{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:16:48Z","timestamp":1788308208943,"version":"build-2803163510"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,28]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>This study aimed to develop a novel 3D Hounsfield unit (HU) technique for assessing volumetric bone mineral density (vBMD) using routine preoperative CT scans. It was designed to enable opportunistic osteoporosis screening by leveraging existing imaging data. The diagnostic accuracy of this approach was rigorously evaluated against quantitative CT (QCT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors retrospectively analyzed the records of spine surgery patients who underwent both spinal CT and QCT within a 1-week period. Patients were divided into 3 groups (osteoporosis, osteopenia, and normal bone mineral density [BMD]) based on QCT-vBMD. Baseline characteristics and radiological parameters were compared among the 3 groups. Three-dimensional HU measurements were obtained from lumbar CT scans. Multivariable logistic regression, Pearson correlation analysis, and receiver operating characteristic (ROC) analysis were used to assess the relationships between vBMD and 3D-HU. To evaluate interscanner reliability, a subset of patients received additional CT scanning using both GE and Philips systems. Bland-Altman analysis was used to assess agreement between 3D-HU measurements from different scanner platforms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 264 enrolled patients, 94 were classified as osteoporotic, 114 as osteopenic, and 56 as having normal BMD. Multivariable logistic regression analyses identified lower 3D-HU as an independent predictor of both osteoporosis (OR 0.723, 95% CI 0.618\u20130.806; p &lt; 0.0001) and osteopenia (OR 0.698, 95% CI 0.564\u20130.799; p &lt; 0.0001). Three-dimensional HU demonstrated a strong correlation with QCT-vBMD (T12, r = 0.979; L1, r = 0.968; L2, r = 0.962). ROC analysis demonstrated that 3D-HU achieved diagnostic accuracy comparable to QCT for both osteoporosis and osteopenia. Specifically, for osteoporosis, the area under the ROC curve (AUC) was 99.1% (sensitivity 94.7%, specificity 98.3%); for osteopenia, the AUC was 98.5% (sensitivity 93.9%, specificity 94.6%). Bland-Altman analysis demonstrated excellent interscanner agreement (mean difference 0.13; 95% limits of agreement \u22128.23 to 8.50), with only 2% of measurements falling outside the agreement limits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Three-dimensional HU represents a novel vBMD assessment methodology that achieves diagnostic parity with QCT. Crucially, this precision is attained using conventional CT scanners without extra radiation exposure or specialized equipment. This study demonstrated that precise, universally accessible osteoporosis screening is now achievable, promising a transformative advance in public bone health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.3.spine251518","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:01:24Z","timestamp":1787702484000},"page":"1-10","source":"Crossref","is-referenced-by-count":0,"title":["Combining universal access with high precision for revolutionary osteoporosis screening: CT-based 3D-HU volumetric bone density"],"prefix":"10.3171","author":[{"given":"Rongkun","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinxin","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumei","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunlin","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"You","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Geng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohong","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Shanxi Provincial People\u2019s Hospital, Shanxi Medical University, Taiyuan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jizhe","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Shanxi Provincial People\u2019s Hospital, Shanxi Medical University, Taiyuan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijun","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, People\u2019s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"10169","key":"b1","series-title":"Lancet","first-page":"364","article-title":"Osteoporosis","volume":"393","author":"Compston JE","year":"2019","unstructured":"Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019;393(10169):364\u2013376. doi:10.1016\/S0140-6736(18)32112-3"},{"issue":"1","key":"b2","series-title":"BMC Public Health","first-page":"1963","article-title":"Proximal hip fractures in 71,920 elderly patients: incidence, epidemiology, mortality and costs from a retrospective observational study","volume":"23","author":"Vigan\u00f2 M","year":"2023","unstructured":"Vigan\u00f2 M, Pennestr\u00ec F, Listorti E, Banfi G. Proximal hip fractures in 71,920 elderly patients: incidence, epidemiology, mortality and costs from a retrospective observational study. BMC Public Health. 2023;23(1):1963. doi:10.1186\/s12889-023-16776-4"},{"issue":"5","key":"b3","series-title":"Curr Osteoporos Rep","first-page":"592","article-title":"Osteoporosis and fracture risk among older US Asian adults","volume":"21","author":"Lo JC","year":"2023","unstructured":"Lo JC, Yang W, Park-Sigal JJ, Ott SM. Osteoporosis and fracture risk among older US Asian adults. Curr Osteoporos Rep. 2023;21(5):592\u2013608. doi:10.1007\/s11914-023-00805-7"},{"issue":"9","key":"b4","series-title":"Osteoporos Int","first-page":"2243","article-title":"Burden of high fracture probability worldwide: secular increases 2010\u20132040","volume":"26","author":"Od\u00e9n A","year":"2015","unstructured":"Od\u00e9n A, McCloskey EV, Kanis JA, Harvey NC, Johansson H. Burden of high fracture probability worldwide: secular increases 2010\u20132040. Osteoporos Int. 2015;26(9):2243\u20132248. doi:10.1007\/s00198-015-3154-6"},{"issue":"9","key":"b5","series-title":"Osteoporos Int","first-page":"1561","article-title":"Mortality among older adults with osteoporotic vertebral fracture","volume":"34","author":"Gold LS","year":"2023","unstructured":"Gold LS, Suri P, O\u2019Reilly MK, Kallmes DF, Heagerty PJ, Jarvik JG. Mortality among older adults with osteoporotic vertebral fracture. Osteoporos Int. 2023;34(9):1561\u20131575. doi:10.1007\/s00198-023-06796-6"},{"issue":"9","key":"b6","series-title":"Lancet Healthy Longev","first-page":"E580","article-title":"Global, regional, and national burden of bone fractures in 204 countries and territories, 1990\u20132019: a systematic analysis from the Global Burden of Disease Study 2019","volume":"2","author":"Wu AM","year":"2021","unstructured":"Wu AM, Bisignano C, James SL,  Global, regional, and national burden of bone fractures in 204 countries and territories, 1990\u20132019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Healthy Longev. 2021;2(9):E580\u2013E592. doi:10.1016\/S2666-7568(21)00172-0"},{"issue":"24","key":"b7","series-title":"JAMA","first-page":"2521","article-title":"Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement","volume":"319","author":"Curry SJ","year":"2018","unstructured":"Curry SJ, Krist AH, Owens DK,  Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA. 2018;319(24):2521\u20132531. doi:10.1001\/jama.2018.7498"},{"issue":"9","key":"b8","series-title":"JBMR Plus","first-page":"e10192","article-title":"Healthcare policy changes in osteoporosis can improve outcomes and reduce costs in the United States","volume":"3","author":"Lewiecki EM","year":"2019","unstructured":"Lewiecki EM, Ortendahl JD, Vanderpuye-Orgle J,  Healthcare policy changes in osteoporosis can improve outcomes and reduce costs in the United States. JBMR Plus. 2019;3(9):e10192. doi:10.1002\/jbm4.10192"},{"issue":"3","key":"b9","series-title":"J Clin Densitom","first-page":"291","article-title":"Dual-energy X-ray absorptiometry","volume":"20","author":"Jain RK","year":"2017","unstructured":"Jain RK, Vokes T. Dual-energy X-ray absorptiometry. J Clin Densitom. 2017;20(3):291\u2013303. doi:10.1016\/j.jocd.2017.06.014"},{"issue":"6","key":"b10","series-title":"Rheumatology (Oxford)","first-page":"968","article-title":"Friend or foe: high bone mineral density on routine bone density scanning, a review of causes and management","volume":"52","author":"Gregson CL","year":"2013","unstructured":"Gregson CL, Hardcastle SA, Cooper C, Tobias JH. Friend or foe: high bone mineral density on routine bone density scanning, a review of causes and management. Rheumatology (Oxford). 2013;52(6):968\u2013985. doi:10.1093\/rheumatology\/ket007"},{"issue":"3","key":"b11","series-title":"J Clin Densitom","first-page":"393","article-title":"Clinical use of quantitative computed tomography\u2013based advanced techniques in the management of osteoporosis in adults: the 2015 ISCD official positions\u2014part III","volume":"18","author":"Engelke K","year":"2015","unstructured":"Engelke K, Lang T, Khosla S,  Clinical use of quantitative computed tomography\u2013based advanced techniques in the management of osteoporosis in adults: the 2015 ISCD official positions\u2014part III. J Clin Densitom. 2015;18(3):393\u2013407. doi:10.1016\/j.jocd.2015.06.010"},{"issue":"6","key":"b12","series-title":"Bone","first-page":"713","article-title":"Lumbar vertebral body compressive strength evaluated by dual-energy X-ray absorptiometry, quantitative computed tomography, and ashing","volume":"25","author":"Ebbesen EN","year":"1999","unstructured":"Ebbesen EN, Thomsen JS, Beck-Nielsen H, Nepper-Rasmussen HJ, Mosekilde L. Lumbar vertebral body compressive strength evaluated by dual-energy X-ray absorptiometry, quantitative computed tomography, and ashing. Bone. 1999;25(6):713\u2013724. doi:10.1016\/s8756-3282(99)00216-1"},{"issue":"5","key":"b13","series-title":"Eur Spine J","first-page":"1098","article-title":"Assessment of bone quality at the lumbar and sacral spine using CT scans: a retrospective feasibility study in 50 comparing CT and DXA data","volume":"29","author":"Berger-Groch J","year":"2020","unstructured":"Berger-Groch J, Thiesen DM, Ntalos D, Hennes F, Hartel MJ. Assessment of bone quality at the lumbar and sacral spine using CT scans: a retrospective feasibility study in 50 comparing CT and DXA data. Eur Spine J. 2020;29(5):1098\u20131104. doi:10.1007\/s00586-020-06292-z"},{"issue":"2","key":"b14","series-title":"Radiology","first-page":"360","article-title":"Opportunistic osteoporosis screening at routine abdominal and thoracic CT: normative L1 trabecular attenuation values in more than 20 000 adults","volume":"291","author":"Jang S","year":"2019","unstructured":"Jang S, Graffy PM, Ziemlewicz TJ, Lee SJ, Summers RM, Pickhardt PJ. Opportunistic osteoporosis screening at routine abdominal and thoracic CT: normative L1 trabecular attenuation values in more than 20 000 adults. Radiology. 2019;291(2):360\u2013367. doi:10.1148\/radiol.2019181648"},{"issue":"1","key":"b15","series-title":"J Orthop Surg Res","first-page":"257","article-title":"CT-based vertebral three-dimensional Hounsfield unit can predict the new vertebral fracture after percutaneous vertebral augmentation in postmenopausal women: a retrospective study","volume":"20","author":"Chang R","year":"2025","unstructured":"Chang R, Chang F, You Y,  CT-based vertebral three-dimensional Hounsfield unit can predict the new vertebral fracture after percutaneous vertebral augmentation in postmenopausal women: a retrospective study. J Orthop Surg Res. 2025;20(1):257. doi:10.1186\/s13018-025-05651-0"},{"issue":"11","key":"b16","series-title":"Eur Spine J","first-page":"4998","article-title":"Novel CT-based vertebral three-dimensional Hounsfield unit for assessment of bone mineral density","volume":"34","author":"Chang R","year":"2025","unstructured":"Chang R, You Y, Cai L,  Novel CT-based vertebral three-dimensional Hounsfield unit for assessment of bone mineral density. Eur Spine J. 2025;34(11):4998\u20135006. doi:10.1007\/s00586-025-09010-9"},{"key":"b17","series-title":"Clin Interv Aging","first-page":"1317","article-title":"A concise review of testosterone and bone health","volume":"11","author":"Mohamad NV","year":"2016","unstructured":"Mohamad NV, Soelaiman IN, Chin KY. A concise review of testosterone and bone health. Clin Interv Aging. 2016;11:1317\u20131324. doi:10.2147\/CIA.S115472"},{"issue":"6","key":"b18","series-title":"Best Pract Res Clin Endocrinol Metab","first-page":"101551","article-title":"Menopausal hormone therapy for the management of osteoporosis","volume":"35","author":"Gosset A","year":"2021","unstructured":"Gosset A, Pouill\u00e8s JM, Tr\u00e9mollieres F. Menopausal hormone therapy for the management of osteoporosis. Best Pract Res Clin Endocrinol Metab. 2021;35(6):101551. doi:10.1016\/j.beem.2021.101551"},{"issue":"11 Suppl","key":"b19","series-title":"J Am Coll Radiol","first-page":"S417","article-title":"ACR Appropriateness Criteria\u00ae Osteoporosis and Bone Mineral Density: 2022 update","volume":"19","author":"Yu JS","year":"2022","unstructured":"Yu JS, Krishna NG, Fox MG,  ACR Appropriateness Criteria\u00ae Osteoporosis and Bone Mineral Density: 2022 update. J Am Coll Radiol. 2022;19(11 Suppl):S417\u2013S432. doi:10.1016\/j.jacr.2022.09.007"},{"issue":"1","key":"b20","series-title":"J Clin Densitom","first-page":"101435","article-title":"Executive summary of the 2023 Adult Position Development Conference of the International Society for Clinical Densitometry: DXA reporting, follow-up BMD testing and trabecular bone score application and reporting","volume":"27","author":"Shuhart C","year":"2024","unstructured":"Shuhart C, Cheung A, Gill R, Gani L, Goel H, Szalat A. Executive summary of the 2023 Adult Position Development Conference of the International Society for Clinical Densitometry: DXA reporting, follow-up BMD testing and trabecular bone score application and reporting. J Clin Densitom. 2024;27(1):101435. doi:10.1016\/j.jocd.2023.101435"},{"issue":"11","key":"b21","series-title":"J Bone Joint Surg Am","first-page":"1057","article-title":"Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management","volume":"93","author":"Schreiber JJ","year":"2011","unstructured":"Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011;93(11):1057\u20131063. doi:10.2106\/JBJS.J.00160"},{"issue":"6","key":"b22","series-title":"Quant Imaging Med Surg","first-page":"3803","article-title":"Correlation between vertebral bone mineral density and multi-level virtual non-calcium imaging parameters from dual-layer spectral detector computed tomography","volume":"14","author":"Yang Y","year":"2024","unstructured":"Yang Y, Hou J, Niu Y,  Correlation between vertebral bone mineral density and multi-level virtual non-calcium imaging parameters from dual-layer spectral detector computed tomography. Quant Imaging Med Surg. 2024;14(6):3803\u20133815. doi:10.21037\/qims-23-1543"},{"issue":"1","key":"b23","series-title":"J Orthop Surg Res","first-page":"297","article-title":"The quantification of 3D-trabecular architecture of the fourth cervical vertebra using CT osteoabsorptiometry and micro-CT","volume":"18","author":"Poilliot A","year":"2023","unstructured":"Poilliot A, Gay-Dujak MHP, M\u00fcller-Gerbl M. The quantification of 3D-trabecular architecture of the fourth cervical vertebra using CT osteoabsorptiometry and micro-CT. J Orthop Surg Res. 2023;18(1):297. doi:10.1186\/s13018-023-03760-2"},{"issue":"6","key":"b24","series-title":"Radiol Med","first-page":"744","article-title":"CT-based radiomics can identify physiological modifications of bone structure related to subjects\u2019 age and sex","volume":"128","author":"Levi R","year":"2023","unstructured":"Levi R, Garoli F, Battaglia M,  CT-based radiomics can identify physiological modifications of bone structure related to subjects\u2019 age and sex. Radiol Med. 2023;128(6):744\u2013754. doi:10.1007\/s11547-023-01641-6"},{"issue":"6","key":"b25","series-title":"Med Phys","first-page":"3886","article-title":"Finite element analysis of trabecular bone microstructure using CT imaging and continuum mechanical modeling","volume":"49","author":"Guha I","year":"2022","unstructured":"Guha I, Zhang X, Rajapakse CS, Chang G, Saha PK. Finite element analysis of trabecular bone microstructure using CT imaging and continuum mechanical modeling. Med Phys. 2022;49(6):3886\u20133899. doi:10.1002\/mp.15629"},{"issue":"10","key":"b26","series-title":"Spine (Phila Pa 1976)","first-page":"667","article-title":"3D-printed titanium prosthetic reconstruction of the C2 vertebra: techniques and outcomes of three consecutive cases","volume":"45","author":"Hunn SAM","year":"2020","unstructured":"Hunn SAM, Koefman AJ, Hunn AWM. 3D-printed titanium prosthetic reconstruction of the C2 vertebra: techniques and outcomes of three consecutive cases. Spine (Phila Pa 1976).2020;45(10):667\u2013672. doi:10.1097\/BRS.0000000000003360"},{"issue":"1","key":"b27","series-title":"Spine J","first-page":"69","article-title":"Importance of gap evaluation in the ossification of posterior longitudinal ligament lesions using 3-dimensional computed tomography","volume":"25","author":"Alaa H","year":"2025","unstructured":"Alaa H, Tung NTC, Ueno T,  Importance of gap evaluation in the ossification of posterior longitudinal ligament lesions using 3-dimensional computed tomography. Spine J. 2025;25(1):69\u201379. doi:10.1016\/j.spinee.2024.08.030"},{"issue":"1156","key":"b28","series-title":"Br J Radiol","first-page":"705","article-title":"Dual-energy CT applications in musculoskeletal disorders","volume":"97","author":"Cheong SCW","year":"2024","unstructured":"Cheong SCW, Yan YY, Sheikh A,  Dual-energy CT applications in musculoskeletal disorders. Br J Radiol. 2024;97(1156):705\u2013715. doi:10.1093\/bjr\/tqae023"},{"issue":"4","key":"b29","series-title":"Osteoporos Int","first-page":"1419","article-title":"Degenerative changes at the lumbar spine\u2014implications for bone mineral density measurement in elderly women","volume":"24","author":"Tenne M","year":"2013","unstructured":"Tenne M, McGuigan F, Besjakov J, Gerdhem P, \u00c5kesson K. Degenerative changes at the lumbar spine\u2014implications for bone mineral density measurement in elderly women. Osteoporos Int. 2013;24(4):1419\u20131428. doi:10.1007\/s00198-012-2048-0"},{"issue":"3","key":"b30","series-title":"Am J Med","first-page":"306","article-title":"Trends and disparities in osteoporosis screening among women in the United States, 2008-2014","volume":"130","author":"Gillespie CW","year":"2017","unstructured":"Gillespie CW, Morin PE. Trends and disparities in osteoporosis screening among women in the United States, 2008-2014. Am J Med. 2017;130(3):306\u2013316. doi:10.1016\/j.amjmed.2016.10.018"},{"issue":"9","key":"b31","series-title":"Acta Neurochir (Wien)","first-page":"2327","article-title":"The role of bone mineral density in adult spinal deformity patients undergoing corrective surgery: a matched analysis","volume":"164","author":"Khalid SI","year":"2022","unstructured":"Khalid SI, Nunna RS, Smith JS,  The role of bone mineral density in adult spinal deformity patients undergoing corrective surgery: a matched analysis. Acta Neurochir (Wien). 2022;164(9):2327\u20132335. doi:10.1007\/s00701-022-05317-4"},{"issue":"1","key":"b32","series-title":"Spine J","first-page":"134","article-title":"Osteoporosis increases the likelihood of revision surgery following a long spinal fusion for adult spinal deformity","volume":"21","author":"Gupta A","year":"2021","unstructured":"Gupta A, Cha T, Schwab J,  Osteoporosis increases the likelihood of revision surgery following a long spinal fusion for adult spinal deformity. Spine J. 2021;21(1):134\u2013140. doi:10.1016\/j.spinee.2020.08.002"},{"key":"b33","series-title":"World Neurosurg","first-page":"e830","article-title":"Does preoperative bone mineral density impact fusion success in anterior cervical spine surgery? A prospective cohort study","volume":"164","author":"Pinter ZW","year":"2022","unstructured":"Pinter ZW, Monsef JB, Salmons HI,  Does preoperative bone mineral density impact fusion success in anterior cervical spine surgery? A prospective cohort study. World Neurosurg. 2022;164:e830\u2013e834. doi:10.1016\/j.wneu.2022.05.058"},{"issue":"2","key":"b34","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Hounsfield units of the vertebral body and pedicle as predictors of pedicle screw loosening after degenerative lumbar spine surgery","volume":"49","author":"Xu F","year":"2020","unstructured":"Xu F, Zou D, Li W,  Hounsfield units of the vertebral body and pedicle as predictors of pedicle screw loosening after degenerative lumbar spine surgery. Neurosurg Focus. 2020;49(2):E10. doi:10.3171\/2020.5.FOCUS20249"},{"issue":"6","key":"b35","series-title":"Spine J","first-page":"957","article-title":"Low Hounsfield units on computed tomography are associated with cage subsidence following oblique lumbar interbody fusion (OLIF)","volume":"22","author":"Ran L","year":"2022","unstructured":"Ran L, Xie T, Zhao L, Huang S, Zeng J. Low Hounsfield units on computed tomography are associated with cage subsidence following oblique lumbar interbody fusion (OLIF). Spine J. 2022;22(6):957\u2013964. doi:10.1016\/j.spinee.2022.01.018"},{"key":"b36","series-title":"World Neurosurg","first-page":"e711","article-title":"Inter-rater reliability of Hounsfield units as a measure of bone density: applications in the treatment of thoracolumbar fractures","volume":"158","author":"Ullrich BW","year":"2022","unstructured":"Ullrich BW, Schwarz F, McLean AL,  Inter-rater reliability of Hounsfield units as a measure of bone density: applications in the treatment of thoracolumbar fractures. World Neurosurg. 2022;158:e711\u2013e716. doi:10.1016\/j.wneu.2021.11.043"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2026.3.SPINE251518\/article-10.3171-2026.3.SPINE251518.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2026.3.SPINE251518\/article-10.3171-2026.3.SPINE251518.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:30Z","timestamp":1788307230000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2026.3.SPINE251518\/article-10.3171-2026.3.SPINE251518.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":36,"URL":"https:\/\/doi.org\/10.3171\/2026.3.spine251518","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8,28]]}}}