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Postoperative decrease of regional volumetric bone mineral density measured by quantitative computed tomography after lumbar fusion surgery in adjacent vertebrae



We investigated the effect of posterior lumbar fusion surgery on the regional volumetric bone mineral density (vBMD) measured by quantitative computed tomography. Surgery negatively affected the regional vBMD in adjacent levels. Interbody fusion was independently associated with vBMD decline and preoperative epidural steroid injections (ESIs) were associated with less postoperative vBMD decline.


Few studies investigate postoperative BMD changes after lumbar fusion surgery utilizing quantitative computed tomography (QCT). Additionally, it remains unclear what preoperative and operative factors contribute to postoperative BMD changes. The purpose of this study is to investigate the effect of lumbar fusion surgery on regional volumetric bone mineral density (vBMD) in adjacent vertebrae and to identify potential modifiers for postoperative BMD change.


The data of patients undergoing posterior lumbar fusion with available pre- and postoperative CTs were reviewed. The postoperative changes in vBMD in the vertebrae one or two levels above the upper instrumented vertebra (UIV+1, UIV+2) and one level below the lower instrumented vertebra (LIV+1) were analyzed. As potential contributing factors, history of ESI, and the presence of interbody fusion, as well as various demographic/surgical factors, were included.


A total of 90 patients were included in the study analysis. Mean age (±SD) was 62.1 ± 11.7. Volumetric BMD (±SD) in UIV+1 was 115.4 ± 36.9 mg/cm3 preoperatively. The percent vBMD change in UIV+1 was − 10.5 ± 12.9% (p < 0.001). UIV+2 and LIV+1 vBMD changes showed similar trends. After adjusting with the interval between surgery and the secondary CT, non-Caucasian race, ESI, and interbody fusion were independent contributors to postoperative BMD change in UIV+1.


Posterior lumbar fusion surgery negatively affected the regional vBMDs in adjacent levels. Interbody fusion was independently associated with vBMD decline. Preoperative ESIs were associated with less postoperative vBMD decline, which was most likely a result of a preoperative decrease in vBMD due to ESIs.

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We would like to thank J. Waldman, Hospital for Special Surgery; J.K. Brown and A. Chason, Mindways Software, for their technical support.

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Corresponding author

Correspondence to A. P. Hughes.

Ethics declarations

This study was approved by the Institutional Review Board at the Hospital for Special Surgery (IRB no. 2016-0751). The informed consent from each patient was waived because of the retrospective nature of this study.

Conflicts of interest

IO, CJ, SNS, COM, TS, CR, and JS declare that they have no conflict of interest.

JAC served as a consultant/scientific advisory board member for Pfizer, Carestream, and Image Analysis Group.

AAS has received ownership interest from Paradigm Spine, LLC., and Spinal Kinetics, Inc., research support from Spinal Kinetics, Inc., and MiMedx Group, Inc., served as a consultant/scientific advisory board member for Clariance Inc., Nuvasive, Inc., Capital Royality, LP., Kuros Biosciences AG, Ortho Development Corp, 4WEB, Inc., Leerink Partners, LLC., and Depuy Orthopaedics, Inc.

FPC has received royalties from Nuvasive, Inc., served as a consultant/scientific advisory board member Vertical Spine, LLC., 4WEB Medical, Healthpoint Capital Partners, LP, Orthobond Corporation, Woven Orthopedic Technologies, received ownership interest from VBVP VI, LLC., received research support from Spinal Kinetics, Inc.; Ivy Healthcare Capital Partners, LLC; ISPH II, LLC; NuVasive, Inc., Mallinckrodt Pharmaceuticals, Centinel Spine, Inc. (fka Raymedica, LLC), Beatrice & Samuel A. Seaver Foundation, 4WEB Medical, Woven Orthopedic Technologies, Depuy Synthes, Orthobond Corporation, Pfizer, Inc., Paradigm Spine, LLC,7D Surgical, Inc. received others from Spinal Kinetics, Inc., Vertical Spine, LLC, Bonovo Orthopedics, Inc., Viscogliosi Brothers, LLC, Liventa Bioscience (fka AF Cell Medical), Woven Orthopedic Technologies, Healthpoint Capital Partners, LP, Paradigm Spine, LLC, Tissue Differentiation Intelligence, LLC.

FPG has received royalties from Lanx/Zimmer Biomet Spine, Depuy Synthes Spine, Nuvasive, Inc., Ortho Development Corp., ownership interest from Healthpoint Capital Partners, Paradigm Spine, LLC, Centinel Spine, Inc., and Liventa BioSciences, Inc., grant from Nuvasive, Inc., and MiMedx Group, Inc., outside of this work and served as a consultant for Ortho Development Corp, Nuvasive, Inc., Depuy Synthes Spine, and Lanx/Zimmer Biomet Spine.

APH has received research support from Pfizer, Inc., grants from Nuvasive, Inc., and 4WEB Medical.

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Okano, I., Jones, C., Salzmann, S.N. et al. Postoperative decrease of regional volumetric bone mineral density measured by quantitative computed tomography after lumbar fusion surgery in adjacent vertebrae. Osteoporos Int 31, 1163–1171 (2020).

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  • Bone mineral density
  • Interbody fusion
  • Lumbar fusion surgery
  • Lumbar spine
  • Quantitative computed tomography