Does Baseline Hounsfield Unit Predict Patients’ Outcomes Following Surgical Management of Unstable Osteoporotic Thoracolumbar Fractures?

Medicina, vol. 61, pp. 227

Abstract

Background and Objectives: Osteoporotic fractures in the thoracic/lumbar spine pose significant challenges in surgical management, with high risks of complications. This study investigates the role of preoperative CT scans and Hounsfield Units (HUs) in predicting postoperative outcomes. Materials and Methods: A retrospective study was conducted from November 2015 to January 2018. Sixty-one patients over 60 years of age with unstable osteoporotic thoracolumbar spine fractures (OF: 3–4) were included. Preoperative CT scans were performed to measure HU values. Postoperative standing X-rays were taken at 3–12 months to assess signs of loosening, adjacent fractures, or screw dislodgement. HU was divided into quartiles: Q1 (<56.24), Q2 (56.24–72.63), Q3 (72.63–87.59), and Q4 (>87.59). Results: Out of the 61 patients, 14 (23%) exhibited signs of screw loosening, adjacent fractures, or screw dislodgement within 3 to 12 months postoperatively. The mean HU value measured was 65.21, with a range from 21.43 to 140.7. Notably, all patients with observed loosening or dislodgement had HU values below 68. HU significantly predicted mortality, with the second quartile showing a markedly increased risk (adjusted odds ratio [aOR] = 8.12; p = 0.044). However, HU quartiles were not significant predictors of other outcomes. Other factors (fracture level and ASA classification) also influenced clinical outcomes, particularly mortality. Conclusions: HU values from preoperative CT scans are crucial in predicting the risk of screw loosening, dislodgement, and adjacent fractures in osteoporotic spinal fractures. Integrating HU assessment into clinical practice can improve preoperative planning, allowing for more targeted surgical interventions and better clinical outcomes.

Authors 10

1. Ahmed Qretam
   Affiliation as printed

   Department of Spine, Neuro- and Orthopedic Surgery, Rhein-Maas Clinic, 52146 Würselen, Germany

2. Julien Ceuterick
   Affiliation as printed

   Department of Spine, Neuro- and Orthopedic Surgery, Rhein-Maas Clinic, 52146 Würselen, Germany

3. Maher A. Ghandour Aachen Department of Orthopedics, Trauma, and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH, 52074 Aachen, Germany

4. Ümit Mert

   Witten/Herdecke University · Helios Universitätsklinikum Wuppertal

   Affiliation as printed

   Department of Trauma and Orthopaedic Surgery, Helios University Hospital Wuppertal, Univeristy of Witten/Herdecke, 42283 Wuppertal, Germany

5. Christian Herren Aachen Department of Orthopedics, Trauma, and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH, 52074 Aachen, Germany

6. Miguel Pishnamaz Aachen Department of Orthopedics, Trauma, and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH, 52074 Aachen, Germany

7. Matthias Knobe

   St. Marien Hospital

   Affiliation as printed

   Departments of Traumatology, St. Marien Hospital Ahaus, 48683 Ahaus, Germany

8. Frank Hildebrand Aachen Department of Orthopedics, Trauma, and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH, 52074 Aachen, Germany

9. Rolf Sobottke
   Affiliation as printed

   Department of Spine, Neuro- and Orthopedic Surgery, Rhein-Maas Clinic, 52146 Würselen, Germany

10. Mohamad Agha Mahmoud corresponding Aachen Department of Orthopedics, Trauma, and Reconstructive Surgery

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH, 52074 Aachen, Germany

    Department of Spine, Neuro- and Orthopedic Surgery, Rhein-Maas Clinic, 52146 Würselen, Germany