TY - JOUR
T1 - Assessing underlying bone quality in spine surgery patients
T2 - a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives
AU - Pennington, Zach
AU - Ehresman, Jeff
AU - Lubelski, Daniel
AU - Cottrill, Ethan
AU - Schilling, Andrew
AU - Ahmed, A. Karim
AU - Feghali, James
AU - Witham, Timothy F.
AU - Sciubba, Daniel
N1 - Funding Information:
Author disclosures: ZP: Nothing to disclose. JE: Nothing to disclose. DL: Nothing to disclose. EC: Grants: National Institute on Aging, National Institute of Health – F30 grant (F). AS: Nothing to disclose. AKA: Nothing to disclose. JF: Nothing to disclose. TFW: Stock Ownership: Augmedics (B); Consulting: DePuy Synthes (B); Speaking and/or Teaching Arrangements: AO Spine North America (B); Scientific Advisory Board/Other Office: Augmedics (B); Grants: Gordon and Marilyn Macklin Foundation (G), Eli Lilly and Company (C). DMS: Consulting: Baxter Medical (C), DePuy Synthes (D), Ethicon (B), Globus (B), K2M (C), Medical Devices (E), Medtronic (C), NuVasive (B), Stryker (F); Trips/Travel: Baxter (A), DePuy Synthes (B), Globus (B), K2M (B), Medical Devices, Inc (C), Medicrea (B), Medtronic (C), NuVasive (B), Stryker (C), Synthes (C); Grants: Baxter Medical (D), Stryker (E).
Funding Information:
Author disclosures: ZP : Nothing to disclose. JE : Nothing to disclose. DL : Nothing to disclose. EC : Grants: National Institute on Aging, National Institute of Health – F30 grant (F). AS : Nothing to disclose. AKA : Nothing to disclose. JF : Nothing to disclose. TFW : Stock Ownership: Augmedics (B); Consulting: DePuy Synthes (B); Speaking and/or Teaching Arrangements: AO Spine North America (B); Scientific Advisory Board/Other Office: Augmedics (B); Grants: Gordon and Marilyn Macklin Foundation (G), Eli Lilly and Company (C). DMS : Consulting: Baxter Medical (C), DePuy Synthes (D), Ethicon (B), Globus (B), K2M (C), Medical Devices (E), Medtronic (C), NuVasive (B), Stryker (F); Trips/Travel: Baxter (A), DePuy Synthes (B), Globus (B), K2M (B), Medical Devices, Inc (C), Medicrea (B), Medtronic (C), NuVasive (B), Stryker (C), Synthes (C); Grants: Baxter Medical (D), Stryker (E).
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/2
Y1 - 2021/2
N2 - Poor bone quality and low bone mineral density (BMD) have been previously tied to higher rates of postoperative mechanical complications in patients undergoing spinal fusion. These include higher rates of proximal junctional kyphosis, screw pullout, pseudoarthrosis, and interbody subsidence. For these reasons, accurate preoperative assessment of a patient's underlying bone quality is paramount for all elective procedures. Dual-energy X-ray absorptiometry (DXA) is currently considered to be the gold standard for assessing BMD. However, a growing body of research has suggested that in vivo assessments of BMD using DXA are inaccurate and have, at best, moderate correlations to postoperative mechanical complications. Consequently, there have been investigations into using alternative methods for assessing in vivo bone quality, including using computed tomography (CT) and magnetic resonance imaging (MRI) volumes that are commonly obtained as part of surgical evaluation. Here we review the data regarding the accuracy of DXA for the evaluation of spine bone quality and describe the alternative imaging modalities currently under investigation.
AB - Poor bone quality and low bone mineral density (BMD) have been previously tied to higher rates of postoperative mechanical complications in patients undergoing spinal fusion. These include higher rates of proximal junctional kyphosis, screw pullout, pseudoarthrosis, and interbody subsidence. For these reasons, accurate preoperative assessment of a patient's underlying bone quality is paramount for all elective procedures. Dual-energy X-ray absorptiometry (DXA) is currently considered to be the gold standard for assessing BMD. However, a growing body of research has suggested that in vivo assessments of BMD using DXA are inaccurate and have, at best, moderate correlations to postoperative mechanical complications. Consequently, there have been investigations into using alternative methods for assessing in vivo bone quality, including using computed tomography (CT) and magnetic resonance imaging (MRI) volumes that are commonly obtained as part of surgical evaluation. Here we review the data regarding the accuracy of DXA for the evaluation of spine bone quality and describe the alternative imaging modalities currently under investigation.
KW - Bone mineral density
KW - Compression fracture
KW - DXA
KW - Dual-energy X-ray absorptiometry
KW - Osteoporosis
KW - preoperative evaluation
KW - quantitative computed tomography
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U2 - 10.1016/j.spinee.2020.08.020
DO - 10.1016/j.spinee.2020.08.020
M3 - Review article
C2 - 32890786
AN - SCOPUS:85091827923
SN - 1529-9430
VL - 21
SP - 321
EP - 331
JO - Spine Journal
JF - Spine Journal
IS - 2
ER -