the cancellous vertebral body and the cortical endplate were used for predicting CS, in comparison, the measurement method of HU value in the cancellous vertebral body was more standardized, but which region is more important to CS remains unknown. Different cutoff thresholds of HU value have been established in different surgical procedures for predicting CS. The HU value may be superior to dual-energy X-ray absorptiometry (DEXA) for CS prediction; however, the usage standard of HU value has not been well established.

Conclusions

The HU value shows great potential for predicting CS and constitutes an advantage over DEXA. However, general consensuses about how CS is defined and HU is measured, which part of HU value is more important, and the appropriate cutoff threshold of the HU value for osteoporosis and CS still require exploration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Dantas F, Dantas FLR, Botelho RV (2022) Effect of interbody fusion compared with posterolateral fusion on lumbar degenerative spondylolisthesis: a systematic review and meta-analysis. Spine J 22:756–768

    Article  PubMed  Google Scholar 

  2. Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ (2015) Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg 1:2–18

    PubMed  PubMed Central  Google Scholar 

  3. Wu H, Shan Z, Zhao F, Cheung JPY (2021) Poor bone quality, multilevel surgery, and narrow and tall cages are associated with intraoperative endplate injuries and late-onset cage subsidence in lateral lumbar interbody fusion: a systematic review. Clin Orthop Relat Res 480(1):163–188

    Article  PubMed Central  Google Scholar 

  4. Marchi L, Abdala N, Oliveira L, Amaral R, Coutinho E, Pimenta L (2013) Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion. J Neurosurg Spine 19:110–118

    Article  PubMed  Google Scholar 

  5. Xie F, Yang Z, Tu Z et al (2022) The value of Hounsfield units in predicting cage subsidence after transforaminal lumbar interbody fusion. BMC Musculoskelet Disord 23:882

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zhao L, Xie T, Wang X et al (2022) Clinical and radiological evaluation of cage subsidence following oblique lumbar interbody fusion combined with anterolateral fixation. BMC Musculoskelet Disord 23:214

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Yao Y-C, Chou P-H, Lin H-H, Wang S-T, Liu C-L, Chang M-C (2020) Risk factors of cage subsidence in patients received minimally invasive transforaminal lumbar interbody fusion. Spine 45:E1279–E1285

    Article  PubMed  Google Scholar 

  8. Soliman MAR, Aguirre AO, Kuo CC et al (2022) Vertebral bone quality score independently predicts cage subsidence following transforaminal lumbar interbody fusion. Spine J 22(12):2017–2023

    Article  PubMed  Google Scholar 

  9. Muraki S, Yamamoto S, Ishibashi H et al (2004) Impact of degenerative spinal diseases on bone mineral density of the lumbar spine in elderly women. Osteoporos Int 15:724–728

    Article  PubMed  Google Scholar 

  10. Choi MK, Kim SM, Lim JK (2016) 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) 158:1421–1427

    Article  PubMed  Google Scholar 

  11. Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG (2011) Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am 93:1057–1063

    Article  PubMed  Google Scholar 

  12. Ran L, Xie T, Zhao L, Huang S, Zeng J (2022) Low Hounsfield units on computed tomography are associated with cage subsidence following oblique lumbar interbody fusion (OLIF). Spine J 22:957–964

    Article  PubMed  Google Scholar 

  13. Wang M, Mummaneni PV, Xi Z et al (2020) Lower Hounsfield units on CT are associated with cage subsidence after anterior cervical discectomy and fusion. J Neurosurg Spine 33(4):425–432

    Article  Google Scholar 

  14. Lee SJ, Binkley N, Lubner MG, Bruce RJ, Ziemlewicz TJ, Pickhardt PJ (2016) Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density. Osteoporos Int 27:1131–1136

    Article  CAS  PubMed  Google Scholar 

  15. Hiyama A, Sakai D, Katoh H, Nomura S, Sato M, Watanabe M (2022) Comparative study of cage subsidence in single-level lateral lumbar interbody fusion. J Clin Med 11(5):1374

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wang Y, Battié MC, Videman T (2012) A morphological study of lumbar vertebral endplates: radiographic, visual and digital measurements. Eur Spine J 21:2316–2323

    Article  PubMed  PubMed Central  Google Scholar 

  17. Okano I, Jones C, Salzmann SN et al (2020) Endplate volumetric bone mineral density measured by quantitative computed tomography as a novel predictive measure of severe cage subsidence after standalone lateral lumbar fusion. Eur Spine J 29:1131–1140

    Article  PubMed  Google Scholar 

  18. Lee JS, Son DW, Lee SH et al (2022) The effect of Hounsfield unit value with conventional computed tomography and intraoperative distraction on postoperative intervertebral height reduction in patients following stand-alone anterior cervical discectomy and fusion. J Korean Neurosurg Soc 65:96–106

    Article  PubMed  Google Scholar 

  19. Wang Hui ZD, Zhuoran S, Longjie W, Shuai J, Weishi Li (2021) Predictive value of vertebral trabecular and endplate Hounsfield Units on cage subsidence followed posterior lumbar interbody fusion. Chin J Orthop 41:864–871

    Google Scholar 

  20. Wu H, Cheung JPY, Zhang T et al (2021) The Role of Hounsfield Unit in Intraoperative Endplate Violation and Delayed Cage Subsidence with Oblique Lateral Interbody Fusion. Glob Spine J. https://doi.org/10.1177/21925682211052515

    Article  Google Scholar 

  21. Wang Z, Mei J, Feng X et al (2022) Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion. J Orthop Surg Res 17:355

    Article  PubMed  PubMed Central  Google Scholar 

  22. Engelke K, Libanati C, Liu Y et al (2009) Quantitative computed tomography (QCT) of the forearm using general purpose spiral whole-body CT scanners: accuracy, precision and comparison with dual-energy X-ray absorptiometry (DXA). Bone 45:110–118

    Article  PubMed  Google Scholar 

  23. Nekkanty S, Yerramshetty J, Kim D-G et al (2010) Stiffness of the endplate boundary layer and endplate surface topography are associated with brittleness of human whole vertebral bodies. Bone 47:783–789

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jones C, Okano I, Salzmann SN et al (2021) Endplate volumetric bone mineral density is a predictor for cage subsidence following lateral lumbar interbody fusion: a risk factor analysis. Spine J 21:1729–1737

    Article  PubMed  Google Scholar 

  25. Cheng C, Wang K, Zhang C, Wu H, Jian F (2021) Clinical results and complications associated with oblique lumbar interbody fusion technique. Ann Transl Med 9:16

    Article  PubMed  PubMed Central  Google Scholar 

  26. Zhou J, Yuan C, Liu C, Zhou L, Wang J (2021) Hounsfield unit value on CT as a predictor of cage subsidence following stand-alone oblique lumbar interbody fusion for the treatment of degenerative lumbar diseases. BMC Musculoskelet Disord 22:960

    Article  PubMed  PubMed Central  Google Scholar 

  27. Xi Z, Mummaneni PV, Wang M et al (2020) The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion. Neurosurg Focus 49:E8

    Article  PubMed  Google Scholar 

  28. Pisano AJ, Fredericks DR, Steelman T, Riccio C, Helgeson MD, Wagner SC (2020) Lumbar disc height and vertebral Hounsfield units: association with interbody cage subsidence. Neurosurg Focus 49:E9

    Article  PubMed  Google Scholar 

  29. Mi J, Li K, Zhao X, Zhao CQ, Li H, Zhao J (2017) Vertebral body hounsfield units are associated with cage subsidence after transforaminal lumbar interbody fusion with unilateral pedicle screw fixation. Clinical Spine Surg 30:E1130-e1136

    Article  Google Scholar 

  30. Formby PM, Kang DG, Helgeson MD, Wagner SC (2016) Clinical and radiographic outcomes of transforaminal lumbar interbody fusion in patients with osteoporosis. Glob Spine J 6:660–664

    Article  Google Scholar 

  31. Ji C, Yu S, Yan N et al (2020) Risk factors for subsidence of titanium mesh cage following single-level anterior cervical corpectomy and fusion. BMC Musculoskelet Disord 21:1–8

    Article  Google Scholar 

  32. Liu J, Ding W, Yang D et al (2020) Modic changes (MCs) associated with endplate sclerosis can prevent cage subsidence in oblique lumbar interbody fusion (OLIF) stand -alone. World Neurosurg 138:E160–E168

    Article  PubMed  Google Scholar 

  33. Guha D, Mushlin HM, Muthiah N et al (2022) Computed tomography Hounsfield units as a predictor of reoperation and graft subsidence after standalone and multilevel lateral lumbar interbody fusion. World Neurosurg 161:e417–e426

    Article  PubMed  Google Scholar 

  34. Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N (2013) Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 158:588–595

    Article  PubMed  PubMed Central  Google Scholar 

  35. Buckens CF, Dijkhuis G, de Keizer B, Verhaar HJ, de Jong PA (2015) Opportunistic screening for osteoporosis on routine computed tomography? An external validation study. Eur Radiol 25:2074–2079

    Article  PubMed  Google Scholar 

  36. Wagner SC, Formby PM, Helgeson MD, Kang DG (2016) Diagnosing the undiagnosed: osteoporosis in patients undergoing lumbar fusion. Spine 41:E1279–E1283

    Article  PubMed  Google Scholar 

  37. Lee S, Chung CK, Oh SH, Park SB (2013) Correlation between bone mineral density measured by dual-energy X-ray absorptiometry and hounsfield units measured by diagnostic CT in lumbar spine. J Korean Neurosurg Soc 54:384–389

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank Sudan Tang MD (Department of Radiology, Daping Hospital of Army Military Medical University, China) for her suggestions and valuable guidance.

Funding

No funding.

Author information

Authors and Affiliations

  1. Department of Orthopedic Spine Surgery, Yan’an Hospital Affiliated to Kunming Medical University, 245# Panlong, Renmingdonglu, Kunming, 650051, Yunnan, People’s Republic of China

    Xingxiao Pu, Daxing Wang & Shao Gu

Authors
  1. Xingxiao Pu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daxing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shao Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Daxing Wang or Shao Gu.

Ethics declarations

Conflict of interest

All authors state that we have no conflicts of interest.

Ethical approval

Institutional review board approval was not required because it is a review paper.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pu, X., Wang, D. & Gu, S. Advances in Hounsfield units value for predicting cage subsidence on spinal interbody fusion surgery. Eur Spine J 32, 3149–3157 (2023). https://doi.org/10.1007/s00586-023-07805-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-07805-2

Keywords

Search

Navigation