Hayden A C, Binkley N, Krueger D, Bernatz J T, Kadri A, Anderson P A
University of Wisconsin Osteoporosis Clinical Research Program, Madison, WI, USA.
Department of Orthopedics Surgery and Rehabilitation, University of Wisconsin, UWMF Centennial Bldg, 1685 Highland Ave, 6th floor, Madison, WI, 53705-2281, USA.
Osteoporos Int. 2022 Aug;33(8):1775-1782. doi: 10.1007/s00198-022-06407-w. Epub 2022 May 12.
This study investigated the impact of spinal degeneration on bone mineral density (BMD), trabecular bone score (TBS), and CT Hounsfield units in an at-risk population. We found that BMD was increased by degeneration, whereas TBS and HU were unaffected. These findings support that TBS is not adversely affected by spinal degeneration.
This study evaluated the impact of spinal degeneration on BMD and TBS measured by dual-energy x-ray absorptiometry (DXA) and on CT HU in a spine surgery patient population.
A retrospective study of 63 patients referred for consideration of spine surgery or with history of spine surgery was performed. Patients were included if a DXA scan and a CT containing the lumbar spine were obtained within 18 months of each other. DXA data were collected and analyzed by vertebral level. Individual vertebrae were assessed for degenerative changes by qualitative evaluation of the anterior and posterior elements using CT. Degeneration scores were compared to BMD T-scores, TBS and CT HU at individual vertebral levels L1-4, and after applying International Society for Clinical Densitometry (ISCD) criteria for excluding vertebrae from diagnostic consideration.
Mean patient age and BMI were 67.2 years and 27.8 kg/m, respectively; 79.4% were female. Mean (SD) lowest T-scores of the hip, spine, and lowest overall T-score were - 1.3 (1.4), - 1.7 (0.9), and - 1.9 (1.0), respectively. Osteoporosis was present by T-score in 38% and osteopenia in 52%; 10% had a history of osteoporotic fracture. The mean degeneration score of individual vertebrae was 4.1 on a 0-6 scale. T-score correlated moderately with degeneration score (Spearman's rho 0.484, p < 0.001), whereas TBS and HU were unrelated. ISCD excluded vertebrae had a higher degeneration score than included vertebrae (p = < 0.001).
In a spine surgery population, TBS and CT HU values are unrelated to degeneration score and thus appear unaffected by lumbar vertebral degenerative changes. Additionally, these data support the ISCD criteria for vertebral exclusion.
本研究调查了脊柱退变对高危人群骨密度（BMD）、骨小梁评分（TBS）和CT亨氏单位的影响。我们发现退变会使BMD升高，而TBS和亨氏单位不受影响。这些发现支持TBS不会受到脊柱退变的不利影响。
本研究评估了脊柱退变对脊柱手术患者群体中通过双能X线吸收法（DXA）测量的BMD和TBS以及对CT亨氏单位的影响。
对63例因考虑脊柱手术或有脊柱手术史而转诊的患者进行了一项回顾性研究。如果在彼此18个月内获得了DXA扫描和包含腰椎的CT，则将患者纳入研究。收集DXA数据并按椎体水平进行分析。通过使用CT对椎体前后结构进行定性评估来评估单个椎体的退变情况。将退变评分与L1 - 4单个椎体水平的BMD T值、TBS和CT亨氏单位进行比较，并在应用国际临床骨密度测量学会（ISCD）排除椎体诊断考虑的标准之后进行比较。
患者的平均年龄和BMI分别为67.2岁和27.8kg/m²；79.4%为女性。髋部、脊柱的平均（标准差）最低T值以及总体最低T值分别为-1.3（1.4）、-1.7（0.9）和-1.9（1.0）。根据T值，38%存在骨质疏松，52%存在骨量减少；10%有骨质疏松性骨折病史。单个椎体的平均退变评分为4.1（范围0 - 6）。T值与退变评分中度相关（Spearman等级相关系数0.484，p < 0.001），而TBS和亨氏单位不相关。ISCD排除的椎体退变评分高于纳入的椎体（p = < 0.001）。
在脊柱手术人群中，TBS和CT亨氏单位值与退变评分无关，因此似乎不受腰椎退变变化的影响。此外，这些数据支持ISCD的椎体排除标准。
