Correlation between vertebral body rotation and two-dimensional vertebral bone density measurement

The aim of this study was to determine the effect of vertebral rotation, as seen in idiopathic scoliosis. on bone mineral density determination for the lumbar spine. Bone mineral content, biplanar vertebral segment area and calculated bone mineral density of each vertebra from L1 to L4 were obtained for a human cadaveric specimen. The average density for the entire L1-L4 segment was also recorded. This was done with the spine in the midline position as well as in rotation up to a maximum of 60 degrees either side of the midline. The spine was rotated in each direction using 10 increments and two bone density readings were done at each rotation interval. The measured biplanar vertebral segment area increased with increasing rotation from 0 to 50 but decreased after 50 degrees of rotation (r=0.73. p <0.001). The bone mineral density was significantly negatively correlated with the degree of rotation (r = -0.92, p <0.001). The decrease in measured bone mineral density was nearly 20% when the lumbar spine was rotated from neutral to 60. This study demonstrates that degree of spinal rotation influences apparent bone mineral density by increasing the apparent vertebral segment area. The measurement change may be as high as 20%. This fact should be considered when investigating scoliotic patients with vertebral segment rotation.