SynthesisEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2025
Evaluating the prognostic role of computed tomography Hounsfield units in anticipating spinal outcomes post-instrumentation: a systematic review and meta-analysis.
Synthesis in 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, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
What it found
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled 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
- Risk factors for immediate severe pain in patients with thoracolumbar junction fracture treated with percutaneous pedicle screw fixation: a retrospective study of 598 patients.Journal of orthopaedic surgery and research · 2026Article
- The HBA-3 score: a simple bedside tool to predict cage subsidence after TLIF.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
- Local fragility index and Radiomics-lite modeling of CT-Derived Hounsfield units for osteoporosis risk assessment in spine surgery patients.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
- Simplified sagittal slice HU measurement as a practical alternative to conventional axial HU in opportunistic osteoporosis screening.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
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe use of Hounsfield unit (HU) measurements derived from preoperative computed tomography (CT) scans has emerged as a promising surrogate for assessing bone mineral density (BMD). This systematic review aims to elucidate the role of HU in predicting spinal outcomes in patients undergoing spinal instrumentation.
methodsA comprehensive systematic review of the English-language literature was performed across multiple databases, focusing specifically on adult patients who underwent spinal instrumentation. Adhering to PRISMA guidelines, studies published between 2017 and 2024 that investigated the correlation between HU measurements and spinal outcomes were included. Data extraction and subsequent meta-analysis were conducted utilizing a random effects model. The methodological quality of the included studies was appraised using the Newcastle-Ottawa Scale, and statistical analyses were executed with R software.
resultsA total of thirty-five retrospective studies met the inclusion criteria, encompassing a cohort of 3,927 patients. The reported rates of complications included cage subsidence at 35.5%, pedicle screw loosening at 27.9%, proximal junctional failure at 28.6%, and pseudoarthrosis at 66.7%. Notably, lower HU values were significantly associated with an increased incidence of complications across all studies. The delineated HU cutoff thresholds for predicting specific complications were as follows: 198 HU for lumbar interbody fusion cage subsidence; 116 HU and 126 HU for pedicle screw loosening in lumbar and thoracic spine fusions, respectively; 151 HU for proximal junctional failure in thoracolumbar spinal fusion; and 240-260 HU for pseudoarthrosis following anterior odontoid screw fixation. HU measurements were typically calculated as the mean HU of the vertebrae in the operational segments: cervical (C2-C7), thoracic (T1-T12), lumbar (L1-L4), or sacral (S1).
conclusionThis meta-analysis substantiates a significant correlation between reduced HU values and spinal complications following instrumentation. Specifically, thresholds of below 130 HU for thoracic and lumbar pedicle screw loosening, below 200 HU for lumbar cage subsidence, approximately 150 HU for proximal junctional failure in the thoracolumbar region, and below 260 HU for pseudoarthrosis subsequent to anterior odontoid screw fixation were identified. The mean vertebral HU of the surgical segments serves as a reliable metric for this assessment.
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