title: Vertebral body Hounsfield units as a predictor of incidental durotomy in primary lumbar spinal surgery.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To assess the association between vertebral body Hounsfield unit (HU) measurements on quantitative computed tomography and the risk for incidental durotomy (ID).
  
  
  BACKGROUND
  ID during spine surgery has been associated with adverse postoperative sequelae that may require prolonged hospital stay and reoperation. Previously identified independent risk factors include age, revision surgery, and lumbar surgery.
  
  
  METHODS
  ID was prospectively documented in spine surgery patients at a single institution during a 2-year period (incidence: 4%, 191/4,822). Patients with ID were matched 1:1 to a control cohort without ID based on age and sex. Inclusion criteria for both cohorts were primary lumbar surgery and quantitative computed tomographic scans within 1 year of date of surgery. Demographic, radiographical, and intraoperative data, along with dual x-ray absorptiometry t scores, were collected and analyzed.
  
  
  RESULTS
  A total of 71 patients with ID met the inclusion criteria (38 male, 33 female). Average age of patients with ID was 63.8 ± 12.9 years (range: 34-85 yr). Computed tomographic scans were acquired 1.5 ± 2.2 months away from date of surgery (range: 0-12 mo). Inter-rater reliability for HU measurements between a fellowship-trained spine surgeon and a research fellow was strong (r = 0.901, P < 0.001). HU values were significantly lower in patients with ID than controls (149.2 ± 60.7 [range: 44.5-301.5] versus 177.0 ± 81.4, [range: 62.0-524.0], respectively; P = 0.023). The area under the receiver operating characteristic curve was 0.603 (P = 0.034). A threshold of 169 HU optimized sensitivity (0.718) and specificity (0.451), and patients with HU value 169 or less were found to be at increased risk for ID (odds ratio: 2.092, 95% confidence interval: 1.042-4.201, P = 0.037).
  
  
  CONCLUSIONS
  Lower HU value is an accessible clinical marker for increased risk of ID. A threshold value of HU was defined (≤169) that may be used clinically to identify patients at elevated risk for ID, which may improve the informed decision making process prior to spinal surgery.
  
  
  METHODS
  3.
authors: From the Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York City, NY.
authors: Jerry Y
authors: JY
authors: Du
authors: Alexander
authors: A
authors: Aichmair
authors: Haruki
authors: H
authors: Ueda
authors: Federico P
authors: FP
authors: Girardi
authors: Frank P
authors: FP
authors: Cammisa
authors: Darren R
authors: DR
authors: Lebl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004388:Dura Mater / Q000293:injuries* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies