Lovecchio Francis, Ang Bryan, Louie Philip K, Chaudary Chirag, Shah Sachin P, Punyala Ananth, Yao Yu-Cheng, Steinhaus Mike, McCarthy Michael H, Huang Russel, Lebl Darren, Lafage Virginie, Albert Todd J, Iyer Sravisht, Qureshi Sheeraz, Kim Han Jo
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA, USA.
Global Spine J. 2024 Jan;14(1):169-176. doi: 10.1177/21925682221098965. Epub 2022 Apr 29.
Retrospective cohort study.
Given changes in bone density induced by degenerative disease, general measures of bone health (ie DEXA) are inadequate to evaluate bone density in surgical areas of interest. Regional differences in HU in the cervical spine may influence surgical strategies. The purposes of our study were to determine whether cervical Hounsfield units (HU) vary by level, examine their relationship with age, comorbidities, and alignment, and propose a technique to measure HU in the lateral masses.
Two hundred twenty-four patients with degenerative spine pathology with a cervical computed tomography were included (2015-2019). Measurements were performed in each vertebral body (C2-T1; mid-axial, anterior-axial, posterior-axial, mid-coronal, and mid-sagittal) and 2 regions of the lateral masses (C3-C6; mid-cor, mid-sag). To evaluate reliability, 6 observers each measured 355 HU values, inter-relater reliability assessed with intraclass correlation coefficients Correlations of HU with age, BMI, comorbidities, and cervical alignment were evaluated.
Bone density differed by level, with the lowest HU scores in the lower cervical spine (C6-T1) ( < .001). No correlations were found between LM HU and age, BMI, CCI, or alignment ( > .05). Increased kyphosis was weakly correlated with VB HU, while age and CCI showed moderate correlations with VB HU at all levels (P<.001). ICC for HU measurements were good to excellent for the VBs, but poor to moderate for the LMs.
Bone is least dense in the lower cervical spine. HU scoring is not reliable in the lateral masses. We recommend that a level-specific approach to bone density is considered in surgical planning.
回顾性队列研究。
鉴于退行性疾病引起的骨密度变化，一般的骨健康测量方法（即双能X线吸收法）不足以评估感兴趣手术区域的骨密度。颈椎中Hounsfield单位（HU）的区域差异可能会影响手术策略。我们研究的目的是确定颈椎HU是否因节段而异，检查它们与年龄、合并症和对线的关系，并提出一种测量侧块中HU的技术。
纳入224例患有颈椎计算机断层扫描的退行性脊柱病变患者（2015 - 2019年）。在每个椎体（C2 - T1；中轴线、前轴线、后轴线、中冠状面和中矢状面）以及侧块的2个区域（C3 - C6；中冠状面、中矢状面）进行测量。为评估可靠性，6名观察者每人测量355个HU值，用组内相关系数评估观察者间可靠性。评估HU与年龄、体重指数、合并症和颈椎对线的相关性。
骨密度因节段而异，下颈椎（C6 - T1）的HU评分最低（P <.001）。未发现侧块HU与年龄、体重指数、Charlson合并症指数（CCI）或对线之间存在相关性（P >.05）。后凸增加与椎体HU呈弱相关，而年龄和CCI在所有节段与椎体HU呈中度相关（P <.001）。椎体HU测量的组内相关系数良好至优秀，但侧块的组内相关系数差至中等。
下颈椎的骨密度最低。侧块的HU评分不可靠。我们建议在手术规划中考虑采用节段特异性的骨密度评估方法。
