ArticleBMC musculoskeletal disorders2022
The value of Hounsfield units in predicting cage subsidence after transforaminal lumbar interbody fusion.
Article in BMC musculoskeletal disorders, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 6 of them syntheses that pooled it.
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Who cites it
22 citing papers in PubMed, 6 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- Generation and validation of a Hounsfield unit (HU) threshold for predicting mechanical and junctional complications following thoracolumbar or lumbar fusion: a systematic review and meta-analysis.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 · 2026Pooled it
- Preoperative CT-derived Hounsfield unit values and mechanical complications after thoracolumbar or lumbar instrumented fusion: a systematic review and meta-analysis.Frontiers in surgery · 2026Pooled it
- Comparing the predictive value of CT-derived hounsfield units and MRI-derived bone quality scores for cage subsidence following spinal fusion: a systematic review and meta-analysis.Journal of orthopaedic surgery and research · 2025Pooled it
- Accuracy of CT hounsfield units for predicting cage subsidence and pedicle screw loosening after lumbar interbody fusion: a systematic review and meta-analysis.Neurosurgical review · 2025Pooled it
- Evaluating the prognostic role of computed tomography Hounsfield units in anticipating spinal outcomes post-instrumentation: a systematic review and meta-analysis.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 · 2025Pooled it
- Comparison of instrumented and stand-alone lateral lumbar interbody fusion for lumbar degenerative disease: a systematic review and meta-analysis.BMC musculoskeletal disorders · 2024Pooled it
- Article
- Postoperative bone loss after posterior lumbar interbody fusion is a risk factor of cage subsidence independently of preoperative CT-derived attenuation: a retrospective study based on hounsfield unit.BMC musculoskeletal disorders · 2026Article
- Preoperative imaging predictors of subsidence of 3D-printed artificial cervical vertebral bodies: a cohort study of 102 patients with nomogram development and validation.BMC musculoskeletal disorders · 2026Article
- The Role of Serum Albumin as a Prognostic Marker in Guillain-Barré Syndrome: A Systematic Review.Journal of inflammation research · 2026Review
- Does adding an interbody cage in L4-L5 posterolateral fusion for degenerative spondylolisthesis and stenosis improve clinical outcome?Brain & spine · 2026Article
- Answer to the letter to the editor of J. Deng, et al. concerning "impact of nonunion on patient-related outcomes after single level minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: a propensity score-matched analysis" by Yamamoto T, et al. (Eur spine J [2025]; doi: 10.1007/s00586-025-09296-9).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
- Article
- Is the size of the transforaminal lumbar cage a risk factor for cage subsidence? a retrospective cohort study.Neurosurgical review · 2025Article
- Modeling and construction of nomogram of cage subsidence after single-segment transforaminal lumbar interbody fusions.Journal of orthopaedic surgery and research · 2025Article
- Opportunistic Hounsfield units measurements on computed tomography scans can predict the number of prevalent vertebral compression fractures in older adults.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
- Low bone mineral density: a primer for the spine surgeon.Spine deformity · 2024Review
- Are the facet joint parameters risk factors for cage subsidence after TLIF in patients with lumbar degenerative spondylolisthesis?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 · 2024Article
- The influence of osteoporosis on mechanical complications in lumbar fusion surgery: a systematic review.North American Spine Society journal · 2024Review
- Hounsfield unit for assessing bone mineral density distribution within lumbar vertebrae and its clinical values.Frontiers in endocrinology · 2024Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCage subsidence may occur following transforaminal lumbar interbody fusion (TLIF) and lead to nonunion, foraminal height loss and other complications. Low bone quality may be a risk factor for cage subsidence. Assessing bone quality through Hounsfield units (HU) from computed tomography has been proposed in recent years. However, there is a lack of literature evaluating the correlation between HU and cage subsidence after TLIF.
methodsTwo hundred and seventy-nine patients suffering from lumbar degenerative diseases from April, 2016 to August, 2018 were enrolled. All underwent one-level TLIF with a minimum of 1-year follow-up. Cage subsidence was defined as > 2 mm loss of disc height at the fusion level. The participants were divided into 2 groups: cage subsidence group (CS) and non-cage subsidence group (non-CS). Bone quality was determined by HU, bone mineral density of lumbar (BMD-l) and femoral (BMD-f) from dual-emission X-ray absorptiometry (DXA). HU of each vertebra from L1 to L4 (e.g., HU1 for HU of L1) and mean value of the four vertebrae (HUm) were calculated. Visual analog scale (VAS) of back/leg pain and Oswestry disability index (ODI) were used to report clinical outcomes.
resultsCage subsidence occurred in 82 (29.4%) cases at follow-ups. Mean age was 50.8 ± 9.0 years with a median follow-up of 18 months (range from 12 to 40 months). A total of 90.3% patients presented fusion with similar fusion rate between the two groups. ODI and VAS in leg were better in non-CS group at last follow-ups. Using receiver operating characteristic curves (ROCs) to predict cage subsidence, HUm provided a larger area under the curve (AUC) than BMD-l (Z = 3.83, P < 0.01) and BMD-f (Z = 2.01, P = 0.02). AUC for HU4 was larger than BMD-f and close to HUm (Z = 0.22, P = 0.481).
conclusionsCage subsidence may indicate worse clinical outcomes. HU value could be a more effective predictor of lumbar cage subsidence compared with T-score of DXA after TLIF.
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