Does the Bone Mineral Density of the Lumbar Spine Correlate With Dual- Energy X- ray Absorptiometry T Score? A Cadaveric- Based Analysis of Computed Tomography Densitometry

Background: Pedicle screw loosening is a complication of spinal instrumentation in osteoporotic patients. Dual-energy x -ray absorptiometry scans are not able to detect variations in bone mineral density (BMD) within specific regions of vertebrae. The purpose of this study was to investigate whether spine T scores correlate with cortical and cancellous BMD of pedicles and other 6 anatomical regions of lumbar spine.Methods: Eleven cadaveric spines with a mean age of 73 years were digitally isolated by applying filters for cortical and cancellous bone on computed tomography images. Eleven L5 vertebrae were separated into 7 anatomical regions of interest using 3-dimensional software modeling. Hounsfield units (HU) were determined for each region and converted to cortical and cancellous BMD with calibration phantoms of known BMD. Correlations between T scores and HU values were calculated using Pearson correlation coefficient.Results: Mean vertebral T score was 0.15. Cortical BMD of pedicles was strongly correlated with T score (R2 = 0.74). There was moderate correlation between T score and cortical BMD of lamina, inferior articular process (IAP), superior articular process (SAP), spinous process, and vertebral body. There was weak correlation between T score and cortical BMD of transverse process (R2 = 0.16). Cancellous BMD of vertebral body was strongly correlated with T score (R2 = 0.82). There was moderate correlation between T score and cancellous BMD of pedicles, spinous process, and transverse process. There was weak correlation between T scores and cancellous BMD of lamina, IAP, and SAP.Conclusions: There is a strong correlation between T scores and cortical BMD of lumbar pedicle. There is strong correlation between T scores and cancellous BMD of vertebral body. Cortical and cancellous BMD of transverse process and lamina were weakly correlated with T score and less affected by osteoporosis.Clinical Relevance: Patients with osteoporosis may especially benefit from the development of extrapedicular fusion strategies due to the relatively higher bone density of these fixation sites.