Osteoporosis in adjacent cervical segments exacerbates disc herniation

Current studies into the relationship between osteoporosis and cervical disc herniation (CDH) remain inconclusive, primarily due to the scarcity of large-sample clinical follow-ups and biomechanical evidence. This retrospective, single-center study analyzed a consecutive series of 933 patients. We compared clinical parameters including age, gender, BMI, smoking history, alcohol consumption, steroid use history, thyroid dysfunction, diabetes history, and C5-C6 Hounsfield Unit (HU) values between groups with and without C5 disc herniation. Use multivariable-adjusted logistic regression to analyze the relationship between C5 and C6 vertebral body HU values and CDH. A finite element model was utilized to assess the impact of osteoporosis on cervical segments. In the Logistic regression analysis, after adjusting for confounding variables, the results showed that decreased HU values in the C5 (OR: 0.951, 95% CI: 0.911-0.992, P = 0.02) and C6 (OR: 0.923, 95% CI: 0.884-0.964, P < 0.001) segments were independent influencing factors for intervertebral disc herniation at the C5 level of the cervical spine. In addition, finite element analysis showed that articular cartilage stress decreased in the reduced bone density group, whereas disc stress and displacement increased. Osteoporosis of adjacent cervical segments increases the risk of disc herniation.