Opportunistic osteoporosis screening in intraoperative CT can accurately identify patients with low volumetric bone mineral density and osteoporosis during spine surgery

被引：0

作者：

Sebastian Rühling ^{[1
]}

Moritz R. Hernandez Petzsche ^{[1
]}

Maximilian T. Löffler ^{[1
]}

Nico Sollmann ^{[2
]}

Thomas Baum ^{[1
]}

Jannis Bodden ^{[3
]}

Julian Schwarting ^{[4
]}

Nicole Lange ^{[1
]}

Kaywan Aftahy ^{[1
]}

Maria Wostrack ^{[1
]}

Claus Zimmer ^{[5
]}

Jan S. Kirschke ^{[5
]}

机构：

[1] Department of Diagnostic and Interventional Neuroradiology, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich

[2] Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau

[3] TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich

[4] Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm

[5] Department of Neurosurgery, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich

来源：

European Spine Journal | 2025年 / 34卷 / 4期

关键词：

Intraoperative volumetric bone mineral density; diagnostic imaging; Opportunistic quantitative computed tomography; Osteoporosis; Spine;

D O I：

10.1007/s00586-025-08697-0

中图分类号：

学科分类号：

摘要：

Purpose: To evaluate the accuracy of opportunistic measurements of volumetric bone mineral density (vBMD) in intraoperative multi-detector CT (MDCT) scans, using preoperative MDCT as the reference. Methods: This retrospective, single-center study included 105 patients (mean age: 73 ± 12.6 years, 53 women) who underwent spine surgery for various indications. All patients had preoperative MDCT with/without intravenous contrast and unenhanced intraoperative scans. VBMD of thoracolumbar vertebrae was automatically extracted using a convolutional neural network (CNN)-based framework with asynchronous calibration and contrast-phase correction. Vertebrae affected by artifacts, fractures, or severe degenerations were excluded. Root-mean-square errors (RMSEs) for associations between pair-wise vertebrae from preoperative and intraoperative vBMD values were calculated in linear regression models. Mean bias and 95%-limits of agreement (LOA) were calculated in Bland-Altman plots. Results: Strong associations between preoperative and intraoperative vBMD values were observed in the thoracic (R2 = 0.94) and lumbar spine (R2 = 0.96). Intraoperative vBMD values showed high accuracy in reference to preoperative measurements with a mean bias of -1.3 mg/cm3 for the thoracic spine (LOA: -18.7 to 16.1 mg/cm3) and − 3.0 mg/cm3 for the lumbar spine (LOA: -17.4 to 11.3 mg/cm3). RMSEs between preoperative and intraoperative vBMD values slightly increased for contrast-enhanced scans (RMSEthoracic: 8.42 vs. 10.1 mg/cm3; RMSElumbar: 7.75 vs. 8.87 mg/cm3). Conclusion: Opportunistic osteoporosis screening with the presented approach is feasible and demonstrates high accuracy in reference to preoperative MDCT scans. This could enable the identification of patients with low bone mass during surgery, allowing surgeons to take measures (e.g., adapted techniques) that prevent postoperative complications and improve patient outcomes. © The Author(s) 2025.

引用

页码：1461 / 1469

页数：8

共 32 条

[1]

Schmidt T., Ebert K., Rolvien T., Et al., A retrospective analysis of bone mineral status in patients requiring spinal surgery, BMC Musculoskelet Disord, 19, (2018)

[2]

Zou D., Jiang S., Zhou S., Et al., Prevalence of osteoporosis in patients undergoing lumbar Fusion for lumbar degenerative diseases: a combination of DXA and Hounsfield units, Spine (Phila Pa 1976), 45, pp. E406-E410, (2020)

[3]

Chin D.K., Park J.Y., Yoon Y.S., Et al., Prevalence of osteoporosis in patients requiring spine surgery: incidence and significance of osteoporosis in spine disease, Osteoporos Int, 18, pp. 1219-1224, (2007)

[4]

Loffler M.T., Sollmann N., Burian E., Et al., Opportunistic osteoporosis screening reveals low bone density in patients with screw loosening after lumbar semi-rigid instrumentation: a case-control study, Front Endocrinol (Lausanne), 11, (2020)

[5]

Bjerke B.T., Zarrabian M., Aleem I.S., Et al., Incidence of osteoporosis-related complications following posterior lumbar Fusion, Glob Spine J, 8, pp. 563-569, (2018)

[6]

O'Leary P.T., Bridwell K.H., Lenke L.G., Et al., Risk factors and outcomes for catastrophic failures at the top of long pedicle screw constructs: a matched cohort analysis performed at a single center, Spine (Phila Pa 1976), 34, pp. 2134-2139, (2009)

[7]

Rometsch E., Spruit M., Zigler J.E., Et al., Screw-related complications after instrumentation of the osteoporotic spine: a systematic literature review with Meta-analysis, Glob Spine J, 10, pp. 69-88, (2020)

[8]

Elder B.D., Lo S.F.L., Holmes C., Et al., The biomechanics of pedicle screw augmentation with cement, pp. 1432-1445, (2015)

[9]

Wagner A., Haag E., Joerger A.K., Et al., Cement-augmented Carbon Fiber–Reinforced Pedicle Screw Instrumentation for spinal metastases: Safety and Efficacy, World Neurosurg, 154, pp. e536-e546, (2021)

[10]

Krappinger D., Kastenberger T.J., Schmid R., Die Behandlung osteoporotischer Wirbelkörperfrakturen Mit Augmentierter Instrumentation, Oper Orthop Traumatol, 24, pp. 4-12, (2012)

← 1 2 3 4 →