Abstract
Purpose
This is the first study to evaluate the predictive value of the vertebral bone quality (VBQ) score on cage subsidence after transforaminal lumbar interbody fusion (TLIF) in a Chinese population using the spinal quantitative computed tomography (QCT) as the clinical standard. Meanwhile, the accuracy of the MRI-based VBQ score in bone mineral density (BMD) measurement was verified.
Methods
We performed a retrospective study of patients who underwent single-level TLIF from 2015 to 2020 with at least 1 year of follow-up. Cage subsidence was measured using postoperative radiographic images based on cage protrusion through the endplates more than 2 mm. The VBQ score was measured on T1-weighted MRI. The results were subjected to statistical analysis.
Results
A total of 283 patients (61.1% of female) were included in the study. The subsidence rate was with 14.1% (n = 40), and the average cage subsidence was 2.3 mm. There was a significant difference in age, sex, VBQ score and spinal QCT between the subsidence group and the no-subsidence group. The multivariable analysis demonstrated that only an increased VBQ score (OR = 2.690, 95% CI 1.312–5.515, p = 0.007) and decreased L1/2 QCT-vBMD (OR = 0.955, 95% CI 0.933–0.977, p < 0.001) were associated with an increased rate of cage subsidence. The VBQ score was found to be moderately correlated with the spinal QCT (r = −0.426, p < 0.001). The VBQ score was shown to significantly predict cage subsidence, with an accuracy of 82.5%.
Conclusion
Our findings indicate that the MRI-based VBQ score is a significant predictor of cage subsidence and could be used to assess BMD.
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Data availability
Data will be available by contacting Limin Liu, the corresponding author, at the above address.
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Acknowledgements
This study was supported in part by the Projects of the Science and Technology Department of Sichuan Province (2022ZDZX0029 and 2021YFS0218), the National Natural Science Foundation of China (82172495; 82072434 and 82272546) and the 1·3·5 project for disciplines of excellence—Clinical Research Incubation Project, West China Hospital, Sichuan University (2021HXFH003). Research Development Program of North Sichuan Medical College (CBY20-QA-Y24). Research Development Plan of the Affiliated Hospital of North Sichuan Medical College (2022JC020).
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Approval obtained from Biomedical Ethics Review Committee of West China Hospital, Sichuan University (Approval number: 2023–250). The requirement for informed consent was waived to the retrospective analysis.
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Ai, Y., Chen, Q., Huang, Y. et al. MRI-based vertebral bone quality score for predicting cage subsidence by assessing bone mineral density following transforaminal lumbar interbody fusion: a retrospective analysis. Eur Spine J 32, 3167–3175 (2023). https://doi.org/10.1007/s00586-023-07854-7
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DOI: https://doi.org/10.1007/s00586-023-07854-7