{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T17:31:51Z","timestamp":1781803911337,"version":"3.54.5"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Spine metastases are commonly treated with radiotherapy for local tumor control; pathologic fracture is a potential complication of spinal radiotherapy. Both Hounsfield units (HUs) on CT and vertebral bone quality (VBQ) on MRI have been argued to predict stability as measured by odds of pathologic fracture, although it is unclear if there is a difference in the predictive power between the two methodologies. The objective of the present study was to examine whether one methodology is a better predictor of pathologic fracture following radiotherapy for mobile spine metastases.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Patients who underwent radiotherapy (conventional external-beam radiation therapy, stereotactic body radiation therapy, or intensity-modulated radiation therapy) for mobile spine (C1\u2013L5) metastases at a tertiary care center were retrospectively identified. Details regarding underlying pathology, patient demographics, and tumor morphology were collected. Vertebral involvement was assessed using the Weinstein-Boriani-Biagini (WBB) system. Bone quality of the non\u2013tumor-involved bone was assessed on both pretreatment CT and MRI. Univariable analyses were conducted to identify independent predictors of fracture, and Kaplan-Meier analyses were used to identify significant predictors of time to pathologic fracture. Stepwise Cox regression analysis was used to determine independent predictors of time to fracture.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>One hundred patients were included (mean age 62.7 \u00b1 11.9 years; 61% male), of whom 35 experienced postradiotherapy pathologic fractures. The most common histologies were lung (22%), prostate (21%), breast (14%), and renal cell (13%). On univariable analysis, the mean HUs of the vertebrae adjacent to the fractured vertebra were significantly lower among those experiencing fracture; VBQ was not significantly associated with fracture odds. Survival analysis showed that average HUs \u2264 132, nonprostate pathology, involvement of \u2265 3 vertebral body segments on the WBB system, Spine Instability Neoplastic Score (SINS) \u2265 7, and the presence of axial pain all predicted increased odds of fracture (all p &lt; 0.001). Cox regression found that HUs \u2264 132 (OR 2.533, 95% CI 1.257\u20135.103; p = 0.009), \u2265 3 WBB vertebral body segments involved (OR 2.376, 95% CI 1.132\u20134.987; p = 0.022), and axial pain (OR 2.036, 95% CI 0.916\u20134.526; p = 0.081) predicted increased fracture odds, while prostate pathology predicted decreased odds (OR 0.076, 95% CI 0.009\u20130.613; p = 0.016). Sensitivity analysis suggested that an HU threshold of \u2264 132 and a SINS of \u2265 7 identified patients at increased risk of fracture.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The present results suggest that bone density surrogates as measured on CT, but not MRI, can be used to predict the risk of pathologic fracture following radiotherapy for mobile spine metastases. More extensive vertebral body involvement and the presence of mechanical axial pain additionally predict increased fracture odds.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.8.spine23420","type":"journal-article","created":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T01:53:19Z","timestamp":1697248399000},"page":"19-27","source":"Crossref","is-referenced-by-count":20,"title":["Comparison of Hounsfield units and vertebral bone quality score for the prediction of time to pathologic fracture in mobile spine metastases treated with radiotherapy"],"prefix":"10.3171","volume":"40","author":[{"given":"Zach","family":"Pennington","sequence":"first","affiliation":[{"name":"Departments of Neurologic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony L.","family":"Mikula","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Lakomkin","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Martini","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle J.","family":"Clarke","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun S.","family":"Sebastian","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett A.","family":"Freedman","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Rose","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Mohammed","family":"Karim","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Nassr","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman O.","family":"Kowalchuk","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth W.","family":"Merrell","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William E.","family":"Krauss","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy L.","family":"Fogelson","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D.","family":"Elder","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9","key":"b1","series-title":"Spine J","first-page":"1414","article-title":"Spinal metastases 2021: a review of the current state of the art and future directions","volume":"21","author":"Sciubba DM","year":"2021","unstructured":"Sciubba DM, Pennington Z, Colman MW,  Spinal metastases 2021: a review of the current state of the art and future directions. 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J Neurosurg Spine. 2020;34(3):364\u2013373."},{"issue":"9486","key":"b4","series-title":"Lancet","first-page":"643","article-title":"Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial","volume":"366","author":"Patchell RA","year":"2005","unstructured":"Patchell RA, Tibbs PA, Regine WF,  Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. 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