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„Hounsfield units“ als Maß für die Knochendichte – Anwendungsmöglichkeiten in der Wirbelsäulenchirurgie

Hounsfield units as a measure of bone density—applications in spine surgery

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Zusammenfassung

Trotz der heutigen guten diagnostischen und therapeutischen Möglichkeiten ist die Dunkelziffer der an Osteoporose erkrankten Patienten weiterhin sehr hoch und die Therapie folglich meist unzureichend. Häufig wird die Diagnose erst nach Auftreten einer Fraktur gestellt. Ursächlich hierfür ist sicherlich neben den anfallenden Kosten wie auch der zusätzlichen Strahlenexposition die nur eingeschränkte Verfügbarkeit der Dual-energy-Röntgenabsorptiometrie (DEXA) als auch der quantitativen Computertomographie (q-CT). Auf der Suche nach einer alternativen Technik erwiesen sich die „Hounsfield units“ (HU) der klinischen CT-Untersuchung als richtungsweisend. So zeigte sich eine signifikante Korrelation zwischen den T‑Werten der DEXA-Messung und den HU des gleichen Wirbelkörpers. Aufgrund der weiten Verbreitung klinischer CT-Untersuchungen des Thorax und des Abdomens kann durch diese Methode die Dunkelziffer der Erkrankung im Rahmen des Osteoporosescreenings sicherlich deutlich reduziert werden – ohne zusätzliche Kosten, Strahlenexposition oder Mehraufwand für den Patienten. Neben der Osteoporosediagnostik ermöglichen die berechneten HU auch eine bessere präoperative Planung als auch Vorhersage des weiteren Krankheitsverlaufs. So lässt sich das Risiko für Wirbelkörperfrakturen, Schraubenlockerungen und Cagesinterungen nach ventralen Fusionsoperationen suffizient vorhersagen. Auf diese Weise lassen sich bereits präoperativ Modifikationen des chirurgischen Vorgehens treffen, um den Schraubenhalt und die Cageverankerung zu verbessern und Anschlussfrakturen zu vermeiden.

Abstract

Despite today’s good diagnostic and therapeutic options for osteoporosis, the number of unidentified cases is very high and therapy is therefore usually inadequate. Frequently, the diagnosis of osteoporosis is made only after the occurrence of a fracture. The reason for this, apart from the costs incurred as well as the additional radiation exposure of the diagnostics, is certainly the limited availability of dual energy X‑ray absorptiometry (DEXA) as well as quantitative computed tomography (q-CT). In search of an alternative technique, Hounsfield units (HU) of the clinical CT examination proved to be ground-breaking: the results of previous investigations demonstrated a reliable correlation between the T values of the DEXA measurement and the HU of the same vertebral body. Due to the widespread use of clinical CT scans of the thorax and the abdomen for a variety of indications, it is expected that the number of unidentified cases of osteoporosis can be significantly reduced—without additional costs and radiation exposure associated with osteoporosis screening. In addition to osteoporosis diagnostics, the calculated HU may also provide better preoperative planning as well as predicting the further course of the disease. Thus, the risk for vertebral body fractures, screw loosening and cage sintering after ventral fusion operations can be sufficiently predicted. In this way, preoperative modifications to the surgical procedure can be made to reduce the risk of implant failure.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln (AöR), Kerpener Straße 62, 50937, Köln, Deutschland

    Max J. Scheyerer

  2. Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Merseburger Straße 165, 06112, Halle, Deutschland

    Bernhard Ullrich

  3. Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    Georg Osterhoff &  Ulrich A. Spiegl

  4. Zentrum für Wirbelsäulen- und Skoliosetherapie, Schön Klinik Nürnberg Fürth, Europa-Allee 1, 90763, Fürth, Deutschland

    Klaus J. Schnake

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  1. Max J. Scheyerer
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Arbeitsgruppe Osteoporotische Frakturen der Sektion Wirbelsäule der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie

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Scheyerer, M.J., Ullrich, B., Osterhoff, G. et al. „Hounsfield units“ als Maß für die Knochendichte – Anwendungsmöglichkeiten in der Wirbelsäulenchirurgie. Unfallchirurg 122, 654–661 (2019). https://doi.org/10.1007/s00113-019-0658-0

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