• Eur Spine J · Jul 2024

    Multicenter Study

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

    • Ippei Yamauchi, Hiroaki Nakashima, Sadayuki Ito, Naoki Segi, Jun Ouchida, Ryotaro Oishi, Yuichi Miyairi, Yoshinori Morita, Yukihito Ode, Yasuhiro Nagatani, Yuya Okada, Kazuaki Morishita, Yosuke Takeichi, Yujiro Kagami, Hiroto Tachi, Kazuma Ohshima, Keisuke Ogura, Ryuichi Shinjo, Tetsuya Ohara, Taichi Tsuji, Tokumi Kanemura, and Shiro Imagama.
    • Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
    • Eur Spine J. 2024 Jul 1; 33 (7): 282428312824-2831.

    PurposeTo determine the most valid bone health parameter to predict mechanical complications (MCs) following surgery for adult spinal deformity (ASD).MethodsThis 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.ResultsOf 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).ConclusionPatients 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.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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