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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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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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.
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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