{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T17:43:47Z","timestamp":1770745427308,"version":"3.49.0"},"reference-count":23,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,2,14]],"date-time":"2021-02-14T00:00:00Z","timestamp":1613260800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Objective: Osteoporosis is increasing in incidence as the ageing population continues to grow. Decreased bone mineral density poses a challenge for the spine surgeon. In patients requiring lumbar interbody fusion, differences in diagnostics and surgical approaches may be warranted. In this systematic review, the authors examine studies performing lumbar interbody fusion in patients with osteopenia or osteoporosis and suggest avenues for future study. Methods: A systematic literature review of the PubMed and MEDLINE databases was performed for studies published between 1986 and 2020. Studies evaluating diagnostics, surgical approaches, and other technical considerations were included. Results: A total of 13 articles were ultimately selected for qualitative analysis. This includes studies demonstrating the utility of Hounsfield units in diagnosis, a survey of surgical approaches, as well as exploring the use of vertebral augmentation and cortical bone screw trajectory. Conclusions: This systematic review provides a summary of preliminary findings with respect to the use of Hounsfield units as a diagnostic tool, the benefit or lack thereof with respect to minimally invasive approaches, and the question of whether or not cement augmentation or cortical bone trajectory confers benefit in osteoporotic patients undergoing lumbar interbody fusion. While the findings of these studies are promising, the current state of the literature is limited in scope and, for this reason, definitive conclusions cannot be drawn from these data. The authors highlight gaps in the literature and the need for further exploration and study of lumbar interbody fusion in the osteoporotic spine.<\/jats:p>","DOI":"10.3390\/brainsci11020241","type":"journal-article","created":{"date-parts":[[2021,2,14]],"date-time":"2021-02-14T08:53:56Z","timestamp":1613292836000},"page":"241","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Diagnostic, Surgical, and Technical Considerations for Lumbar Interbody Fusion in Patients with Osteopenia and Osteoporosis: A Systematic Review"],"prefix":"10.3390","volume":"11","author":[{"given":"Sauson","family":"Soldozy","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr.","given":"Samuel R.","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danyas","family":"Sarathy","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Skaff","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhargav","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer D.","family":"Sokolowski","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faheem A.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC 3800, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Marc","family":"Voyadzis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC 3800, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaan","family":"Ya\u011fmurlu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avery L.","family":"Buchholz","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark E.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hasan R.","family":"Syed","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1001\/jama.2017.21995","article-title":"Treatment of Osteoporosis","volume":"319","author":"Cotts","year":"2018","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2S","DOI":"10.1097\/00007632-199712151-00002","article-title":"Epidemiology of Spinal Osteoporosis","volume":"22","author":"Melton","year":"1997","journal-title":"Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1016\/S8756-3282(09)80004-5","article-title":"Epidemiology of Osteoporosis","volume":"13","author":"Kanis","year":"1992","journal-title":"Bone"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Lee, Y.L., and Yip, K.M. (1996). The Osteoporotic Spine. Clin. Orthop. Relat. Res., 91\u201397.","DOI":"10.1097\/00003086-199602000-00012"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S85","DOI":"10.1007\/s00198-004-1723-1","article-title":"The Current Treatment\u2014A Survey of Osteoporotic Fracture Treatment. Osteoporotic Spine Fractures: The Spine Surgeon\u2019s Perspective","volume":"16","author":"Heini","year":"2005","journal-title":"Osteoporos Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1097\/01.BRS.0000048651.92777.30","article-title":"Prediction of Osteoporotic Spinal Deformity","volume":"28","author":"Keller","year":"2003","journal-title":"Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.spinee.2010.09.024","article-title":"Instrumentation of the Osteoporotic Spine: Biomechanical and Clinical Considerations","volume":"11","author":"Ponnusamy","year":"2011","journal-title":"Spine J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E1279","DOI":"10.1097\/BRS.0000000000001612","article-title":"Diagnosing the Undiagnosed: Osteoporosis in Patients Undergoing Lumbar Fusion","volume":"41","author":"Wagner","year":"2016","journal-title":"Spine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s11420-013-9367-3","article-title":"An Association Can Be Found between Hounsfield Units and Success of Lumbar Spine Fusion","volume":"10","author":"Schreiber","year":"2014","journal-title":"HSS J."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Zou, D., Muheremu, A., Sun, Z., Zhong, W., Jiang, S., and Li, W. (2020). Computed Tomography Hounsfield Unit-Based Prediction of Pedicle Screw Loosening after Surgery for Degenerative Lumbar Spine Disease. J. Neurosurg. Spine, 1\u20136.","DOI":"10.3171\/2019.11.SPINE19868"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1590\/1806-9282.65.6.779","article-title":"Efficacy and Safety of Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Lumbar Spinal Stenosis Combined with Osteoporosis","volume":"65","author":"Gu","year":"2019","journal-title":"Rev. Assoc. Med. Bras."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4926","DOI":"10.1038\/s41598-019-41366-z","article-title":"Repeat Decompression and Fusions Following Posterolateral Fusion versus Posterior\/Transforaminal Lumbar Interbody Fusion for Lumbar Spondylosis: A National Database Study","volume":"9","author":"Park","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e19205","DOI":"10.1097\/MD.0000000000019205","article-title":"Clinical and Radiological Comparison of 2 Level Anterior Lumbar Interbody Fusion with Posterolateral Fusion and Percutaneous Pedicle Screw in Elderly Patients with Osteoporosis","volume":"99","author":"Lee","year":"2020","journal-title":"Medicine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"118","DOI":"10.4103\/0028-3886.222826","article-title":"Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Bone Cement-Augmented Pedicle Screws for Lumbar Spondylolisthesis in Patients with Osteoporosis. Case Series and Review of Literature","volume":"66","author":"Prasad","year":"2018","journal-title":"Neurol. India"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"105377","DOI":"10.1016\/j.clineuro.2019.105377","article-title":"Comparison of the Fenestrated Pedicle Screw and Conventional Pedicle Screw in Minimally Percutaneous Fixation for the Treatment of Spondylolisthesis with Osteoporotic Spine","volume":"183","author":"Wang","year":"2019","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e288","DOI":"10.1016\/j.wneu.2018.06.181","article-title":"Pedicle Screw with Cement Augmentation in Unilateral Transforaminal Lumbar Interbody Fusion: A 2-Year Follow-Up Study","volume":"118","author":"Cao","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"618.e13","DOI":"10.1016\/j.wneu.2016.08.036","article-title":"Salvage Percutaneous Vertebral Augmentation Using Polymethyl Methacrylate in Patients with Failed Interbody Fusion","volume":"95","author":"Yun","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"322","DOI":"10.14444\/5037","article-title":"Anterior Lumbar Interbody Fusion With Cement Augmentation Without Posterior Fixation to Treat Isthmic Spondylolisthesis in an Osteopenic Patient-A Surgical Technique","volume":"12","author":"Cyriac","year":"2018","journal-title":"Int. J. Spine Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e465","DOI":"10.3928\/01477447-20190604-01","article-title":"Early Clinical Outcome of Lumbar Spinal Fixation With Cortical Bone Trajectory Pedicle Screws in Patients With Osteoporosis With Degenerative Disease","volume":"42","author":"Liu","year":"2019","journal-title":"Orthopedics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3147","DOI":"10.1007\/s00586-016-4928-z","article-title":"First Clinical Results of Minimally Invasive Vector Lumbar Interbody Fusion (MIS-VLIF) in Spondylodiscitis and Concomitant Osteoporosis: A Technical Note","volume":"26","author":"Rieger","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.carj.2011.08.005","article-title":"The Assessment of Anemia from Attenuation Values of Cranial Venous Drainage on Unenhanced Computed Tomography of the Head","volume":"64","author":"Bruni","year":"2013","journal-title":"Can. Assoc. Radiol. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E438","DOI":"10.1111\/j.1464-410X.2012.10964.x","article-title":"A 970 Hounsfield Units (HU) Threshold of Kidney Stone Density on Non-Contrast Computed Tomography (NCCT) Improves Patients\u2019 Selection for Extracorporeal Shockwave Lithotripsy (ESWL): Evidence from a Prospective Study","volume":"110","author":"Ouzaid","year":"2012","journal-title":"BJU Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.acra.2012.02.022","article-title":"Computed Tomography Scans in the Evaluation of Fatty Liver Disease in a Population Based Study: The Multi-Ethnic Study of Atherosclerosis","volume":"19","author":"Zeb","year":"2012","journal-title":"Acad. Radiol."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/2\/241\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:24:12Z","timestamp":1760160252000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/2\/241"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,14]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["brainsci11020241"],"URL":"https:\/\/doi.org\/10.3390\/brainsci11020241","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,14]]}}}