Interpreting the DXA analysis: When should you hold off on spinal fusion?

Dual energy x-ray absorptiometry (DXA) is the standard assessment of bone mineral density (BMD) and is used for the diagnosis of osteoporosis and monitoring the effectiveness of osteoporosis treatment. Its results are predictive of both vertebral compression fractures and vertebral screw pullout strength. Though low BMD and the presence of osteoporosis are associated with failure of spinal instrumentation and junctional kyphosis, DXA scans are not universally obtained prior to spinal fusions, and there exists no consensus on T-score thresholds for determining if spinal fusions are a reasonable option in patients with diminished bone quality.