Purpose
This study aimed to evaluate the predictive performance of preoperative computed tomography–based Hounsfield unit (HU) and magnetic resonance imaging-based vertebral bone quality score (VBQS) for cage subsidence after 1- to 2-level oblique lumbar interbody fusion (OLIF), and whether it differs by intraoperative cage placement position.
Methods
Ninety-one OLIF levels in 54 patients (2015–2022) were retrospectively reviewed in this single-center cohort. Subsidence was defined as ≥2 mm middle disc-height reduction or ≥2 mm cage protrusion at 1 year. Multivariable logistic regression with cluster-robust standard errors estimated adjusted odds ratios (OR); the pre-specified primary test was the lower-instrumented-vertebra HU×cage-position interaction.
Results
Subsidence occurred in 24 of 91 levels (26.4%). Each one-standard-deviation decrease in lower-instrumented-vertebra HU was independently associated with subsidence (adjusted OR, 0.40; 95% confidence interval, 0.20 to 0.81; p=0.011); VBQS was not. The subsidence group included more osteoporosis-range levels (<110 HU; 62.5% vs. 25.4%, p=0.003). The interaction was not significant (p=0.553), but the HU effect concentrated in middle-placed cages (adjusted OR, 0.345; p=0.012) and attenuated in anterior-placed cages (OR, 0.50; p=0.185).
Conclusion
Lower-instrumented-vertebra HU is an independent predictor of cage subsidence after 1- to 2-level OLIF, most evident in middle-placed cages.

Purpose
To assess the volume of fusion mass after posterior lumbar interbody fusion (PLIF) using Hounsfield units methods.
Methods
The present study was within the frame work about a prospective observational cohort study to compare the surgical outcomes of a single-level PLIF for LSS between the local bone (LbG) and local bone plus hydroxyapatite groups (LbHa). The fusion material for each case was determined by the amount of available local bone. After the fusion material was chosen, patients were assigned to either the LbG group (n=20) or the LbHa group (n=20). The primary outcome was the assessment of fusion mass volume in each group.
Results
We used the new method using Hounsfield units for volumetric assessments of interbody fusion mass. There was no difference in fusion rates or volume of the fusion mass between the 2 groups.
Conclusions
Hounsfield unit method, that is the CT-based summation method using a cross-sectional slice, can be applied usefully to other areas of orthopaedics.