Abstract:
Introduction. Dual x-ray absorptiometry (DEXA) scan has been the gold standard for assessing bone mineral density
prior to spinal instrumentation surgery. DEXA scans, on the other hand, can produce falsely elevated measurements in
patients with severe degenerative changes, compression fractures, and aortic calcification, which can lead to incorrect
patient selection and failed interbody fusion.
Materials and methods. Detailed anamnesis of disease development, thorough clinical examination, patient-reported
outcome measures (pain VAS, ODI, SF-12), preoperative and postoperative bone-window CT of the spine (interbody fusion
status assessment), vertebral bone mineral density assessment by DEXA scan, vertebral bone density measurement in
Hounsfield units by computer tomography, and the review of published literature were analysed.
Results. A 67-year-old woman was diagnosed with L4-L5 degenerative spondylolisthesis. DEXA scan revealed normal
bone mineral density in the lumbar vertebrae. The patient underwent midline lumbar interbody fusion (MIDLIF). The
postoperative course was complicated by the occurrence of clinical and radiographic signs of pseudarthrosis. She refused
revision surgery and was lost to follow-up. Three years postoperatively, she presented in good physical condition, with
significant improvement in pain and functional disability. A CT scan showed delayed successful interbody fusion with
complete resolution of radiolucency around implants.
Conclusions. This case report summarizes some of the possible errors in diagnosis and surgical treatment in patients with
degenerative pathology associated with severe vertebral osteoporosis.
