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Lower preoperative Hounsfield unit values as a risk factor for poor 5-year clinical outcomes after lumbar spine surgery

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Abstract

Objective

Hounsfield Unit (HU) value has been associated with future osteoporotic fractures and postoperative complications. However, no studies on the impact of low HU values on mid-term clinical outcomes following lumbar spine surgery have been reported. We aimed to evaluate the usefulness of preoperative HU values for 5-year clinical outcomes following lumbar spine surgery.

Methods

We enrolled 200 patients who underwent lumbar surgery (≤ 3-disc levels) for lumbar spinal stenosis. HU values were assessed using preoperative lumbar computed tomography as part of routine preoperative planning for lumbar surgery. Patients were divided into two groups based on the cutoff value of the HU values obtained from the receiver operating characteristic curve for the incidence of vertebral fractures within five years postoperatively. Clinical scores preoperatively and 1, 2, and 5 years postoperatively, including Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form-36 (SF-36), were compared using a mixed-effects model.

Results

Comparative analysis indicated that all domains of JOABPEQ, except for lumbar function, and the physical component summary of the SF-36 were significantly worse in the low HU group than in the high HU group. Using multiple regression analysis, low HU values were significantly correlated with worse 5-year postoperative scores in all domains of JOABPEQ and SF-36.

Conclusion

Low preoperative HU values are a risk factor for poor 5-year clinical outcomes after lumbar spine surgery. HU values are not only a valuable tool for analyzing bone mineral density but also may be a valuable poor prognostic factor of postoperative clinical outcomes.

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Acknowledgements

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

Funding

None declared.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Osaka City General Hospital, 2-13-22, Miyakojima Hon-Dori, Miyakojima-Ku, Osaka City, Osaka, 534-0021, Japan

    Hiroshi Taniwaki, Masatoshi Hoshino, Yuki Kinoshita, Akira Matsumura & Takashi Namikawa

  2. Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan

    Minori Kato, Shinji Takahashi & Hiroaki Nakamura

Authors
  1. Hiroshi Taniwaki
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  2. Masatoshi Hoshino
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  3. Yuki Kinoshita
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  4. Akira Matsumura
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  5. Takashi Namikawa
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  6. Minori Kato
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  7. Shinji Takahashi
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  8. Hiroaki Nakamura
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Corresponding author

Correspondence to Hiroshi Taniwaki.

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The study protocol was approved by the institutional review board of Osaka City General Hospital.

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Taniwaki, H., Hoshino, M., Kinoshita, Y. et al. Lower preoperative Hounsfield unit values as a risk factor for poor 5-year clinical outcomes after lumbar spine surgery. Eur Spine J 33, 11–18 (2024). https://doi.org/10.1007/s00586-023-07995-9

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  • DOI: https://doi.org/10.1007/s00586-023-07995-9

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