SynthesisJournal of orthopaedic surgery and research2025
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.
Synthesis in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Article
- Quantitative CT-Derived Volumetric Bone Mineral Density Threshold for Predicting Cage Subsidence After Oblique Lumbar Interbody Fusion.Tomography (Ann Arbor, Mich.) · 2026Article
- Diagnostic performance of lumbar computed tomography Hounsfield unit thresholds for osteoporosis and osteopenia: 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 · 2026Review
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5 authors.
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Abstract
backgroundCage subsidence is the most common hardware-related complication of spinal fusion, often associated with suboptimal outcomes. Poor vertebral bone quality has repeatedly been suggested as a key risk factor. Therefore, we aim to evaluate and compare the predictive value of indirect bone quality metrics, Hounsfield units and vertebral bone quality (VBQ) scores, for cage subsidence following spinal fusion.
methodsStandard medical databases were searched to identify studies comparing HU or VBQ scores between patients with and without subsidence. Standard mean differences (SMD), diagnostic odds ratios (DOR), sensitivity, specificity, and area under the curve (AUC) were pooled. Meta-regression was performed to assess the influence of covariates.
resultsA total of 28 studies with 3,729 patients were included. Patients with subsidence had significantly lower HU (SMD: -1.22; 95% CI: [-1.5, -0.95], Z = 8.82, P < 0.001) and higher VBQ scores (SMD: 1.14; 95% CI: [0.91, 1.37], P < 0.001). Pooled diagnostic performance was high for both HU (AUC: 0.88, DOR: 19.3) and VBQ (AUC: 0.84, DOR: 14.8). Sensitivity and specificity were comparable and exceeded 79% for both metrics. Meta-regression identified no significant effect modifiers in multivariate models.
conclusionBoth HU and VBQ scores demonstrate strong and comparable diagnostic accuracy for predicting cage subsidence. While HU seemed to exhibit slight superiority, VBQ provides a radiation-free, cost-effective alternative with comparable performance. Incorporating these metrics into preoperative planning may improve risk stratification and guide surgical planning in spinal fusion.
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