Assessing underlying bone quality in spine surgery patients: a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives

Zach Pennington, Jeff Ehresman, Daniel Lubelski, Ethan Cottrill, Andrew Schilling, A. Karim Ahmed, James Feghali, Timothy F. Witham, Daniel M. Sciubba

Research output: Contribution to journalReview articlepeer-review

Abstract

Poor bone quality and low bone mineral density (BMD) have been previously tied to higher rates of postoperative mechanical complications in patients undergoing spinal fusion. These include higher rates of proximal junctional kyphosis, screw pullout, pseudoarthrosis, and interbody subsidence. For these reasons, accurate preoperative assessment of a patient's underlying bone quality is paramount for all elective procedures. Dual-energy X-ray absorptiometry (DXA) is currently considered to be the gold standard for assessing BMD. However, a growing body of research has suggested that in vivo assessments of BMD using DXA are inaccurate and have, at best, moderate correlations to postoperative mechanical complications. Consequently, there have been investigations into using alternative methods for assessing in vivo bone quality, including using computed tomography (CT) and magnetic resonance imaging (MRI) volumes that are commonly obtained as part of surgical evaluation. Here we review the data regarding the accuracy of DXA for the evaluation of spine bone quality and describe the alternative imaging modalities currently under investigation.

Original languageEnglish (US)
Pages (from-to)321-331
Number of pages11
JournalSpine Journal
Volume21
Issue number2
DOIs
StatePublished - Feb 2021

Keywords

  • Bone mineral density
  • Compression fracture
  • DXA
  • Dual-energy X-ray absorptiometry
  • Osteoporosis
  • preoperative evaluation
  • quantitative computed tomography

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Assessing underlying bone quality in spine surgery patients: a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives'. Together they form a unique fingerprint.

Cite this