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Preoperative low Hounsfield units in the lumbar spine are associated with postoperative mechanical complications in adult spinal deformity

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Abstract

Purpose

To determine the most valid bone health parameter to predict mechanical complications (MCs) following surgery for adult spinal deformity (ASD).

Methods

This multicenter study retrospectively examined the records of patients who had undergone fusion of three or more motion segments, including the pelvis, with a minimum two-year follow-up period. Patients with moderate and severe global alignment and proportion scores were included in the study and divided into two groups: those who developed MCs and those who did not. Bone mineral density (BMD) of the lumbar spine and femoral neck was measured using dual-energy X-ray absorptiometry, and Hounsfield units (HUs) were measured in the lumbar spine on computed tomography. Radiographic parameters were evaluated preoperatively, immediately after surgery, and at final follow-up.

Results

Of 108 patients, 30 (27.8%) developed MCs, including 26 cases of proximal junctional kyphosis/failure, 2 of distal junctional failure, 6 of rod fracture, and 11 reoperations. HUs were significantly lower in patients who experienced MCs (113.7 ± 41.1) than in those who did not (137.0 ± 46.8; P = 0.02). BMD did not differ significantly between the two groups. The preoperative and two-year postoperative global tilt, as well as the immediately postoperative sagittal vertical axis, were significantly greater in patients who developed MCs than in those who did not (P = 0.02, P < 0.01, and P = 0.01, respectively).

Conclusion

Patients who experienced MCs following surgery for ASD had lower HUs than those who did not. HUs may therefore be more useful than BMD for predicting MCs following surgery for ASD.

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Acknowledgements

We would like to thank Editage (https://www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan

    Ippei Yamauchi, Hiroaki Nakashima, Sadayuki Ito, Naoki Segi, Jun Ouchida, Ryotaro Oishi, Yuichi Miyairi, Yoshinori Morita, Yukihito Ode, Yasuhiro Nagatani, Yuya Okada & Shiro Imagama

  2. Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan

    Ippei Yamauchi & Tetsuya Ohara

  3. Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan

    Kazuaki Morishita, Kazuma Ohshima & Tokumi Kanemura

  4. Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Obu, Japan

    Yosuke Takeichi

  5. Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan

    Yujiro Kagami, Keisuke Ogura & Ryuichi Shinjo

  6. Department of Orthopedic Surgery, Toyota Kosei Hospital, Toyota, Japan

    Hiroto Tachi & Taichi Tsuji

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  1. Ippei Yamauchi
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  2. Hiroaki Nakashima
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Corresponding author

Correspondence to Hiroaki Nakashima.

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The authors declare that there are no conflicts of interest in this study and the article has no funding.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of our hospital (No. 2016–0177).

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Yamauchi, I., Nakashima, H., Ito, S. et al. Preoperative low Hounsfield units in the lumbar spine are associated with postoperative mechanical complications in adult spinal deformity. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08261-2

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  • DOI: https://doi.org/10.1007/s00586-024-08261-2

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