In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • CT Hounsfield Units as a Predictor for the Worsening of Traumatic Vertebral Compression Fractures

    Final Number:

    Ha Nguyen MD; Hesham M. Soliman MD; Mohit Patel; Luyuan Li; Shekar N. Kurpad MD PhD; Dennis J. Maiman MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: With vertebral compression fractures (VCF), the height loss has been associated with kyphotic deformity and intractable pain—two indications for potential surgical intervention. Consequently, assessment of factors associated with continual height loss can provide insights regarding management. Computed tomography Hounsfield units (CT HU), a measure of radio-density, has been implicated for the assessment of bone quality. No studies have assessed the relationship between CT HU and traumatic VCF. Consequently, the objective of this study was to evaluate this relationship, with the hypothesis that lower CT HU is associated with progressive worsening of traumatic VCF.

    Methods: Patients who sustained a traumatic VCF from a motor vehicle accident from 2006 to 2015 were reviewed retrospectively. Inclusion criteria were single VCF from L1 to L4, appropriate imaging, and appropriate follow up. Clinical data was extracted [age, gender, and body mass index (BMI), length of follow up]. Initial CT imaging was evaluated for averaged HU at the levels above and below the index level of the VCF. Interval percentage change (IPC) in anterior compression was evaluated between x rays obtained during initial presentation and at follow-up.

    Results: Age, BMI, and CT HU values significantly correlated to IPC (p < 0.01) while initial height loss and length of follow up did not. A multiple linear regression for IPC that combined age, BMI, and CT HU values elicited a regression model with R2 0.648, and adjusted R2 0.606; each variable in the model exhibited p < 0.05.

    Conclusions: Based on this study, age, BMI, and CT HU values significantly correlated with worsening VCF and are independent predictors of worsening VCF. These factors can help determine appropriate clinical follow-up and need for surgical intervention.

    Patient Care: Provide another predictor for progression of vertebral compression fractures that can help clinical management

    Learning Objectives: 1) Evaluate the utility of CT HU values 2) Understand the predictors for worsening of vertebral compression fractures

    References: [1] Atalay B, Caner H, Gokce C, Altinors N. Kyphoplasty: 2 years of experience in a neurosurgery department. Surgical neurology 2005;64 Suppl 2:S72-6. [2] Cankaya D, Yilmaz S, Deveci A, Dundar A, Yoldas B, Toprak A, Tabak Y. Clinical and radiological outcomes of conservative treatment after stable post-traumatic thoracolumbar fractures in elderly: Is it really best option for all elderly patients? Annals of medicine and surgery (2012) 2015;4(4):346-50. [3] Cao J, Kong L, Meng F, Zhang Y, Shen Y. Risk factors for new vertebral compression fractures after vertebroplasty: a meta-analysis. ANZ journal of surgery 2016. [4] DeWald CJ, Stanley T. Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality. Spine 2006;31(19 Suppl):S144-51. [5] Hwee Weng DH, Jun HT, Chuen ST, Ming BT, Huh BL, Hwan TH. Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine: Does it Correlate With Level-specific Bone Mineral Density Scores? Spine 2015;40(24):1903-9. [6] Julka A, Tolhurst SR, Srinivasan RC, Graziano GP. Functional outcomes and height restoration for patients with multiple myeloma-related osteolytic vertebral compression fractures treated with kyphoplasty. Journal of spinal disorders & techniques 2014;27(6):342-6. [7] Jun DS, Shin WJ, An BK, Paik JW, Park MH. The Relationship between the Progression of Kyphosis in Stable Thoracolumbar Fractures and Magnetic Resonance Imaging Findings. Asian spine journal 2015;9(2):170-7. [8] Kong LD, Wang P, Wang LF, Shen Y, Shang ZK, Meng LC. Comparison of vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures with intravertebral clefts. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 2014;24 Suppl 1:S201-8. [9] Ma X, Xing D, Ma J, Wang J, Chen Y, Xu W, Yang Y, Ma B, Zhu S. Risk factors for new vertebral compression fractures after percutaneous vertebroplasty: qualitative evidence synthesized from a systematic review. Spine 2013;38(12):E713-22. [10] Maestretti G, Cremer C, Otten P, Jakob RP. Prospective study of standalone balloon kyphoplasty with calcium phosphate cement augmentation in traumatic fractures. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2007;16(5):601-10. [11] Meredith DS, Schreiber JJ, Taher F, Cammisa FP, Jr., Girardi FP. Lower preoperative Hounsfield unit measurements are associated with adjacent segment fracture after spinal fusion. Spine 2013;38(5):415-8. [12] Nguyen HS, Shabani S, Patel M, Maiman D. Posterolateral lumbar fusion: Relationship between computed tomography Hounsfield units and symptomatic pseudoarthrosis. Surgical neurology international 2015;6(Suppl 24):S611-4. [13] Patil S, Nene AM. Predictors of kyphotic deformity in osteoporotic vertebral compression fractures: a radiological study. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2014;23(12):2737-42. [14] Ruosi C, Liccardo S, Rubino M, Colella G, Di Somma C, Colao A. Importance of spinal deformity index in risk evaluation of VCF (vertebral compression fractures) in obese subjects: prospective study. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2013;22 Suppl 6:S945-9. [15] Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. The Journal of bone and joint surgery. American volume 2011;93(11):1057-63. [16] Schreiber JJ, Hughes AP, Taher F, Girardi FP. An association can be found between hounsfield units and success of lumbar spine fusion. HSS journal : the musculoskeletal journal of Hospital for Special Surgery 2014;10(1):25-9. [17] Stadhouder A, Buskens E, Vergroesen DA, Fidler MW, de Nies F, Oner FC. Nonoperative treatment of thoracic and lumbar spine fractures: a prospective randomized study of different treatment options. Journal of orthopaedic trauma 2009;23(8):588-94. [18] Suh SP, Kim CW, Jo YH, Kang CN. Height Restoration after Balloon Kyphoplasty in Rheumatoid Patients with Osteoporotic Vertebral Compression Fracture. Asian spine journal 2015;9(4):581-6. [19] Sun G, Tang H, Li M, Liu X, Jin P, Li L. Analysis of risk factors of subsequent fractures after vertebroplasty. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2014;23(6):1339-45. [20] Tang H, Zhao JD, Li Y, Chen H, Jia P, Chan KM, Li G. Efficacy of percutaneous kyphoplasty in treating osteoporotic multithoracolumbar vertebral compression fractures. Orthopedics 2010;33(12):885. [21] Tatsumi RL, Ching AC, Byrd GD, Hiratzka JR, Threlkeld JE, Hart RA. Predictors and prevalence of patients undergoing additional kyphoplasty procedures after an initial kyphoplasty procedure. The spine journal : official journal of the North American Spine Society 2010;10(11):979-86. [22] Teyssedou S, Saget M, Prebet R, Leclercq N, Vendeuvre T, Pries P. Evaluation of percutaneous surgery in the treatment of thoracolumbar fractures. Preliminary results of a prospective study on 65 patients. Orthopaedics & traumatology, surgery & research : OTSR 2012;98(1):39-47. [23] Tolba R, Bolash RB, Shroll J, Costandi S, Dalton JE, Sanghvi C, Mekhail N. Kyphoplasty increases vertebral height, decreases both pain score and opiate requirements while improving functional status. Pain practice : the official journal of World Institute of Pain 2014;14(3):E91-7. [24] Toyone T, Toyone T, Tanaka T, Wada Y, Kamikawa K, Ito M, Kimura K, Yamasita T, Matsushita S, Shiboi R, Kato D, Kaneyama R, Otsuka M. Changes in vertebral wedging rate between supine and standing position and its association with back pain: a prospective study in patients with osteoporotic vertebral compression fractures. Spine 2006;31(25):2963-6. [25] Young C, Munk PL, Heran MK, Lane MD, Le HB, Lee S, Badii M, Clarkson PW, Ouellette HA. Treatment of severe vertebral body compression fractures with percutaneous vertebroplasty. Skeletal radiology 2011;40(12):1531-6.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy