Evidence map›Paper›PMID 40758177›Full record

SynthesisEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026

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.

Manjot Singh, Jinho Kim, Joseph Nassar, Andrew Xu, Simbarashe Peresuh, Krish Shah, Michael Farias, Bassel Diebo, Alan Daniels

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

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, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Hounsfield unit threshold to predict lumbar fusion failure: a finite element study.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026
    Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Manjot SinghBrown University, Providence, United States.
Jinho KimBrown University, Providence, United States.
Joseph NassarBrown University, Providence, United States.
Andrew XuBrown University, Providence, United States.
Simbarashe PeresuhBrown University, Providence, United States.
Krish ShahBrown University, Providence, United States.
Michael FariasBrown University, Providence, United States.
Bassel DieboBrown University, Providence, United States.
Alan DanielsBrown University, Providence, United States. alandanielsmd@gmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeComputed tomography-based Hounsfield unit (HU) measurements can be used to evaluate localized bone mineral density preoperatively in spinal fusion patients. While multiple studies have reported HU cutoffs predictive of screw loosening, cage subsidence, proximal junctional kyphosis/failure (PJK/PJF), and other mechanical complications, a standardized validated HU threshold has not been established.

methodsA comprehensive search of PubMed, Scopus, Embase, and Cochrane Library was performed for articles that reported HU measurements in thoracolumbar or lumbar fusion patients with and without postoperative complications. Random-effects meta-analyses were performed to compare mean HU in patients with and without complications. Global threshold was generated through pooled analyses of studies that reported HU cutoffs. This threshold was validated on studies that did not identify any HU cutoff.

resultsAcross 42 studies (6,240 patients), mean age was 61.7 years, 39.0% were males, and mean CCI was 2.4. In total, 36.1% had cage subsidence, 29.4% had screw loosening, 32.9% had PJK/PJF, and 18.0% had other mechanical complications. Meta-analyses revealed that patients with mechanical/junctional complications had 0.8 standard deviations (95%CI = 0.7-1.0, p < 0.01) lower HU than control patients. From the 25 studies (3,103 patients) that reported HU cutoffs, a global threshold of 118 HU (sensitivity = 72.9%, specificity = 63.9%) was established. From the remaining 17 studies (3,137 patients) that did not report HU cutoffs, patients below this threshold had 2.8 times (95%CI = 1.9-4.1, p < 0.01) higher odds of complications than patients above this threshold (sensitivity = 45.8%, specificity = 77.4%).

conclusionIn patients undergoing thoracolumbar or lumbar fusions, preoperative Hounsfield unit values under 118 were associated with a 2.8-fold higher risk of postoperative mechanical and junctional complications. Preoperative surgical planning may utilize this threshold to guide surgical optimization and planning. Specifically, a simple stratification model, with < 120 HU as high risk, 120-150 HU as intermediate risk, and > 150 HU as low risk may facilitate clinical application and promote standardized HU assessments. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Indexed as

Lumbar VertebraePostoperative ComplicationsSpinal FusionThoracic VertebraeTomography, X-Ray ComputedBone DensityHumansComplicationsCutoffHounsfield unitsLumbar fusionSurgical planningThoracolumbar fusionThreshold

Identifiers

PMID40758177

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.