• Ping Liu, Bin Zhou, Fei Chen, Zhehao Dai, and Yijun Kang.
• Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha City, China.
• World Neurosurg. 2020 Apr 1; 136: e204-e213.

ObjectiveWe assessed the trabecular microarchitecture of the spinous process as an autograft and investigated its correlations with fusion success and clinical outcomes for patients undergoing posterior lumbar interbody fusion.MethodsMicro-computed tomography reconstruction techniques were used to scan cancellous bone specimens from spinous processes. We then measured the microarchitectural parameters for 105 subjects.ResultsThe patient cohort included 44 older men and 61 postmenopausal women with a minimum of 2-year follow-up data available. The complete fusion rate was 87.6% (92 of 105) at the last follow-up. When stratified by fusion status, the union group had significantly greater bone surface/total volume (BS/TV) and trabecular number but significantly lower trabecular separation than the nonunion group. No statistically significant differences were observed between the 2 groups in the clinical variables, except for the bone mineral density at the femoral neck (P = 0.028). On binomial logistic regression analysis, BS/TV was identified as an independent predictor for fusion success (odds ratio, 8.532; P = 0.032). The receiver operating characteristic curve showed that BS/TV had excellent performance in predicting successful fusion (area under the curve, 0.807). Using a cutoff value for BS/TV of 3.145, a greater BS/TV was significantly associated with visual analog scale scores for lower back pain 6 months postoperatively and lower Oswestry disability index scores at 12 and 24 months postoperatively but not with visual analog scale scores for leg pain.ConclusionsOur data suggest that microstructural deterioration of the spinal process as an autograft has detrimental effects on spinal fusion and clinical outcomes for patients undergoing instrumented posterior lumbar interbody fusion. Specifically, the microstructural parameter BS/TV has good potential for assessing lumbar bone quality and predicting fusion success.Copyright © 2019 Elsevier Inc. All rights reserved.

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