Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ (2015) Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg 1(1):2–18. https://doi.org/10.3978/j.issn.2414-469X.2015.10.05

Article  PubMed  PubMed Central  Google Scholar 

Kim YH, Ha KY, Rhyu KW et al (2020) Lumbar interbody fusion: techniques, pearls and pitfalls. Asian Spine J 14(5):730–741. https://doi.org/10.31616/asj.2020.0485

Article  PubMed  PubMed Central  Google Scholar 

Wu X, Shi J, Wu J et al (2019) Pedicle screw loosening: the value of radiological imagings and the identification of risk factors assessed by extraction torque during screw removal surgery. J Orthop Surg Res 14:6. https://doi.org/10.1186/s13018-018-1046-0

Article  PubMed  PubMed Central  Google Scholar 

Bokov A, Bulkin A, Aleynik A, Kutlaeva M, Mlyavykh S (2019) Pedicle screws loosening in patients with degenerative diseases of the lumbar spine: potential risk factors and relative contribution. Glob Spine J 9(1):55–61. https://doi.org/10.1177/2192568218772302

Article  Google Scholar 

Parisien A, Wai EK, ElSayed MS, Frei H (2022) Subsidence of spinal fusion cages: a systematic review. Int J Spine Surg 16(6):1103. https://doi.org/10.14444/8363

Article  PubMed  PubMed Central  Google Scholar 

Ali Baig R, Quiceno E, Soliman MAR et al (2025) Definition of cage subsidence in transforaminal lumbar interbody fusion (TLIF) approach and posterior lumbar interbody fusion (PLIF) approach– a systematic review. J Clin Neurosci 133:111048. https://doi.org/10.1016/j.jocn.2025.111048

Article  PubMed  Google Scholar 

Marie-Hardy L, Pascal-Moussellard H, Barnaba A, Bonaccorsi R, Scemama C (2020) Screw loosening in posterior spine fusion: prevalence and risk factors. Glob Spine J 10(5):598–602. https://doi.org/10.1177/2192568219864341

Article  Google Scholar 

Yuan L, Zhang X, Zeng Y, Chen Z, Li W, Incidence (2023) Risk, and outcome of pedicle screw loosening in degenerative lumbar scoliosis patients undergoing Long-Segment fusion. Global Spine J 13(4):1064–1071. https://doi.org/10.1177/21925682211017477

Article  PubMed  Google Scholar 

St Jeor JD, Jackson TJ, Xiong AE et al (2020) Osteoporosis in spine surgery patients: what is the best way to diagnose osteoporosis in this population? Neurosurg Focus 49(2):E4. https://doi.org/10.3171/2020.5.FOCUS20277

Article  PubMed  Google Scholar 

Davidson S, Vecellio A, Flagstad I et al (2023) Discrepancy between DXA and CT-based assessment of spine bone mineral density. Spine Deform 11(3):677–683. https://doi.org/10.1007/s43390-023-00646-5

Article  PubMed  Google Scholar 

Wanderman N, Freedman B, Currier B, Huddleston P, Yaszemski M, Nassr A (2018) Interpreting the DXA analysis: when should you hold off on spinal fusion? Semin Spine Surg 30(1):36–40. https://doi.org/10.1053/j.semss.2017.09.007

Article  Google Scholar 

Deshpande N, Hadi MS, Lillard JC et al (2023) Alternatives to DEXA for the assessment of bone density: a systematic review of the literature and future recommendations. Published Online January 6. https://doi.org/10.3171/2022.11.SPINE22875

Zaidi Q, Danisa OA, Cheng W (2019) Measurement techniques and utility of Hounsfield unit values for assessment of bone quality prior to spinal instrumentation: a review of current literature. Spine (Phila Pa 1976) 44(4):E239–E244. https://doi.org/10.1097/BRS.0000000000002813

Article  PubMed  Google Scholar 

Ahern DP, McDonnell JM, Riffault M et al (2021) A meta-analysis of the diagnostic accuracy of Hounsfield units on computed topography relative to dual-energy X-ray absorptiometry for the diagnosis of osteoporosis in the spine surgery population. Spine J 21(10):1738–1749. https://doi.org/10.1016/j.spinee.2021.03.008

Article  PubMed  Google Scholar 

PRISMA statement. PRISMA statement. Accessed April 22 (2024) https://www.prisma-statement.org

Whiting PF, Rutjes AWS, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536. https://doi.org/10.7326/0003-4819-155-8-201110180-00009

Article  PubMed  Google Scholar 

Pu X, Wang X, Ran L et al (2023) Comparison of predictive performance for cage subsidence between CT-based Hounsfield units and MRI-based vertebral bone quality score following oblique lumbar interbody fusion. Eur Radiol 33(12):8637–8644. https://doi.org/10.1007/s00330-023-09929-x

Article  PubMed  Google Scholar 

Shu L, Wang X, Li L et al (2023) Computed Tomography-Based prediction of lumbar pedicle screw loosening. Biomed Res Int 2023:8084597. https://doi.org/10.1155/2023/8084597

Article  PubMed  PubMed Central  Google Scholar 

Yao YC, Chao H, Kao KY et al (2023) CT hounsfield unit is a reliable parameter for screws loosening or cages subsidence in minimally invasive transforaminal lumbar interbody fusion. Sci Rep 13(1):1620. https://doi.org/10.1038/s41598-023-28555-7

Article  CAS  PubMed  PubMed Central  Google Scholar 

Wu H, Cheung JPY, Zhang T et al (2023) The role of Hounsfield unit in intraoperative endplate violation and delayed cage subsidence with oblique lateral interbody fusion. Global Spine J 13(7):1829–1839. https://doi.org/10.1177/21925682211052515

Article  PubMed  Google Scholar 

Zhou J, Yuan C, Liu C, Zhou L, Wang J (2021) Hounsfield unit value on CT as a predictor of cage subsidence following stand-alone oblique lumbar interbody fusion for the treatment of degenerative lumbar diseases. BMC Musculoskelet Disord 22(1):960. https://doi.org/10.1186/s12891-021-04833-1

Article  PubMed  PubMed Central  Google Scholar 

Sakai Y, Takenaka S, Matsuo Y et al (2018) Hounsfield unit of screw trajectory as a predictor of pedicle screw loosening after single level lumbar interbody fusion. J Orthop Sci 23(5):734–738. https://doi.org/10.1016/j.jos.2018.04.006

Article  PubMed  Google Scholar 

Xie F, Yang Z, Tu Z et al (2022) The value of Hounsfield units in predicting cage subsidence after transforaminal lumbar interbody fusion. BMC Musculoskelet Disord 23(1):882. https://doi.org/10.1186/s12891-022-05836-2

Article  PubMed  PubMed Central  Google Scholar 

Xi Z, Mummaneni PV, Wang M et al (2020) The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion. Neurosurg Focus 49(2):E8. https://doi.org/10.3171/2020.5.FOCUS20169

Article  PubMed  Google Scholar 

Ishikawa Y, Katsumi K, Mizouchi T, Sato M, Yamazaki A (2023) Importance of computed tomography Hounsfield units in predicting S1 screw loosening after lumbosacral fusion. J Clin Neurosci 113:1–6. https://doi.org/10.1016/j.jocn.2023.04.019

Article  PubMed  Google Scholar 

Ran L, Xie T, Zhao L, Huang S, Zeng J (2022) Low Hounsfield units on computed tomography are associated with cage subsidence following oblique lumbar interbody fusion (OLIF). Spine J 22(6):957–964. https://doi.org/10.1016/j.spinee.2022.01.018

Article  PubMed  Google Scholar 

Zhao H, Wang YJ, Wang RG et al (2023) Three-dimensional hounsfield units measurement of pedicle screw trajectory for predicating screw loosening in lumbar fusion surgery. Clin Interv Aging 485–493. https://doi.org/10.2147/CIA.S389059

Article  PubMed  PubMed Central  Google Scholar 

Zou D, Muheremu A, Sun Z, Zhong W, Jiang S, Li W (2020) Computed tomography hounsfield unit-based prediction of pedicle screw loosening after surgery for degenerative lumbar spine disease. J Neurosurg Spine 32(5):716–721. https://doi.org/10.3171/2019.11.SPINE19868

Article  PubMed  Google Scholar 

Wang Y, Zhang J, Tong T, Miao D, Wang F, Wang L (2024) Comparison of Hounsfield unit, vertebral bone quality, and dual-energy X-ray absorptiometry T-score for predicting cage subsidence after posterior lumbar interbody fusion. Glob Spine J (4):21925682241293038. https://doi.org/10.1177/21925682241293038

Article  Google Scholar 

Li J, Zhang Z, Xie T, Song Z, Song Y, Zeng J (2023) The preoperative hounsfield unit value at the position of the future screw insertion is a better predictor of screw loosening than other methods. Eur Radiol 33(3):1526–1536. https://doi.org/10.1007/s00330-022-09157-9

Article  CAS  PubMed  Google Scholar 

Zhang Q, Zhao Fanfan, Zhang Yu, Gong X (2024) Longitudinal study on pre- and post-operation CT imaging for predicting pedicle screw loosening in patients with lumbar degenerative disease. Ther Clin Risk Manag 185–194. https://doi.org/10.2147/TCRM.S453639

Article  PubMed  PubMed Central  Google Schola