ArticleFrontiers in endocrinology2020
Opportunistic Osteoporosis Screening Reveals Low Bone Density in Patients With Screw Loosening After Lumbar Semi-Rigid Instrumentation: A Case-Control Study.
Article in Frontiers in endocrinology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
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Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.
- CT image-based biomarkers for opportunistic screening of osteoporotic fractures: a systematic review and meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Pooled it
- Multimodal model predicts screw loosening at user-specified postoperative time points after single-level lumbar interbody fusion.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Review
- A comprehensive review of biomechanical factors influencing pedicle screw fixation strength and the critical role of artificial intelligence.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Radiological evaluation and complications of percutaneous vertebroplasty and fenestrated pedicle screw fixation with bone cement augmentation: propensity-score matched cohort study.BMC musculoskeletal disorders · 2026Article
- Interbody cage subsidence after ACDF: a predictor of non-union and neck pain despite normal bone mineral density.Neurosurgical review · 2026Article
- Laminectomy aloneWorld journal of orthopedics · 2026Review
- SBMC surgery · 2026Article
- Simulated low-dose multi-detector computed tomography: spatial effects on surrogate parameters of bone strength at the proximal femur.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Prediction of screw loosening by measuring the insertion torque in non-osteoporotic patients: an in vitro study.BMC musculoskeletal disorders · 2025Article
- Opportunistic osteoporosis screening in intraoperative CT can accurately identify patients with low volumetric bone mineral density and osteoporosis during spine surgery.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- Undetected low bone mineral density in patients undergoing lumbar fusion surgery-prevalence and risk factors.North American Spine Society journal · 2025Article
- Cervicothoracic volumetric bone mineral density assessed by opportunistic QCT may be a reliable marker for osteoporosis in adults.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- The influence of osteoporosis on mechanical complications in lumbar fusion surgery: a systematic review.North American Spine Society journal · 2024Review
- Systematic Review and Meta-Analysis of the Effect of Osteoporosis on Reoperation Rates and Complications after Surgical Management of Lumbar Degenerative Disease.Journal of bone metabolism · 2024Article
- Automated Opportunistic Trabecular Volumetric Bone Mineral Density Extraction Outperforms Manual Measurements for the Prediction of Vertebral Fractures in Routine CT.Diagnostics (Basel, Switzerland) · 2023Article
- Systematic Literature Review and Meta-Analysis on the Clinical Outcomes of Spine Surgeries in Patients with Concurrent Osteoporosis.Spine surgery and related research · 2023Review
- Computed Tomography-Based Prediction of Lumbar Pedicle Screw Loosening.BioMed research international · 2023Article
- Quantitative CT for Preoperative Assessment of Lumbar Degenerative Spondylolisthesis: The Unique Impact of L4 Bone Mineral Density on Single-Level Disease.HSS journal : the musculoskeletal journal of Hospital for Special Surgery · 2022Article
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Authors and funding
9 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Objective: Decreased bone mineral density (BMD) impairs screw purchase in trabecular bone and can cause screw loosening following spinal instrumentation. Existing computed tomography (CT) scans could be used for opportunistic osteoporosis screening for decreased BMD. Purpose of this case-control study was to investigate the association of opportunistically assessed BMD with the outcome after spinal surgery with semi-rigid instrumentation for lumbar degenerative instability. Methods: We reviewed consecutive patients that had primary surgery with semi-rigid instrumentation in our hospital. Patients that showed screw loosening in follow-up imaging qualified as cases. Patients that did not show screw loosening or-if no follow-up imaging was available (n = 8)-reported benefit from surgery ≥ 6 months after primary surgery qualified as controls. Matching criteria were sex, age, and surgical construct. Opportunistic BMD screening was performed at L1 to L4 in perioperative CT scans by automatic spine segmentation and using asynchronous calibration. Processing steps of this deep learning-driven approach can be reproduced using the freely available online-tool Anduin (https://anduin.bonescreen.de). Area under the curve (AUC) was calculated for BMD as a predictor of screw loosening. Results: Forty-six elderly patients (69.9 ± 9.1 years)-23 cases and 23 controls-were included. The majority of surgeries involved three spinal motion segments (n = 34). Twenty patients had low bone mass and 13 had osteoporotic BMD. Cases had significantly lower mean BMD (86.5 ± 29.5 mg/cm³) compared to controls (118.2 ± 32.9 mg/cm³, p = 0.001), i.e. patients with screw loosening showed reduced BMD. Screw loosening was best predicted by a BMD < 81.8 mg/cm³ (sensitivity = 91.3%, specificity = 56.5%, AUC = 0.769, p = 0.002). Conclusion: Prevalence of osteoporosis or low bone mass (BMD ≤ 120 mg/cm³) was relatively high in this group of elderly patients undergoing spinal surgery. Screw loosening was associated with BMD close to the threshold for osteoporosis (< 80 mg/cm³). Opportunistic BMD screening is feasible using the presented approach and can guide the surgeon to take measures to prevent screw loosening and to increase favorable outcomes.
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