CT Osteoabsorptiometry Assessment of Subchondral Bone Density Predicts Intervertebral Implant Subsidence in a Human ACDF Cadaver Model

Study Design: Cadaveric biomechanics study. Objective: Subchondral bone mineral density (sBMD) reflects the long-term mineralization and distribution of stress on joints. The use of 3-dimensional (3-D) methods to evaluate sBMD, including computed tomography osteoabsorptiometry (CT-OAM), enables the assessment of density distribution with emphasis on subchondral bone. This study sought to measure the sBMD of cervical endplates using CT-OAM and correlate it to mechanical implant subsidence in a cadaveric model. Methods: Fourteen fresh human cadaveric cervical spines were subjected to dynamic testing after single level discectomy and instrumentation using a PEEK interbody spacer. Specimens were imaged with CT 3 times: 1st) whole intact cervical spine, 2nd) after implantation, and 3 (rd)) after testing. These images were used to assess sBMD distributions using CT-OAM directly underneath the spacer. Subsidence was defined as the displacement of the device into the endplates. Results: The observed failure mode was consistently recorded as subsidence, with a mean of 0.45 +/- 0.36 mm and 0.40 +/- 0.18 mm for the C4-5 and C6-7 levels, respectively. There were no differences by level. The experimental cyclic test showed that denser endplates experienced less deformation under the same load. Conclusions: This study achieved its stated aim of validating the use of CT-OAM as a method to analyze the sBMD of the cervical endplates. Studies such as this are providing new information on available technology such as CT-OAM, providing new tools for clinicians treating spinal conditions in need of augmentation and stabilization via interbody devices.

Automated summary

This study evaluated the subchondral bone mineral density (sBMD) of cervical endplates using CT-OAM and its correlation with mechanical implant subsidence in a cadaveric model. The results showed that denser endplates experienced less deformation under the same load. The study validated the use of CT-OAM as a method to analyze sBMD, providing new tools for clinicians treating spinal conditions.