Association Between Hounsfield Units and Vertebral Body Re-collapse 3 Months After Posterior Fixation for Thoracolumbar Burst Fractures in Working-Age Patients: A Retrospective Register-Based Cohort Study.

Authors

Jabbar Mohammed, Ryo Fujita, Johan Wänman, Mikael Kontakis, Fabian Burmeister, Khalid Dasouki, Tsutomu Endo, Sebastian Mukka, Paul Gerdhem, Simon Blixt

Published in

International journal of spine surgery. Sep 03, 2026. Epub Sep 03, 2026.

Abstract

Factors associated with early re-collapse after posterior fixation of thoracolumbar burst fractures have been sparsely examined in previous studies. Early re-collapse is challenging to predict due to multifactorial risk. Therefore, we aimed to investigate factors associated with vertebral re-collapse within the first 3 months following posterior fixation.
This retrospective study used data from the Swedish Fracture Register (2015-2019) and included patients aged 18 to 66 years with a single-level thoracolumbar burst fracture between T11 and L3 treated with posterior fixation. Fractures were classified according to the load-sharing classification (LSC) and the 2013 AO Spine Injury Classification System. Bone quality was assessed using Hounsfield unit (HU) values. In addition, postoperative pedicle screw depth within the vertebral body (% depth) and the number of instrumented vertebrae were recorded. To evaluate postoperative vertebral collapse, kyphosis angle, wedge angle, and anterior/posterior vertebral height ratio were measured. Re-collapse was defined as an anterior vertebral height loss of at least 20%, and pedicle screw pull-out was also assessed. Multivariable logistic regression was used to identify factors associated with vertebral re-collapse within 3 months postoperatively.
This study comprised 100 patients. Sixteen patients had radiographic vertebral re-collapse, and 15 had pedicle screw pull-out. Lower HU values were significantly associated with vertebral re-collapse (OR 0.97, 95% CI 0.94-0.99, P = 0.01). Higher preoperative LSC scores were also significantly associated with an increased risk of re-collapse (OR: 2.35, 95% CI: 1.07-6.82, P = 0.02). In contrast, neither screw insertion depth nor the number of instrumented vertebrae was associated with re-collapse.
Lower HU values and higher preoperative LSC scores were associated with an increased risk of early vertebral re-collapse within 3 months after posterior fixation of thoracolumbar burst fractures. However, early re-collapse appears to be multifactorial and remains difficult to predict, warranting further investigation.
This study provides clinically relevant insights into early re-collapse after posterior fixation of thoracolumbar burst fractures and identifies factors associated with early mechanical failure.

PMID:
42692788
Bibliographic data and abstract were imported from PubMed on 04 Sep 2026.

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