Preoperative bone mineral density quantitatively assessed by Hounsfield units is associated with failed back surgery syndrome after lumbar fusion surgery - a retrospective study

Sep 29, 2026

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Retrospective analysis evaluates whether preoperative bone mineral density (BMD) quantified by CT-derived Hounsfield unit (HU) values relates to failed back surgery syndrome (FBSS) after lumbar fusion. In 115 lumbar fusion patients, BMD was assessed using both CT-derived HUs and dual-energy X-ray absorptiometry, alongside questionnaires covering pain catastrophizing, anxiety, and depression. After surgery, 14 patients developed FBSS. Multivariate logistic regression identified rest pain intensity, BAI, PCS, and HU values as independently associated with FBSS, supporting preoperative HU-based risk identification.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Study Design and Purpose

Methods and Data Collection

Outcomes and Statistical Analysis

Results

Conclusions

Background and Introduction

Clinical Study ASJ Asian Spine J. 2025;19(6): 939-948 [https://doi.org/10.31616/asj.2025.0129](https://doi.org/10.31616/asj.2025.0129)[ ](https://doi.org/10.31616/asj.2025.0129)PISSN 1976-1902 • eISSN 1976-7846 Preoperative bone mineral density quantitatively assessed by Hounsfield units is associated with failed back surgery syndrome after lumbar fusion surgery: a retrospective study Longlong Qiu1,*, Haocheng Xu2,*, Liming Yu1,*, Xiaojie Chen1, Junwei Qu1, Xinlei Xia2, Chaojun Zheng2, Qiwang Chen1 1Department of Orthopaedics, Ningbo Ninth Hospital, Ningbo, China 2Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China Preoperative BMD quantitatively assessed by HU is associated with failed back surgery syndrome after lumbar fusion surgery | | | | | --- | --- | --- | | | | | |
CONCLUSION
This study revealed that preoperative BMD, as quantified by CT-derived HU values, may be associated with FBSS.
Longlong Qiu et al. Asian Spine J. 2025;19(6): 939-948.
[doi.org/10.31616/asj.2025.0129](doi.org/10.31616/asj.2025.0129) | | | | Received Mar 5, 2025; Revised May 3, 2025; Accepted May 15, 2025
Corresponding author: Qiwang Chen
Department of Orthopaedics, Ningbo Ninth Hospital, No. 68 Xiangbei Road, Jiangbei District, Ningbo 315020, China Tel: +86-0574-55683345, Fax: +86-0574-87672961, [E-mail:](E-mail: 36982901@qq.com)[ 36982901@qq.com](E-mail: 36982901@qq.com)[ ](E-mail: 36982901@qq.com)[Co-corresponding author:](Co-corresponding author: Chaojun Zheng)[ Chaojun Zheng](Co-corresponding author: Chaojun Zheng)
Department of Orthopaedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai 200040, China Tel: +86-021-5288-7136, Fax: +86-021-6248-9191, [E-mail:](E-mail: Countd2388@163.com)[ Countd2388@163.com](E-mail: Countd2388@163.com); [Cjzheng17@fudan.edu.cn](Cjzheng17@fudan.edu.cn)
*These authors contributed equally to this work and should be considered co-first authors. | | | Copyright Ⓒ 2025 by Korean Society of Spine Surgery This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([http://creativecommons.org/licenses/by-nc/4.0/](http://creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Asian Spine Journal • pISSN 1976-1902 eISSN 1976-7846 • [www.asianspinejournal.org](www.asianspinejournal.org) Preoperative bone mineral density quantitatively assessed by Hounsfield units is associated with failed back surgery syndrome after lumbar fusion surgery: a retrospective study Longlong Qiu1,*, Haocheng Xu2,*, Liming Yu1,*, Xiaojie Chen1, Junwei Qu1, Xinlei Xia2, Chaojun Zheng2, Qiwang Chen1 Study Design: Retrospective analysis. Purpose: To evaluate preoperative bone mineral density (BMD), as quantified by computerized tomography (CT)-derived Hounsfield unit (HU) values, in patients who underwent lumbar fusion and to examine the link between BMD and failed back surgery syndrome (FBSS) . Overview of Literature: FBSS is a serious complication affecting 10%–40% of patients undergoing lumbosacral spinal surgery. Given the detrimental impact of FBSS on the psychological and physiological wellbeing of patients, preoperative identification of those at risk for developing FBSS and the implementation of targeted interventions to minimize this complication are highly important. Methods: Preoperatively, all 115 patients underwent BMD assessments using both CT-derived HUs and dual-energy X-ray absorptiometry and were administered multiple questionnaires, including the Pain Catastrophizing Scale (PCS), Beck Anxiety Inventory (BAI), and Beck Depression Index (BDI) . Both pain intensity and pain-related disability were assessed before and after lumbar fusion surgery. Results: Postoperatively, 14 patients (14/115, 12.2%) experienced FBSS. Multivariate logistic regr

FAQs

What does the study evaluate regarding lumbar fusion patients?

The study evaluates whether preoperative BMD quantified by CT-derived Hounsfield unit (HU) values is linked to failed back surgery syndrome (FBSS) after lumbar fusion.

How were patients assessed before surgery?

All 115 patients underwent BMD assessment using CT-derived HU values and dual-energy X-ray absorptiometry, and completed questionnaires including the Pain Catastrophizing Scale (PCS), Beck Anxiety Inventory (BAI), and Beck Depression Index (BDI).

Which preoperative factors were independently associated with FBSS?

Rest numeric rating pain scale score, BAI score, PCS score, and HU value were independently associated with FBSS according to multivariate logistic regression.

Sep 29, 2026

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