Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0044-1793929
Original Article

Bone Mineral Density Distribution in the Posterior Wall of the Lateral Mass Evaluated by Computed Tomography Osteoabsorptiometry

Kazuma Doi 
1   Center for Minimally Invasive Spinal Surgery, Shin Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
,
Nozomu Inoue
2   Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, United States
,
Satoshi Tani
1   Center for Minimally Invasive Spinal Surgery, Shin Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
,
Junichi Mizuno
1   Center for Minimally Invasive Spinal Surgery, Shin Yurigaoka General Hospital, Kawasaki, Kanagawa, Japan
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective Cervical open-door laminoplasty using plates and miniscrews is gaining popularity. One of the complications of this procedure is the loosening or back-out of the miniscrews inserted in the lateral mass (LM). Bone mineral density (BMD) measured by computed tomography (CT) has been used as a predictor of bone strength. However, bone density distribution in the LM remains unclear.

Materials and Methods We investigated bone density distribution in the posterior wall of the LM. A total of 120 LMs were analyzed from the patients who underwent laminoplasty. The distribution of BMD defined by Hounsfield unit (HU) in the posterior wall of the LM was measured by CT osteoabsorptiometry. The posterior wall was divided into nine zones, which consisted of three columns (lateral, center, and medial) and three rows (cranial, center, and caudal). BMD in each zone was averaged and compared by zones and cervical levels.

Results Overall mean ± standard deviation BMD was 1,092 ± 433 HU. Averaged BMD in the entire posterior wall was highest at C4 (1,365 ± 459 HU), second highest at C3 (1,239 ± 435 HU), and lower in the lower levels. BMD in the medial–center zone (1,357 ± 443 HU) was the highest in all zones. BMD in the medial–caudal region at C7 was only 59% of the highest BMD in the medial–center region at C4.

Conclusion The medial–center to the cranial region was most suitable for miniscrew fixation for laminoplasty. These biomechanical findings would be useful in the preoperative planning of laminoplasty especially for the determination of the LM screw entry points and in the design of laminoplasty implants.

Keywords

bone mineral density - lateral mass - osteoabsorptiometry - screw loosening

Ethical Approval

The Institutional Review Board of Shin Yurigaoka General Hospital approved this study (no. 20230227-2). Any patient information was anonymized prior to image acquisition, and the requirement for informed consent was waived due to the nature of this study.




Publication History

Article published online:
19 November 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Liu G, Buchowski JM, Riew KD. Screw back-out following “open-door” cervical laminoplasty: a review of 165 plates. Asian Spine J 2015; 9 (06) 849-854
    CrossrefPubMedGoogle Scholar
  • 2 Anderst WJ, Thorhauer ED, Lee JY, Donaldson WF, Kang JD. Cervical spine bone mineral density as a function of vertebral level and anatomic location. Spine J 2011; 11 (07) 659-667
    CrossrefPubMedGoogle Scholar
  • 3 Müller-Gerbl M, Putz R, Hodapp N, Schulte E, Wimmer B. Computed tomography-osteoabsorptiometry for assessing the density distribution of subchondral bone as a measure of long-term mechanical adaptation in individual joints. Skeletal Radiol 1989; 18 (07) 507-512
    CrossrefPubMedGoogle Scholar
  • 4 Pan CC, Simon P, Espinoza Orías AA. et al. Lumbar facet joint subchondral bone density in low back pain and asymptomatic subjects. Skeletal Radiol 2020; 49 (04) 571-576
    CrossrefPubMedGoogle Scholar
  • 5 Hara T, Ohara Y, Abe E. et al. Cervical endplate bone density distribution measured by CT osteoabsorptiometry and direct comparison with mechanical properties of the endplate. Eur Spine J 2021; 30 (09) 2557-2564
    CrossrefPubMedGoogle Scholar
  • 6 Irie TY, Irie T, Espinoza Orías AA. et al. Three-dimensional distribution of CT attenuation in the lumbar spine pedicle wall. Sci Rep 2021; 11 (01) 1709
    CrossrefPubMedGoogle Scholar
  • 7 Morishita Y, Hida S, Miyazaki M. et al. The effects of the degenerative changes in the functional spinal unit on the kinematics of the cervical spine. Spine 2008; 33 (06) E178-E182
    CrossrefPubMedGoogle Scholar
  • 8 Kim MK, Cho HJ, Kwak DS, You SH. Characteristics of regional bone quality in cervical vertebrae considering BMD: determining a safe trajectory for cervical pedicle screw fixation. J Orthop Res 2018; 36 (01) 217-223
    CrossrefPubMedGoogle Scholar
  • 9 Briski DC, Goel VK, Waddell BS. et al. Does spanning a lateral lumbar interbody cage across the vertebral ring apophysis increase loads required for failure and mitigate endplate violation. Spine 2017; 42 (20) E1158-E1164
    CrossrefPubMedGoogle Scholar
  • 10 Segami K, Espinoza Orías AA, Miyamoto H, Kanzaki K, An HS, Inoue N. Regional distribution of computed tomography attenuation across the lumbar endplate. PLoS One 2021; 16 (10) e0259001
    CrossrefPubMedGoogle Scholar
  • 11 Zavras AG, Dandu N, Espinoza-Orias AA. et al. Computed tomography osteoabsorptiometry evaluation of cervical endplate subchondral bone mineral density. Global Spine J 2023; 13 (07) 1803-1811
    CrossrefPubMedGoogle Scholar
  • 12 Okuyama K, Abe E, Suzuki T, Tamura Y, Chiba M, Sato K. Can insertional torque predict screw loosening and related failures? An in vivo study of pedicle screw fixation augmenting posterior lumbar interbody fusion. Spine 2000; 25 (07) 858-864
    CrossrefPubMedGoogle Scholar
  • 13 Kuklo TR, Lehman Jr RA. Effect of various tapping diameters on insertion of thoracic pedicle screws: a biomechanical analysis. Spine 2003; 28 (18) 2066-2071
    CrossrefPubMedGoogle Scholar
  • 14 Kanematsu R, Hanakita J, Takahashi T, Minami M, Inoue T, Honda F. Risk factor analysis of facet fusion following cervical lateral mass screw fixation with a minimum 1-year follow-up: assessment of maximal insertional screw torque and incidence of loosening. Neurol Med Chir (Tokyo) 2021; 61 (01) 40-46
    CrossrefPubMedGoogle Scholar
  • 15 Heller JG, Estes BT, Zaouali M, Diop A. Biomechanical study of screws in the lateral masses: variables affecting pull-out resistance. J Bone Joint Surg Am 1996; 78 (09) 1315-1321
    CrossrefPubMedGoogle Scholar
  • 16 Hostin RA, Wu C, Perra JH, Polly DW, Akesen B, Wroblewski JM. A biomechanical evaluation of three revision screw strategies for failed lateral mass fixation. Spine 2008; 33 (22) 2415-2421
    CrossrefPubMedGoogle Scholar
  • 17 Heller JG, Silcox III DH, Sutterlin III CE. Complications of posterior cervical plating. Spine 1995; 20 (22) 2442-2448
    CrossrefPubMedGoogle Scholar
  • 18 Chahla J, Liu JN, Manderle B. et al. Bony ingrowth of coil-type open-architecture anchors compared with screw-type PEEK anchors for the medial row in rotator cuff repair: a randomized controlled trial. Arthroscopy 2020; 36 (04) 952-961
    CrossrefPubMedGoogle Scholar
  • 19 Orías AAE, Sheha E, Zavras A. et al. CT osteoabsorptiometry assessment of subchondral bone density predicts intervertebral implant subsidence in a human ACDF cadaver model. Global Spine J 2023; 13 (05) 1374-1383
    CrossrefPubMedGoogle Scholar