Duculan Roland, Fong Alex M, Carrino John A, Cammisa Frank P, Sama Andrew A, Hughes Alexander P, Lebl Darren R, Farmer James C, Huang Russel C, Sandhu Harvinder S, Mancuso Carol A, Girardi Federico P
Hospital for Special Surgery, New York, NY, USA.
Weill Cornell Medicine, New York, NY, USA.
HSS J. 2022 Nov;18(4):469-477. doi: 10.1177/15563316221096675. Epub 2022 Jun 7.
Quantitative computed tomography (qCT) efficiently measures 3-dimensional vertebral bone mineral density (BMD), but its utility in measuring BMD at various vertebral levels in patients with lumbar degenerative spondylolisthesis (LDS) is unclear. : We sought to determine whether qCT could differentiate BMD at different levels of LDS, particularly at L4-L5, the most common single level for LDS. In addition, we sought to describe patterns of BMD for single-level and multiple-level LDS. : We conducted a study of patients undergoing surgery for LDS who were part of a larger longitudinal study comparing preoperative and intraoperative images. Preoperative patients were grouped as single-level or multiple-level LDS, and qCT BMD was obtained for L1-S1 vertebrae. Mean BMD was compared with literature reports; in multivariable analyses, BMD of each vertebra was assessed according to the level of LDS, controlling for covariates and for BMD of other vertebrae. : Of 250 patients (mean age: 67 years, 64% women), 22 had LDS at L3-L4 only, 170 at L4-L5 only, 13 at L5-S1 only, and 45 at multiple levels. Compared with other disorders reported in the literature, BMD in our sample similarly decreased from L1 to L3 then increased from L4 to S1, but mean BMD per vertebra in our sample was lower. Nearly half of our sample met criteria for osteopenia. In multivariable analysis controlling for BMD at other vertebrae, lower L4 BMD was associated with LDS at L4-L5, greater pelvic incidence minus lumbar lordosis, and not having diabetes. In contrast, in similar multivariable analysis, greater L4 BMD was associated with LDS at L3-L4. Bone mineral density of L3 and L5 was not associated with LDS levels. : In our sample of preoperative patients with LDS, we observed lower BMD for LDS than for other lumbar disorders. L4 BMD varied according to the level of LDS after controlling for covariates and BMD of other vertebrae. Given that BMD can be obtained from routine imaging, our findings suggest that qCT data may be useful in the comprehensive assessment of and strategy for LDS surgery. More research is needed to elucidate the cause-effect relationships among spinopelvic alignment, LDS, and BMD.
定量计算机断层扫描（qCT）能有效测量三维椎体骨密度（BMD），但其在测量腰椎退行性椎体滑脱（LDS）患者不同椎体水平骨密度方面的效用尚不清楚。我们试图确定qCT是否能够区分LDS不同水平的骨密度，尤其是在L4-L5，这是LDS最常见的单一水平。此外，我们试图描述单节段和多节段LDS的骨密度模式。我们对接受LDS手术的患者进行了一项研究，这些患者是一项更大的纵向研究的一部分，该研究比较了术前和术中图像。术前患者被分为单节段或多节段LDS，并获取L1-S1椎体的qCT骨密度。将平均骨密度与文献报告进行比较；在多变量分析中，根据LDS水平评估每个椎体的骨密度，同时控制协变量和其他椎体的骨密度。在250例患者（平均年龄：67岁，64%为女性）中，22例仅在L3-L4有LDS，170例仅在L4-L5有LDS，13例仅在L5-S1有LDS，45例为多节段。与文献中报道的其他疾病相比，我们样本中的骨密度同样从L1到L3降低，然后从L4到S1升高，但我们样本中每个椎体的平均骨密度较低。我们样本中近一半符合骨质减少标准。在控制其他椎体骨密度的多变量分析中，较低的L4骨密度与L4-L5的LDS、较大的骨盆倾斜度减去腰椎前凸以及未患糖尿病有关。相比之下，在类似的多变量分析中，较高的L4骨密度与L3-L4的LDS有关。L3和L5的骨密度与LDS水平无关。在我们的术前LDS患者样本中，我们观察到LDS的骨密度低于其他腰椎疾病。在控制协变量和其他椎体骨密度后，L4骨密度根据LDS水平而变化。鉴于可以从常规成像中获得骨密度，我们的研究结果表明qCT数据可能有助于LDS手术的综合评估和策略制定。需要更多研究来阐明脊柱骨盆排列、LDS和骨密度之间的因果关系。
