Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, China.
World Neurosurg. 2022 Aug;164:e169-e176. doi: 10.1016/j.wneu.2022.04.065. Epub 2022 Apr 21.
This study had 3 objectives: to compare bone mineral density (BMD) from 3 axial slices, subchondral trabecular bone 2 mm inferior to the cranial endplate, middle of the vertebral body, and subchondral trabecular bone 2 mm superior to the caudal endplate; assess BMD variations and correlations of C1-T1 vertebrae; and correlate BMD with clinical outcomes and cervical sagittal parameters in patients undergoing anterior cervical discectomy and fusion.
The study enrolled 71 patients who underwent anterior cervical discectomy and fusion between March 2017 and January 2020. Patient demographics, clinical outcomes, cervical sagittal parameters, and Hounsfield units (HUs) of C1-T1 vertebrae were recorded. Analysis of variance was performed to compare HUs from the axial slices. Pearson correlation coefficient was performed to calculate the relationship between mean HUs of C1-T1 and to assess correlations of mean HUs with clinical outcomes and cervical sagittal parameters.
There were no significant differences between HUs of 3 axial levels. Mean HUs were highest in the mid-cervical spine (C4). Significant correlations in mean HUs among all measured spinal levels were observed. Age, sex, and body mass index were not related to mean HUs. Visual analog scale, Neck Disability Index, and Patient Health Questionnaire-9 scores were not related to HUs before and after surgery. There were significant correlations among mean HUs of C2-T1 vertebrae, C2-C7 sagittal vertical axis, and cranial tilt. Mean HUs of C4 had the strongest correlation with C2-C7 sagittal vertical axis.
To our knowledge, this is the first study of cranial and caudal subchondral trabecular BMD using HUs and comparing them with the middle of the vertebral body and study of correlations between mean HUs of C1-T1 vertebrae and clinical outcomes and cervical sagittal parameters. Correcting C2-C7 sagittal vertical axis and cranial tilt would improve BMD of C1-T1 vertebrae.
本研究有 3 个目标：比较 3 个轴向切片的骨密度（BMD），距颅端终板下 2mm 的软骨下骨小梁、椎体中部和距尾端终板上 2mm 的软骨下骨小梁；评估 C1-T1 椎体的 BMD 变化和相关性；以及在接受前路颈椎间盘切除和融合术的患者中，将 BMD 与临床结果和颈椎矢状参数相关联。
本研究纳入了 2017 年 3 月至 2020 年 1 月期间接受前路颈椎间盘切除和融合术的 71 例患者。记录患者的人口统计学资料、临床结果、颈椎矢状参数和 C1-T1 椎体的 Hounsfield 单位（HU）。采用方差分析比较轴向切片的 HU。采用皮尔逊相关系数计算 C1-T1 的平均 HU 之间的关系，并评估平均 HU 与临床结果和颈椎矢状参数的相关性。
3 个轴向水平的 HU 之间无显著差异。颈椎中部（C4）的平均 HU 最高。所有测量的脊柱水平之间的平均 HU 均有显著相关性。年龄、性别和体重指数与平均 HU 无关。手术前后视觉模拟量表、颈椎残疾指数和患者健康问卷-9 评分与 HU 无关。C2-T1 椎体的平均 HU、C2-C7 矢状垂直轴和颅倾之间存在显著相关性。C4 的平均 HU 与 C2-C7 矢状垂直轴的相关性最强。
据我们所知，这是首次使用 HU 研究颅侧和尾侧软骨下骨小梁的 BMD，并将其与椎体中部进行比较，以及研究 C1-T1 椎体的平均 HU 与临床结果和颈椎矢状参数之间的相关性。纠正 C2-C7 矢状垂直轴和颅倾可以改善 C1-T1 椎体的 BMD。
