The Pedicles Are Not the Densest Regions of the Lumbar Vertebrae: Implications for Bone Quality Assessment and Surgical Treatment Strategy.
Diagnostic efficacy of Hounsfield units in spine CT for the assessment of real bone mineral density of degenerative spine: correlation study between T-scores determined by DEXA scan and Hounsfield units from CT.
|Journal Title||global spine journal|
|Publication Year Start||2017-01-01|
PMID- 28894687 OWN - NLM STAT- PubMed-not-MEDLINE DA - 20170912 LR - 20170914 IS - 2192-5682 (Print) IS - 2192-5682 (Linking) VI - 7 IP - 6 DP - 2017 Sep TI - The Pedicles Are Not the Densest Regions of the Lumbar Vertebrae: Implications for Bone Quality Assessment and Surgical Treatment Strategy. PG - 567-571 LID - 10.1177/2192568217694141 [doi] AB - STUDY DESIGN: Cadaver study. OBJECTIVE: To determine the bone density of lumbar vertebral anatomic subregions. Bone mineral density (BMD) is a major factor in osseous fixation construct strength. The standard region for implant fixation of the spine is the pedicle; however, other regions may be more viable options with higher bone quality. METHODS: Using computed tomography images, the spine was digitally isolated by applying a filter for adult bone. The spine model was separated into 5 lumbar vertebrae, followed by segmentation of each vertebra into 7 regions and determination of average Hounsfield units (HU). HU was converted to BMD with calibration phantoms of known BMD. RESULTS: Overall mean BMD in vertebral regions ranged from 172 to 393 mg/cm3 with the highest and lowest BMD in the lamina and vertebral body, respectively. Vertebral regions formed 3 distinct groups (P < .03). The vertebral body and transverse processes represent one group with significantly lower BMD than other regions. Spinous process, pedicles, and superior articular processes represent a second group with moderate BMD. Finally, inferior articular process (IAP) and lamina represent a third group with significantly higher BMD than other regions. CONCLUSIONS: Standard lumbar fusion currently uses the vertebral body and pedicles as primary locations for fixation despite their relatively low BMD. Utilization of posterior elements, especially the lamina and IAP, may be advantageous as a supplement to modern constructs or the primary site for fixation, possibly mitigating construct failures due to loosening or pullout. FAU - Hohn, Eric A AU - Hohn EA AD - San Francisco Orthopaedic Residency Program, San Francisco, CA, USA. FAU - Chu, Bryant AU - Chu B AD - The Taylor Collaboration, San Francisco, CA, USA. FAU - Martin, Audrey AU - Martin A AD - The Taylor Collaboration, San Francisco, CA, USA. FAU - Yu, Elizabeth AU - Yu E AD - Ohio State University Wexner Medical Center, Columbus, OH, USA. FAU - Telles, Connor AU - Telles C AD - Sierra Pacific Orthopedics, Fresno, CA, USA. FAU - Leasure, Jeremi AU - Leasure J AD - The Taylor Collaboration, San Francisco, CA, USA. FAU - Lynch, Tennyson L AU - Lynch TL AD - San Francisco Orthopaedic Residency Program, San Francisco, CA, USA. FAU - Kondrashov, Dimitriy AU - Kondrashov D AD - Spine Surgeon, St. Mary's Spine Center, San Francisco, CA, USA. LA - eng PT - Journal Article DEP - 20170411 PL - England TA - Global Spine J JT - Global spine journal JID - 101596156 PMC - PMC5582706 OTO - NOTNLM OT - CT OT - DEXA OT - bone mineral density OT - bone phantoms OT - lamina OT - lumbar spine OT - osteoporosis OT - screw fixation COI - Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Connor Telles is a consultant for Spine Art USA and Misonix Inc. Jeremi Leasure is in association with DePuySynthes, Medtronic, Stryker, Exactech, Spineart, SI-Bone, ConforMIS, Kinamed, Cotera, RJI Orthopaedics, and Neptune Orthopaedics. Dimitriy Kondrashov is in association with AO Foundation, Spineart, SI-Bone, and LifeSpine. EDAT- 2017/09/13 06:00 MHDA- 2017/09/13 06:01 CRDT- 2017/09/13 06:00 AID - 10.1177/2192568217694141 [doi] AID - 10.1177_2192568217694141 [pii] PST - ppublish SO - Global Spine J. 2017 Sep;7(6):567-571. doi: 10.1177/2192568217694141. Epub 2017 Apr 11.