SynthesisFrontiers in surgery2026
Preoperative CT-derived Hounsfield unit values and mechanical complications after thoracolumbar or lumbar instrumented fusion: a systematic review and meta-analysis.
Synthesis in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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6 authors.
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Abstract
Background/objectives: Mechanical complications after thoracolumbar or lumbar instrumented fusion remain a major concern, especially in patients with poor bone quality. CT-derived Hounsfield unit (HU) values may offer an accessible marker of local bone strength, but the evidence is inconsistent. We evaluated its association with postoperative mechanical complications. Methods: PubMed, Embase, Web of Science, Scopus, the Cochrane Library, and Google Scholar were searched for studies of adults undergoing instrumented fusion reporting HU and postoperative mechanical outcomes. The primary outcome was overall mechanical complications. Random-effects models were used; continuous per-HU odds ratios, dichotomous low-versus-high estimates, and hazard ratios were analyzed separately. Results: Thirty-five retrospective studies were included. In twelve reporting an adjusted per-HU odds ratio, each one-unit increase carried lower odds of mechanical complications (OR 0.983; 95% CI, 0.978-0.989; Conclusions: Lower preoperative HU is associated with a higher risk of postoperative mechanical complications. The per-unit association was small but significant; low-versus-high comparisons were directionally consistent but rested on disparate thresholds and were not combined. HU is best used as an opportunistic marker that prompts further bone-health evaluation and individualized planning, rather than as a validated risk-stratification tool, a fixed per-unit estimate, or a universal threshold. Standardized HU measurement, consistent outcome definitions, and prospective validation are needed. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261376259, PROSPERO, CRD420261376259.
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