Quantitative CT-based bone strength parameters for the prediction of novel spinal implant stability using resonance frequency analysis: a cadaveric study involving experimental micro-CT and clinical multislice CT

BACKGROUND: To predict conventional test forces (peak torque and pull-out force) and a new test force (implant stability quotient [ISQ] value of a spinal pedicle screw) from computed tomography (CT) parameters, including micro-architectural parameters, using high-resolution micro-CT and clinical multislice CT (MSCT) in human cadaveric vertebrae. METHODS: Micro-CT scans before/after screw insertion (n = 68) and MSCT scans before screw insertion (n = 58) of human cadaveric vertebrae were assessed for conventional test forces and ISQ value. Three-dimensional volume position adjustment between pre-insertion micro-CT and MSCT scans and post-insertion scans (micro-CT) was performed to extract the volume of the cancellous bone surrounding the pedicle screw. The following volume bone mineral density and micro-architectural parameters were calculated: bone volume fraction, bone surface density (bone surface/total volume (BS/TV)), trabecular thickness, trabecular separation, trabecular number, structure model index, and number of nodes (branch points) of the cancellous bone network/total volume (NNd/TV) using Spearman's rank correlation coefficient with Bonferroni correction. RESULTS: Conventional test forces showed the strongest correlation with BS/TV: peak torque, ρ = 0.811, p = 4.96 × 10-17(micro-CT) and ρ = 0.730, p = 7.87 × 10-11 (MSCT); pull-out force, ρ = 0.730, p = 1.64 × 10-12 (micro-CT) and ρ = 0.693, p = 1.64 × 10-9 (MSCT). ISQ value showed the strongest correlation with NNd/TV: ρ = 0.607, p = 4.01 × 10-8 (micro-CT) and ρ = 0.515, p = 3.52 × 10-5 (MSCT). CONCLUSIONS: Test forces, including the ISQ value, can be predicted using micro-CT and MSCT parameters. This is useful for establishing a preoperative fixation strength evaluation system.