• Ichiro Okano, Brandon B Carlson, Erika Chiapparelli, Stephan N Salzmann, Fabian Winter, Toshiyuki Shirahata, Courtney Ortiz Miller, Colleen Rentenberge, Jennifer Shue, John A Carrino, Andrew A Sama, Frank P Cammisa, Federico P Girardi, and Alexander P Hughes.
• Spine Care Service, Hospital for Special Surgery, New York, New York, USA.
• World Neurosurg. 2020 Mar 1; 135: e286-e292.

ObjectiveThere have been some reports on the association between spinal balance parameters and regional bone mineral density (BMD), but the results are controversial. The purpose of this study is to evaluate the relationship between spinopelvic parameters and regional volumetric BMDs (vBMDs) measured by quantitative computed tomography (QCT) in the lumbosacral region of patients undergoing lumbar fusion surgery.MethodsThe data of consecutive patients undergoing posterior lumbar spinal fusion with preoperative computed tomography was reviewed. QCT measurements were conducted in L1-S1 vertebral trabecular bone. The associations between spinopelvic sagittal parameters and vBMDs were evaluated. Multivariate analyses adjusted with age, gender, race, and body mass index were conducted with vBMD as the response variable.ResultsA total of 144 patients were included in the final analyses. Mean age (± standard deviation) was 65.4 ± 11.8 years. Mean vBMD in L1 (± standard deviation) was 118.3 ± 37.4 mg/cm3. After adjusting by cofactors, lumbar lordosis was negatively associated with vBMDs in all levels from L1 to L5 (% regression coefficients and adjusted R2 values: L1, -0.438, 0.268; L2, -0.556, 0.296; L3, -0.608, 0.362; L4, -0.554, 0.228; L5, -0.424, 0.194), but not in S1. Sacral slope was negatively associated with vBMD only at L4 (% coefficient, -0.588; R2, 0.208). Other parameters were not significantly associated with vBMDs at any levels.ConclusionsHigher lumbar lordosis was associated with lower vBMDs in all lumbar spine levels. Our results suggest that BMD is affected not only by metabolic factors but also by the mechanical environment. Further longitudinal studies are needed to elucidate this effect of vBMD on clinical outcomes.Copyright © 2019 Elsevier Inc. All rights reserved.

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