• James T Bernatz, Brian C Goh, Jonathan D Skjaerlund, Anthony L Mikula, Sarah E Johnson, Mohamad Bydon, Jeremy Fogelson, Benjamin Elder, Paul Huddleston, Mohammed Karim, Ahmad Nassr, Arjun Sebastian, and Brett Freedman.
• Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
• Spine. 2024 Aug 15; 49 (16): 112511291125-1129.

Study DesignRetrospective observational study of consecutive patients.ObjectiveThe purpose of the study is to determine if a surgeon's qualitative assessment of bone intraoperatively correlates with radiologic parameters of bone strength.Summary Of Background DataPreoperative radiologic assessment of bone can include modalities such as computed tomography (CT) Hounsfield units (HUs), dual-energy x-ray absorptiometry (DXA) bone mineral density with trabecular bone score (TBS) and magnetic resonance imaging vertebral bone quality (VBQ). Quantitative analysis of bone with screw insertional torque and pull-out strength measurement has been performed in cadaveric models and has been correlated to these radiologic parameters. However, these quantitative measurements are not routinely available for use in surgery. Surgeons anecdotally judge bone strength, but the fidelity of the intraoperative judgment has not been investigated.MethodsAll adult patients undergoing instrumented posterior thoracolumbar spine fusion by one of seven surgeons at a single center over a 3-month period were included. Surgeons evaluated the strength of bone based on intraoperative feedback and graded each patient's bone on a 5-point Likert scale. Two independent reviewers measured preoperative CT HUs and magnetic resonance imaging VBQ. Bone mineral density, lowest T-score, and TBS were extracted from DXA within 2 years of surgery.ResultsEighty-nine patients were enrolled and 16, 28, 31, 13, and 1 patients had Likert grade 1 (strongest bone), 2, 3, 4, and 5 (weakest bone), respectively. The surgeon assessment of bone correlated with VBQ (τ=0.15, P =0.07), CT HU (τ=-0.31, P <0.01), lowest DXA T-score (τ=-0.47, P <0.01), and TBS (τ=-0.23, P =0.06).ConclusionSpine surgeons' qualitative intraoperative assessment of bone correlates with preoperative radiologic parameters, particularly in posterior thoracolumbar surgeries. This information is valuable to surgeons as this supports the idea that decisions based on feel in surgery have a statistical foundation.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

38 keywords...

hide…