Osteoporosis in acute fractures of the cervical spine

The role of opportunistic CT screening

Osa Emohare, Alison Dittmer, Robert A Morgan, Julie A Switzer, David W Polly

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

OBJECT: Recently published data make it possible to generate estimates of bone mineral density (BMD) by using CT attenuation; this innovation can save time and reduce costs. Although advanced age is associated with reduced BMD, especially in patients with a fracture of C-2, relatively few patients ever undergo formal dual x-ray absorptiometry studies. To the authors' knowledge, this is the first study to assess the utility of this technique in elucidating BMD in patients with an acute fracture of the cervical spine. METHODS: Patients who presented to a Level I trauma center with an acute fracture of the cervical spine and underwent abdominal (or L-1) CT scanning either at admission or in the 6 months before or after the injury were evaluated. Using a picture-archiving and communication system, the authors generated regions of interest of similar size in the body of L-1 (excluding the cortex) and computed mean values for CT attenuation. The values derived were compared with threshold values, which differentiate between osteoporotic and nonosteoporotic states; age-stratified groups were also compared. RESULTS: Of the 91 patients whose data were reviewed, 51 were < 65 years old (mean 43.2 years) and 40 were ≥ 65 years old (mean 80.9 years). The overall mean CT attenuation values (in Hounsfield units [HU]), stratified according to age, were 193.85 HU for the younger cohort and 117.39 HU for the older cohort; the result of a comparison between these two values was significant (p < 0.001). CONCLUSIONS: Using opportunistic CT scanning, this study demonstrates the relative frequency of osteoporosis in acute fractures of the cervical spine. It also objectively correlates overall BMD with the known higher frequency of C-2 fractures in older patients. This technique harnesses the presence of opportunistic CT scans of the abdomen, which potentially reduces the need for the extra time and cost that may be associated with dual x-ray absorptiometry scanning.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalJournal of Neurosurgery: Spine
Volume23
Issue number1
DOIs
StatePublished - Jul 1 2015

Fingerprint

Osteoporosis
Spine
Bone Density
X-Rays
Radiology Information Systems
Costs and Cost Analysis
Trauma Centers
Body Size
Abdomen
Age Groups
Wounds and Injuries

Keywords

  • Aging
  • Bone density
  • Bone fractures
  • Cervical spine
  • Degenerative
  • Geriatrics
  • Odontoid process
  • Osteoporosis
  • Spine

Cite this

Osteoporosis in acute fractures of the cervical spine : The role of opportunistic CT screening. / Emohare, Osa; Dittmer, Alison; Morgan, Robert A; Switzer, Julie A; Polly, David W.

In: Journal of Neurosurgery: Spine, Vol. 23, No. 1, 01.07.2015, p. 1-7.

Research output: Contribution to journalArticle

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abstract = "OBJECT: Recently published data make it possible to generate estimates of bone mineral density (BMD) by using CT attenuation; this innovation can save time and reduce costs. Although advanced age is associated with reduced BMD, especially in patients with a fracture of C-2, relatively few patients ever undergo formal dual x-ray absorptiometry studies. To the authors' knowledge, this is the first study to assess the utility of this technique in elucidating BMD in patients with an acute fracture of the cervical spine. METHODS: Patients who presented to a Level I trauma center with an acute fracture of the cervical spine and underwent abdominal (or L-1) CT scanning either at admission or in the 6 months before or after the injury were evaluated. Using a picture-archiving and communication system, the authors generated regions of interest of similar size in the body of L-1 (excluding the cortex) and computed mean values for CT attenuation. The values derived were compared with threshold values, which differentiate between osteoporotic and nonosteoporotic states; age-stratified groups were also compared. RESULTS: Of the 91 patients whose data were reviewed, 51 were < 65 years old (mean 43.2 years) and 40 were ≥ 65 years old (mean 80.9 years). The overall mean CT attenuation values (in Hounsfield units [HU]), stratified according to age, were 193.85 HU for the younger cohort and 117.39 HU for the older cohort; the result of a comparison between these two values was significant (p < 0.001). CONCLUSIONS: Using opportunistic CT scanning, this study demonstrates the relative frequency of osteoporosis in acute fractures of the cervical spine. It also objectively correlates overall BMD with the known higher frequency of C-2 fractures in older patients. This technique harnesses the presence of opportunistic CT scans of the abdomen, which potentially reduces the need for the extra time and cost that may be associated with dual x-ray absorptiometry scanning.",
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