Diagnosing the Undiagnosed
| Autor: | Melvin D. Helgeson, Peter M. Formby, Scott C. Wagner, Daniel G. Kang |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
musculoskeletal diseases medicine.medical_specialty medicine.medical_treatment Osteoporosis Population 03 medical and health sciences Absorptiometry Photon 0302 clinical medicine Lumbar Bone Density Hounsfield scale medicine Humans Orthopedics and Sports Medicine education Aged Retrospective Studies 030222 orthopedics education.field_of_study Lumbar Vertebrae business.industry Perioperative Middle Aged medicine.disease Confidence interval Osteopenia Spinal Fusion Spinal fusion Female Neurology (clinical) Radiology Tomography X-Ray Computed business 030217 neurology & neurosurgery |
| Zdroj: | Spine. 41:E1279-E1283 |
| ISSN: | 1528-1159 0362-2436 |
| DOI: | 10.1097/brs.0000000000001612 |
| Popis: | Study design Retrospective analysis. Objective The aim of the study was to report the incidence of undiagnosed osteoporosis in patients undergoing lumbar spine fusion using computed tomography (CT) Hounsfield units (HU). Summary of background data We used a recent technique utilizing HU to estimate bone mineral density (BMD) of the lumbar spine and hypothesized that this technique would reveal a high percentage of undiagnosed osteoporotic patients undergoing transforaminal lumbar interbody fusion (TLIF). Methods We reviewed patients older than 50 years undergoing TLIF from a single-center and multiple surgeons. We determined the mean HU of L4 on axial CT. Average HU values for patients with diagnosed lumbar osteoporosis (DEXA BMD 0.9 g/cm, respectively). The percentage of patients with HU values consistent with osteoporosis, but without any formal evaluation, was also calculated. Results Over 10 years, 143 patients older than 50 years underwent TLIF, and 128 had available perioperative lumbar CT scans. Men and Women comprised 60.2% and 39.8% of the population, respectively. Average age was 61.5 years (range: 50.0-83.5 years). Twenty-nine patients had both dual-energy X-ray absorptiometry and CT data available for analysis. There was a significant association with decreased HU in patients with lumbar BMD less than 0.75 g/cm (105.6 HU, 95% confidence interval [CI] 6.76) in comparison to patients with osteopenia (146.0 HU, 95% CI 4.09) and with normal BMD (165.9, 95% CI 21.35). Ten men (7.8%) and 15 women (11.7%) had HU values consistent with osteoporosis. Sixty-four percent of patients with osteoporotic HU values had never been formally evaluated for the disease. Conclusion HU may be an alternative to screening preoperative dual-energy X-ray absorptiometry scan and can minimize costs and resource utilization. We found a large proportion of patients older than 50 years undergoing TLIF had HU levels consistent with undiagnosed osteoporosis of the lumbar spine. Level of evidence 4. |
| Databáze: | OpenAIRE |
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