Regional improvements in lumbosacropelvic Hounsfield units following teriparatide treatment
| Autor: | Pierce A. Peters, Brett A. Freedman, Kurt A. Kennel, Benjamin D. Elder, Ahmad Nassr, Soliman Oushy, Anthony L. Mikula, Patrick M. Flanigan, Paul A. Anderson, Jeremy L. Fogelson, Bradford L. Currier, David W. Polly, Arjun S. Sebastian, Mohamad Bydon |
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| Rok vydání: | 2020 |
| Předmět: |
musculoskeletal diseases
Adult Male Sacrum Osteoporosis 030218 nuclear medicine & medical imaging Cohort Studies 03 medical and health sciences 0302 clinical medicine Ala of sacrum Lumbar Absorptiometry Photon Hounsfield scale Teriparatide Medicine Humans Pelvic Bones Pelvis Aged Retrospective Studies Aged 80 and over Lumbar Vertebrae Bone Density Conservation Agents business.industry General Medicine Middle Aged musculoskeletal system medicine.disease Greater sciatic notch medicine.anatomical_structure Treatment Outcome Surgery Female Neurology (clinical) business Nuclear medicine 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Neurosurgical focus. 49(2) |
| ISSN: | 1092-0684 |
| Popis: | OBJECTIVEOpportunistic Hounsfield unit (HU) determination from CT imaging has been increasingly used to estimate bone mineral density (BMD) in conjunction with assessments from dual energy x-ray absorptiometry (DXA). The authors sought to compare the effect of teriparatide on HUs across different regions in the pelvis, sacrum, and lumbar spine, as a surrogate measure for the effects of teriparatide on lumbosacropelvic instrumentation.METHODSA single-institution retrospective review of patients who had been treated with at least 6 months of teriparatide was performed. All patients had at least baseline DXA as well as pre- and post-teriparatide CT imaging. HUs were measured in the pedicle, lamina, and vertebral body of the lumbar spine, in the sciatic notch, and at the S1 and S2 levels at three different points (ilium, sacral body, and sacral ala).RESULTSForty patients with an average age of 67 years underwent a mean of 20 months of teriparatide therapy. Mean HUs of the lumbar lamina, pedicles, and vertebral body were significantly different from each other before teriparatide treatment: 343 ± 114, 219 ± 89.2, and 111 ± 48.1, respectively (p < 0.001). Mean HUs at the S1 level for the ilium, sacral ala, and sacral body were also significantly different from each other: 124 ± 90.1, −10.7 ± 61.9, and 99.1 ± 72.1, respectively (p < 0.001). The mean HUs at the S2 level for the ilium and sacral body were not significantly different from each other, although the mean HU at the sacral ala (−11.9 ± 52.6) was significantly lower than those at the ilium and sacral body (p = 0.003 and 0.006, respectively). HU improvement occurred in most regions following teriparatide treatment. In the lumbar spine, the mean lamina HU increased from 343 to 400 (p < 0.001), the mean pedicle HU increased from 219 to 242 (p = 0.04), and the mean vertebral body HU increased from 111 to 134 (p < 0.001). There were also significant increases in the S1 sacral body (99.1 to 130, p < 0.05), S1 ilium (124 vs 165, p = 0.01), S1 sacral ala (−10.7 vs 3.68, p = 0.04), and S2 sacral body (168 vs 189, p < 0.05).CONCLUSIONSThere was significant regional variation in lumbar and sacropelvic HUs, with most regions significantly increasing following teriparatide treatment. The sacropelvic area had lower HU values than the lumbar spine, more regional variation, and a higher degree of correlation with BMD as measured on DXA. While teriparatide treatment resulted in HUs > 110 in the majority of the lumbosacral spine, the HUs in the sacral ala remained suggestive of severe osteoporosis, which may limit the effectiveness of fixation in this region. |
| Databáze: | OpenAIRE |
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