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• W4386041736 abstract "BACKGROUND CONTEXT Subsidence after interbody cage placement is a complication that can lead to adverse surgical outcomes such as recurrence of radiculopathy, deformity, and aggravation of axial pain. Recent literature has shown that there is a correlation between bone mineral density (BMD) and risk of subsidence. Hounsfield units (HU) derived from computed tomography (CT) scans have been proposed as a complementary method for assessing BMD outside dual-energy X-ray absorptiometry. PURPOSE The purpose of this study was to 1) determine if HU values are associated with radiographic settling following transforaminal and posterior lumbar interbody fusion (TLIF/PLIF), 2) determine clinically sensitive level-specific HU thresholds for subsidence, 3) evaluate which vertebral level is most predictive for radiographic settling, and 4) identify if there is a difference in radiographic settling between expandable and nonexpandable cages. STUDY DESIGN/SETTING Retrospective analysis. PATIENT SAMPLE Orthopedic spine and neurosurgical patients who underwent single-level TLIF or PLIF from 2007-2022. Exclusion criteria included a nondegenerative diagnosis, inadequate radiographs, multilevel and revision surgery, and postoperative follow-up less than one month. OUTCOME MEASURES L1-S1 HUs, change in segmental lordosis, cage subsidence. METHODS Student's t-tests were used to compare the average HUs between the subsidence and non-subsidence groups. Univariate and multivariate logistic regression analyses were performed to identify the relationships between HU, cage type, and cage subsidence using odds ratio (OR). Receiver operating characteristic (ROC) curves were also utilized to identify the most sensitive and specific HU cutoffs for cage subsidence at each vertebral level. RESULTS A total of 50 patients met inclusion criteria. Average follow-up time was 22.7 months. Eighteen (36%) patients had evidence of radiographic cage subsidence. When comparing both subsidence and non-subsidence groups, there was no difference in average HU at any vertebral level. A univariate logistic regression analysis revealed that HU measured at L1-L5 were significantly associated with cage subsidence (L1<145 HU [OR 3.958, p=0.039], L2<145 HU [OR 3.740, p=0.049], L3<110 [OR 14.4, p=0.02], L4<150 [OR 5.333, p=0.047], and L5<155 [7.071, p=0.033]). Multivariate analysis using L1-S1 HU and fusion level as covariates, HU measured at L1-L3 remained significantly associated with subsidence. ROC curve analysis revealed that a cutoff of 106.9 HU at L1 correlated to 92.6% sensitivity/31.2% specificity for cage subsidence (area under curve [AUC] = 0.692), 94.1 HU at L2 with 92.6%/18.7% (AUC=0.613), 120.4 HU at L3 with 92%/50% (AUC=0.750), 118.5 HU at L4 with 100%/45.5% (AUC=0.747), 109.6 HU at L5 with 93.3%/44.4% (AUC=0.726), and 140.6 HU at S1 with 90.5%/25% (AUC=0.675). Both univariate and multivariate logistic regression analyses showed no difference in subsidence between static and expandable cages. CONCLUSIONS A significant association was found between HU and radiographic subsidence following TLIF/PLIF. Highly sensitive HU thresholds for subsidence were found to be 107 HU at L1, 94 HU at L2, 120 HU at L3, 119 HU at L4, 110 HU at L5, and 141 HU at S1. Measurements taken at the L3 and L4 vertebral levels were overall most predictive and accurate of radiographic settling at the above cut-offs. No difference was found in radiographic settling between expandable and nonexpandable cages. These findings suggest the use of HU derived from CT scans shows promise as a tool to predict risk of cage subsidence and guide clinical decision making. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Subsidence after interbody cage placement is a complication that can lead to adverse surgical outcomes such as recurrence of radiculopathy, deformity, and aggravation of axial pain. Recent literature has shown that there is a correlation between bone mineral density (BMD) and risk of subsidence. Hounsfield units (HU) derived from computed tomography (CT) scans have been proposed as a complementary method for assessing BMD outside dual-energy X-ray absorptiometry. The purpose of this study was to 1) determine if HU values are associated with radiographic settling following transforaminal and posterior lumbar interbody fusion (TLIF/PLIF), 2) determine clinically sensitive level-specific HU thresholds for subsidence, 3) evaluate which vertebral level is most predictive for radiographic settling, and 4) identify if there is a difference in radiographic settling between expandable and nonexpandable cages. Retrospective analysis. Orthopedic spine and neurosurgical patients who underwent single-level TLIF or PLIF from 2007-2022. Exclusion criteria included a nondegenerative diagnosis, inadequate radiographs, multilevel and revision surgery, and postoperative follow-up less than one month. L1-S1 HUs, change in segmental lordosis, cage subsidence. Student's t-tests were used to compare the average HUs between the subsidence and non-subsidence groups. Univariate and multivariate logistic regression analyses were performed to identify the relationships between HU, cage type, and cage subsidence using odds ratio (OR). Receiver operating characteristic (ROC) curves were also utilized to identify the most sensitive and specific HU cutoffs for cage subsidence at each vertebral level. A total of 50 patients met inclusion criteria. Average follow-up time was 22.7 months. Eighteen (36%) patients had evidence of radiographic cage subsidence. When comparing both subsidence and non-subsidence groups, there was no difference in average HU at any vertebral level. A univariate logistic regression analysis revealed that HU measured at L1-L5 were significantly associated with cage subsidence (L1<145 HU [OR 3.958, p=0.039], L2<145 HU [OR 3.740, p=0.049], L3<110 [OR 14.4, p=0.02], L4<150 [OR 5.333, p=0.047], and L5<155 [7.071, p=0.033]). Multivariate analysis using L1-S1 HU and fusion level as covariates, HU measured at L1-L3 remained significantly associated with subsidence. ROC curve analysis revealed that a cutoff of 106.9 HU at L1 correlated to 92.6% sensitivity/31.2% specificity for cage subsidence (area under curve [AUC] = 0.692), 94.1 HU at L2 with 92.6%/18.7% (AUC=0.613), 120.4 HU at L3 with 92%/50% (AUC=0.750), 118.5 HU at L4 with 100%/45.5% (AUC=0.747), 109.6 HU at L5 with 93.3%/44.4% (AUC=0.726), and 140.6 HU at S1 with 90.5%/25% (AUC=0.675). Both univariate and multivariate logistic regression analyses showed no difference in subsidence between static and expandable cages. A significant association was found between HU and radiographic subsidence following TLIF/PLIF. Highly sensitive HU thresholds for subsidence were found to be 107 HU at L1, 94 HU at L2, 120 HU at L3, 119 HU at L4, 110 HU at L5, and 141 HU at S1. Measurements taken at the L3 and L4 vertebral levels were overall most predictive and accurate of radiographic settling at the above cut-offs. No difference was found in radiographic settling between expandable and nonexpandable cages. These findings suggest the use of HU derived from CT scans shows promise as a tool to predict risk of cage subsidence and guide clinical decision making." @default.
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• W4386041736 title "197. Level-specific Hounsfield unit thresholds as a predictor of subsidence following transformational and posterior lumbar interbody fusion" @default.
• W4386041736 doi "https://doi.org/10.1016/j.spinee.2023.06.220" @default.
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