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MRI-based vertebral bone quality score for predicting cage subsidence by assessing bone mineral density following transforaminal lumbar interbody fusion: a retrospective analysis

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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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Author notes

  1. Youwei Ai and Qian Chen have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Youwei Ai, Qian Chen, Yong Huang, Hong Ding, Juehan Wang, Ce Zhu, Yueming Song, Ganjun Feng & Limin Liu

  2. Department of Orthopaedics and Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China

    Qian Chen

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  1. Youwei Ai
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Correspondence to Ganjun Feng or Limin Liu.

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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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