Advances in Hounsfield units value for predicting cage subsidence on spinal interbody fusion surgery

• Published in: European spine journal 2023-09, Vol.32 (9), p.3149-3157
• Main Authors: Pu, Xingxiao, Wang, Daxing, Gu, Shao
• Format: Article
• Language: English
• Subjects: Back surgery; Bone surgery; Dual energy X-ray absorptiometry; Medicine; Medicine & Public Health; Neurosurgery; Osteoporosis; Review Article; Subsidence; Surgical Orthopedics; Vertebrae
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-023-07805-2

Purpose A growing number of studies have demonstrated that Hounsfield units (HU) value can effectively assess bone quality and predict cage subsidence (CS) after spinal surgery. The purpose of this review is to provide an overview of the utility of the HU value for predicting CS after spinal surgery and to raise some of the unresolved questions in this field. Methods We searched on PubMed, EMBASE, MEDLINE, and Cochrane Library for studies correlating HU value to CS. Results Thirty-seven studies were included in this review. We found that HU value can predicted the risk of CS effectively after spinal surgery. Moreover, the HU value of the cancellous vertebral body and the cortical endplate were used for predicting CS, in comparison, the measurement method of HU value in the cancellous vertebral body was more standardized, but which region is more important to CS remains unknown. Different cutoff thresholds of HU value have been established in different surgical procedures for predicting CS. The HU value may be superior to dual-energy X-ray absorptiometry (DEXA) for CS prediction; however, the usage standard of HU value has not been well established. Conclusions The HU value shows great potential for predicting CS and constitutes an advantage over DEXA. However, general consensuses about how CS is defined and HU is measured, which part of HU value is more important, and the appropriate cutoff threshold of the HU value for osteoporosis and CS still require exploration.