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MRI-based vertebral bone quality score compared to quantitative computed tomography bone mineral density in patients undergoing cervical spinal surgery

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Abstract

Purpose

The vertebral bone quality (VBQ) score based on magnetic resonance imaging (MRI) was introduced as a bone quality marker in the lumbar spine. Prior studies showed that it could be utilized as a predictor of osteoporotic fracture or complications after instrumented spine surgery. The objective of this study was to evaluate the correlation between VBQ scores and bone mineral density (BMD) measured by quantitative computer tomography (QCT) in the cervical spine.

Methods

Preoperative cervical CT and sagittal T1-weighted MRIs from patients undergoing ACDF were retrospectively reviewed and included. The VBQ score in each cervical level was calculated by dividing the signal intensity of the vertebral body by the signal intensity of the cerebrospinal fluid on midsagittal T1-weighted MRI images and correlated with QCT measurements of the C2–T1 vertebral bodies. A total of 102 patients (37.3% female) were included.

Results

VBQ values of C2–T1 vertebrae strongly correlated with each other. C2 showed the highest VBQ value [Median (range) 2.33 (1.33, 4.23)] and T1 showed the lowest VBQ value [Median (range) 1.64 (0.81, 3.88)]. There was significant weak to moderate negative correlations between and VBQ Scores for all levels [C2: p < 0.001; C3: p < 0.001; C4: p < 0.001; C5: p < 0.004; C6: p < 0.001; C7: p < 0.025; T1: p < 0.001].

Conclusion

Our results indicate that cervical VBQ scores may be insufficient in the estimation of BMDs, which might limit their clinical application. Additional studies are recommended to determine the utility of VBQ and QCT BMD to evaluate their potential use as bone status markers.

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Funding

This research received no specific Grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Lisa Oezel, Ichiro Okano, Conor Jones, Stephan N. Salzmann, Jennifer Shue, Dominik Adl Amini, Manuel Moser, Erika Chiapparelli, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi & Alexander P. Hughes

  2. Department of Radiology and Imaging, 535 East 70th Street, New York, NY, 10021, USA

    John A. Carrino

  3. Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany

    Lisa Oezel

  4. Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Dominik Adl Amini

  5. Department of Spine Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland

    Manuel Moser

  6. Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Stephan N. Salzmann

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  1. Lisa Oezel
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Correspondence to Alexander P. Hughes.

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Conflict of interest

LO, IO, CMJ, SNS, JS, EC, DAA and MM have no relevant financial or non-financial interests to disclose. JAC declares financial interests: Consulting: Covera Health; Globus Medical, Inc; Image Biopsy Lab; Pfizer, Inc; Simplify Medical; Scientific Advisory Board: Carestream, Image Analysis Group; AAS declares financial interests: Royalties: Ortho Development Corp; Private investments: Vestia Ventures MiRUS Investment LLC, ISPH II LLC, ISPH 3 LLC, VBros Venture Partners X Centinel Spine; Consulting: Clariance Inc, Kuros Bioscience AG, Medical Device Business Services Inc; Speaking and Teaching Arrangements: DePuy Synthes Products Inc; Trips/Travel: Medical Device Business Services Inc; Research Support: Spinal Kinetcs Inc; FPC declares financial interests: Royalties: NuVasive Inc; Private investments: Bonovo Orthopedics Inc, Healthpoint Capital Partners LP, ISPH II LLC, Ivy Healthcare Capital Partners LLC, Medical Device Partners II LLC, Medical Device Partners III LLC, Orthobond Corporation, Spine Biopharma LLC, Tissue Differentiation Intelligence LLC, VBVP VI LLC, Woven Orthopedics Technologies; Consulting: 4Web Medical/4Web Inc, Spine Biopharma LLC, Research Support: 4Web Medical/4Web Inc, Beatrice & Samuel A. Seaver Foundation; Non-financial interests: Scientific Advisory Board: Healthpoint Capital Partners LP, Orthobond Corporation, Spine Biopharma LLC, Woven Orthopedic Technologies; FPG declares financial interests: Royalties: NuVasive Inc, Ortho Development Corp, Zimmer Biomet Holdings INC; Stock Ownership: Bonovo Orthopedics Inc, Liventa Bioscience (AF Cell Medical), Paradigm Spine LLC, Healthpoint Capital Partners LP, Alphatec Holdings LLC, LANX Inc, Centinel Spine Inc (fka Raymedica LLC), Tissue Differentiation Intelligence LLC, Spine Kinetics Inc; Consulting: DePuy Synthes Spine, NuVasive Inc; Non-financial interests: Consulting: EIT Emerging Implant Technologies, Spineart USA Inc, Ethicon Inc; APH declares financial interests: Research Support: Kuros Biosciences AG; Fellowship Support: NuVasive Inc, Kuros Bioscience B.V.

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This study was approved by the hospital’s Institutional Review Board (IRB # 2019–2137), and written informed consent was waived given the de-identified nature of the data.

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Oezel, L., Okano, I., Jones, C. et al. MRI-based vertebral bone quality score compared to quantitative computed tomography bone mineral density in patients undergoing cervical spinal surgery. Eur Spine J 32, 1636–1643 (2023). https://doi.org/10.1007/s00586-023-07570-2

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