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Endplate volumetric bone mineral density measured by quantitative computed tomography as a novel predictive measure of severe cage subsidence after standalone lateral lumbar fusion

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Abstract

Purpose

Quantitative computed tomography (QCT) is an alternate imaging method to dual X-ray absorptiometry to measure bone mineral density (BMD). One advantage of QCT is that it allows site-specific volumetric BMD (vBMD) measurements in a small region. In this study, we utilized site-specific, endplate vBMD (EP-vBMD) as a potential predictive marker of severe cage subsidence in standalone lateral lumbar interbody fusion (SA-LLIF) patients and conducted a retrospective comparative study between EP-vBMD and trabecular vBMDs (Tb-vBMD) in the vertebrae.

Methods

Patients undergoing SA-LLIF from 2007 to 2016 were retrospectively reviewed. EP-vBMD was defined as the average of the upper and lower endplate volumetric BMDs measured in cortical and trabecular bone included in a 5-mm area of interest beneath the cage contact surfaces. We compared Tb-vBMDs and EP-vBMDs between disk levels that had severe cage subsidence and levels with no severe subsidence.

Results

Both EP-vBMD and Tb-vBMD could be measured in 210 levels of 96 patients. Severe cage subsidence was observed in 58 levels in 38 patients. Median (IQR) Tb-vBMD was 120.5 mg/cm3 (100.8–153.7) in the non-severe subsidence group and 117.9 mg/cm3 (90.6–149.5) in the severe subsidence group (p = 0.393), whereas EP-vBMD was significantly lower in the severe subsidence group than the non-severe subsidence group (non-severe subsidence 257.4 mg/cm3 (216.3–299.4), severe subsidence 233.5 mg/cm3 (193.4–273.3), p = 0.026).

Conclusion

We introduced a novel site-specific vBMD measurement for cage subsidence risk assessment. Our results showed that EP-vBMD was a reproducible measurement and appeared more predictive for severe cage subsidence after SA-LLIF than Tb-vBMD.

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Funding

No funds were received in support of this work.

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Authors and Affiliations

  1. Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Ichiro Okano, Conor Jones, Stephan N. Salzmann, Marie–Jacqueline Reisener, Oliver C. Sax, Colleen Rentenberger, Jennifer Shue, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi & Alexander P. Hughes

  2. Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    John A. Carrino

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  1. Ichiro Okano
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  2. Conor Jones
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Corresponding author

Correspondence to Alexander P. Hughes.

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Conflict of interest

IO, CJ, MJR, OCS, CR, and JS report that they have no potential conflict of interest. JAC reports consulting fee from Pfizer, Inc., Covera, IAG, Image Biopsy Lab, and Simplify Medical, membership of scientific advisory board/other office of IAG, outside the submitted work. AAS reports royalties from Ortho Development Corp., stock ownership of Paradigm Spine, LLC, Spinal Kinetics, Inc., Vestia Ventures MiRus Investment, LLC, and Integrity Implants, consulting fee from Clariance, Inc., Kuros Biosciences AG, Ortho Development Corp., DePuy Synthes Products, Inc., Medical Device Business Services, Inc., and 4WEB, Inc., membership of scientific advisory board/other office of Clariance, Inc., Kuros Biosciences AG, DePuy Synthes Products, Inc., and Medical Device Business Services, Inc, research support from Spinal Kinetics, Inc., and MiMedx Group, Inc., fellowship support from AOSpine North America, outside the submitted work. FPC reports royalties from NuVasive, Inc., stock ownership of VBVP VI, LLC (originally Centinel Spine), private investments for Spinal Kinetics, Inc., Ivy Healthcare Capital Partners, LLC, ISPH II, LLC, Vertical Spine, LLC, Bonovo Orthopedics, Inc., Viscogliosi Brothers, LLC, Liventa Bioscience (fka AF Cell Medical), Paradigm Spine, LLC, Tissue Differentiation Intelligence, LLC, Woven Orthopedic Technologies, Orthobond Corporation, and Healthpoint Capital Partners, LP, consulting fees from Vertical Spine, LLC, and 4WEB Medical, membership of scientific advisory board/other office of Spinal Kinetics, Inc., Paradigm Spine, LLC, Woven Orthopedic Technologies, Orthobond Corporation, and Healthpoint Capital Partners, LP, research support from 4WEB Medical, NuVasive, Inc., Mallinckrodt Pharmaceuticals, Pfizer, Inc., Spinal Kinetics, Inc., Centinel Spine, Inc. (fka Raymedica, LLC), Beatrice & Samuel A. Seaver Foundation, Paradigm Spine, LLC, 7D Surgical, Inc., Woven Orthopedic Technologies, and Depuy Synthes, outside the submitted work. FPG reports royalties from NuVasive, Inc., Ortho Development Corp, and Zimmer Biomet Holdings, Inc., stock ownership of Bonovo Orthopedics, Inc., Liventa Bioscience (fka AF Cell Medical), Paradigm Spine, LLC, Tissue Differentiation Intelligence, LLC, Alphatec Holdings, LLC, LANX, Inc., Healthpoint Capital Partners, LP, Centinel Spine, Inc. (fka Raymedica, LLC), and Spinal Kinetics, Inc., consulting fee from DePuy Synthes Spine, NuVasive, Inc., EIT Emerging Implant Technologies, Spineart USA, Inc., and Ethicon, Inc., grants from NuVasive, Inc., outside the submitted work. APH reports research support from NuVasive, Inc., 4WEB Medical, and Pfizer, Inc., outside the submitted work.

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Okano, I., Jones, C., Salzmann, S.N. et al. Endplate volumetric bone mineral density measured by quantitative computed tomography as a novel predictive measure of severe cage subsidence after standalone lateral lumbar fusion. Eur Spine J 29, 1131–1140 (2020). https://doi.org/10.1007/s00586-020-06348-0

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