ArticleEuropean radiology2023
The preoperative Hounsfield unit value at the position of the future screw insertion is a better predictor of screw loosening than other methods.
Article in European radiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 2 of them syntheses that pooled it.
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Who cites it
52 citing papers in PubMed, 2 syntheses or guidelines pooled it, 68 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
- 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
- Multilevel Lumbar CT Attenuation Beyond L1: Comparison with QCT-Derived Volumetric Bone Mineral Density and Prevalent Fragility Fracture Status in a Diagnostic Referral Cohort.Diagnostics (Basel, Switzerland) · 2026Article
- Computed tomography-derived Hounsfield unit mapping for pedicle screw planning in degenerative lumbar disease: a narrative review.Asian spine journal · 2026Article
- Asymmetric cement distribution in the coronal plane increases the risk of prosthetic loosening following total knee arthroplasty: an in-silico study.BMC surgery · 2026Article
- Single-slice computed tomography-derived pedicle screw trajectory Hounsfield unit values predict screw loosening after lumbar fusion: a retrospective study in Japan.Asian spine journal · 2026Article
- A clinically applicable energy-based approach for evaluating bone strength.Bone & joint research · 2026Article
- Bone density-optimized pedicle screw planning enhances mechanical stability.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
- Disc collapse aggravates vertebral recollapse following percutaneous kyphoplasty: a clinical review and biomechanical study.Quantitative imaging in medicine and surgery · 2026Article
- MRI-based endplate bone quality scoring system in cervical OPLL: a novel measuring method predicting titanium mesh cage subsidence following ACCF.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
- Changes in PFNA nail position do not influence bone healing and femoral head varus in patients with stable intertrochanteric fractures: a comprehensive clinical and biomechanical study.European journal of medical research · 2026Article
- A Novel Nomogram for Predicting Osteoporotic Vertebral Compression Fractures with Hounsfield Unit and Vertebral Bone Quality: A Retrospective Cohort Study.Clinical interventions in aging · 2026Article
- Low-dose CT for assessing microstructural alterations in Renal Osteodystrophy among uremic patients: a retrospective cohort study.American journal of translational research · 2026Article
- Non-Contiguous OVCF Patients Had a Higher Risk of AVF After PVP Operation Related to Poor Bone Mineral Density Rather Than Aggravated Stress Concentration.Clinical interventions in aging · 2026Article
- Single-Side Iatrogenic Pedicle Injury May Trigger an Increased Risk of Contralateral Screw Loosening: An In Silico Study.JOR spine · 2025Article
- Diagnostic Value of Opportunistic CT-Based Bone Density Assessment in Patients with and Without Sacral Insufficiency Fractures.Diagnostics (Basel, Switzerland) · 2025Article
- The clinical impact of MRI-based vertebral bone quality score for assessment of bone quality.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 · 2025Review
- Sagittal-oriented articular processes and intervertebral disc degeneration phenotypes can concurrently lead to an increased presence of annulus tears in the cranial adjacent motion segment : a clinical review and biomechanical simulation.Bone & joint research · 2025Article
- Article
- Endplate morphology affects the risk of complications by changing the grafted bony occupancy rate in OLIF patients.BMC musculoskeletal disorders · 2025Article
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
Abstract
objectiveScrew loosening is a widely reported issue after spinal screw fixation and triggers several complications after lumbar interbody fusion. Osteoporosis is an essential risk factor for screw loosening. Hounsfield units (HU) value is a credible indicator during bone mineral density (BMD) evaluation. As compared with the general evaluation of BMD, we hypothesized that specific measurements of HU at the precise location of the future screw insertion may be a better predictor of screw loosening.
methodsClinical data of 56 patients treated by oblique lumbar interbody fusion (OLIF) of the L4-L5 segments with an anterior lateral single rod (ALSR) screw fixation were reviewed in this study. Vertebral bodies with ≥ 1 mm width radiolucent zones around the screw were defined as screw loosening. HU in the insertional screw positions, the central transverse plane, and the average values of three and four planes were measured. Regression analyses identified independent risk factors for screw loosening separately. The area under the receiver operating characteristic curve (AUC) was computed to evaluate predictive performance.
resultsThe local HU values were significantly lower in the loosening group, regardless of the selected measuring methods. The AUC of screw loosening prediction was higher in the insertional screw positions' HU than other frequently used methods.
conclusionsThe HU value measured in the insertional screw position is a better predictor of ALSR screw loosening than other methods. The risk of screw loosening should be reduced by optimizing the trajectory of the screw based on the measurement of HU in preoperative CT. KEY POINTS: • Osteoporosis is an essential risk factor for screw loosening, and Hounsfield units (HU) are a credible predictor during bone mineral density (BMD) evaluation. • The HU value measured in the insertional screw position is a better predictor of screw loosening than other frequently used HU measurement methods. • The risk of screw loosening might potentially be reduced by optimizing the trajectory of the screw based on the measurement of HU in preoperative CT.
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