A Novel Cervical Vertebral Bone Quality Score Independently Predicts Cage Subsidence After Anterior Cervical Diskectomy and Fusion

The Cervical Vertebral Bone Quality Score Is a Novel Reliable Index Reflecting the Condition of Paraspinal Muscles and Predicting Loss of Cervical Lordosis After Open-Door Laminoplasty

OBJECTIVE

Recently, the MRI-based cervical vertebral bone quality (C-VBQ) scoring system has demonstrated accuracy in reflecting cervical bone quality and predicting postoperative complications from cervical spine surgery. Studies have shown that cervical bone quality is closely linked to loss of cervical lordosis (LCL) after open-door laminoplasty. Additionally, research on lumbar VBQ indicates a strong correlation between lumbar VBQ scores and lumbar paraspinal muscle quality. However, the relationship of C-VBQ score to cervical paraspinal muscles and LCL remains unclear. Therefore, this study aimed to explore the relationship between C-VBQ score and cervical paraspinal muscle-related parameters as well as postoperative LCL, in addition to exploring the risk factors associated with LCL.

METHODS

A total of 101 patients who underwent standard C3-C7 open-door laminoplasty at our institution from 2012 to 2022 were included in this study. The LCL group was defined as loss of cervical lordosis > 5° at 1-year postoperative follow-up. Cervical X-rays were obtained to measure the C2-7 Cobb angle, C2-7 sagittal vertical axis (SVA), T1 slope, and cervical range of motion (ROM). The relative cross-sectional area (RCSA) and degree of fat infiltration (DFF) of the deep cervical extensors, flexors, and all muscles were measured using image J software. Cervical CT Hounsfield unit (HU) and C-VBQ values were measured on preoperative CT and MRI T1-weighted mid-sagittal images, respectively. Then, demographics, cervical sagittal parameters, ROM, paraspinal muscle-related parameters, CT-HU and C-VBQ values were assessed for their correlation with LCL, and multivariate linear analysis was used to determine the risk factors associated with LCL. Finally, the relationship between C-VBQ scores and cervical paraspinal muscle-related parameters was evaluated.

RESULTS

A total of 55 (54.45%) patients were included in the LCL group due to loss of cervical lordosis > 5° at 1-year follow-up. LCL was positively correlated to the preoperative T1 slope, Flexion ROM, C2-7 ROM, Flexion/Extension ROM, Flexion muscles DFF, Extension muscles DFF, Average DFF, and C-VBQ scores, while it was negatively correlated to Extension ROM, Extension muscles RCSA, Total RCSA, and CT-HU values. Furthermore, Flexion/Extension ROM, Total RCSA, Average DFF, CT-HU, and C-VBQ values were independent risk factors for LCL. In addition, C-VBQ scores were significantly correlated with RCSA and DFF of Flexion and Extension muscles.

CONCLUSIONS

This study is the first to find a significant correlation between C-VBQ scores and cervical paraspinal muscle quality. The C-VBQ score is a comprehensive indicator that reflects the quality of the cervical bone and paravertebral muscles, and it is a novel predictor of LCL after open-door laminoplasty.

Cervical Vertebra Bone Quality Score Predicts Zero-Profile Anchored Spacer Interbody Fusion Cage Subsidence after Anterior Cervical Diskectomy and Fusion: A Retrospective Study

Study DesignRetrospective study.ObjectiveThis retrospective study primary focus is to investigate the relationship between the C-VBQ score and the occurrence of postoperative zero-profile anchored spacer (ROI-C) interbody fusion cage subsidence. Additionally, we aim to evaluate the predictive efficacy of the C-VBQ scoring system for subsidence in the context of ACDF with the ROI-C.MethodsPatients who underwent ACDF with the ROI-C cage at our hospital between January 2016 and December 2022 were included in this study. Univariate analysis and multivariate logistic regression were employed to identify independent risk factors associated with ROI-C cage subsidence after ACDF. Pearson correlation analysis was utilized to assess the correlation between the C-VBQ score and the height of ROI-C cage subsidence.ResultsA total of 102 patients underwent ACDF with ROI-C in our hospital were included in this study. Univariate analysis showed that age (P = 0.021) and C-VBQ score (P < 0.001) were the influencing factors of cage subsidence. Pearson correlation analysis showed that there was a significant positive correlation between the subsidence height of ROI-C cage and C-VBQ (r = 0.55, P < 0.01). Multivariate binary logistic regression analysis showed that C-VBQ score was the only variable that could significantly predict the subsidence of ROI-C cage after ACDF. Higher C-VBQ score was significantly associated with cage subsidence (P < 0.001).The AUC was 0.89, and the cutoff value for C-VBQ was 2.70.ConclusionThe findings indicate a significant correlation between a higher C-VBQ score before surgery and ROI-C cage subsidence after ACDF. The preoperative assessment of C-VBQ proves valuable for clinicians, enabling them to identify patients with low bone mineral density and predict the risk of zero-profile anchored spacer interbody fusion cage subsidence following ACDF.

Predictive value of vertebral specificity of bone mineral density for cage subsidence among patients undergoing anterior cervical diskectomy and fusion: a retrospective study

PURPOSE

To investigate the predictive value of different vertebral specificity of BMD for cage subsidence among patients undergoing ACDF.

METHODS

BMD at different vertebrae was measured by CT image and MRI image. Cage subsidence was defined as ≥ 3 mm loss of fusion segmental height. Logistic regression analysis was used to identify BMD at specific vertebrae associated with cage subsidence. Receiver operating characteristic curve analysis was used to evaluate the value of BMD of different vertebrae in predicting cage subsidence.

RESULTS

117 patients (182 intervertebral spaces) were included, with a mean age of 54.6 ± 10.9years. The mean follow-up was 12.5 ± 3.8months. Of the 182 intervertebral spaces, subsidence was found in 85 (46.7%) intervertebral spaces. The mean Hounsfield unit (HU) values measured by CT in the subsidence group were significantly lower than those in the non-subsidence group (upper vertebral body: 285.8 vs. 361.8, p < 0.001; lower vertebral body: 262.1 vs. 324.0, p < 0.001; average: 273.9 vs. 342.9, p < 0.001). Similarly, the mean bone quality scores measured by MRI in the subsidence group were higher than those in the non-subsidence group (upper vertebral body: 2.69 vs. 2.19, p < 0.001; lower vertebral body: 2.58 vs. 2.18, p < 0.001; average: 2.63 vs. 2.19, p < 0.001). Logistic regression analysis showed that the HU values were significantly negatively correlated with subsidence (p < 0.001), while the bone quality scores were significantly positively correlated with subsidence (p < 0.001). The results show that the Pre-T1 slope, Post-C2-C7 Cobb angle, and Post-T1 slope in the subsidence group were significantly larger than those in the non-subsidence group, with statistically significant differences (Pre-T1 slope: P = 0.015; Post-C2-C7: P < 0.001; Post-T1 slope: P = 0.006). The results from the multivariate logistic regression analysis indicated that bone density indicators remained statistically significant in predicting fusion device subsidence, while the Post-C2-C7 Cobb angle from the sagittal plane parameters also demonstrated statistical significance.The areas under the curve (AUCs) of BMD in the upper vertebrae were greater than those in the lower vertebrae, whether measured by CT (upper vertebral body: 0.754, lower vertebral body: 0.723; upper endplate: 0.766, lower endplate: 0.712) or MRI (upper vertebral body: 0.755, lower vertebral body: 0.717; upper endplate: 0.702, lower endplate: 0.646). These results indicate that the BMD of the upper vertebrae may be a better predictor of cage subsidence than that of the lower vertebrae.

CONCLUSION

The bone density (HU value and VBQ score) at the surgical site is a strong predictor of cage subsidence in patients undergoing ACDF. For BMD assessment, we recommend that site-specific measurements, particularly those of the upper vertebrae, be given greater consideration rather than relying solely on generalized or averaged values.

MRI-based L1 Vertebral Bone Quality Scores Predict Cage Subsidence Following Transforaminal Lumbar Interbody Fusion Similar to L1 CT Hounsfield Units

Cage subsidence is one of the most common complications after transforaminal lumbar interbody fusion (TLIF) and correlates with inferior bone quality. Studies have reported L1 vertebral bone quality score (VBQ) based on MRI to be a promising alternative to evaluating preoperative bone quality. However, to the knowledge of the authors, no study has examined the correlation between L1 VBQ scores and cage subsidence after TLIF.The purpose of the study was (1) to assess the interrelation between the L1 VBQ score and cage subsidence after TLIF; and (2) to compare L1 VBQ and L1 CT Hounsfield Unit (HU) values in predicting cage subsidence after TLIF.We reviewed patients who had undergone TLIF at one institution between 2012 to 2021. Cage subsidence was measured using postoperative lumbar CT based on cage protrusion through the endplates at more than 2 mm. The L1 VBQ score was calculated by dividing mean L1 signal intensity (SI) by mean SI of the cerebrospinal fluid (CSF) at L1. The L1 HU value representing bone mineral density (BMD) was measured using computed tomography. We then performed Student's t-test for independent samples and logistic regression analyses for statistical analysis. We also conducted receiver operating characteristic (ROC) analysis to assess the predictive ability of the L1 VBQ score and L1 CT HU.Of 233 participants, cage subsidence was observed in 41 patients (17.6%). Comparison between the characteristics of patients between the group with subsidence and the group without subsidence revealed significant differences in the age, VBQ score, and L1 CT HU. Multivariate logistic regression showed that higher L1 VBQ score (OR = 2.499, 95% CI: 1.205-5.180, p = 0.014) and lower L1 CT HU (OR = 0.960, 95% CI: 0.933-0.987, p = 0.005) were associated with an increased rate of cage subsidence. Area under the curve (AUC) analysis of the L1 VBQ score returned 0.735 (95% CI: 0.620-0.850) and the suitable threshold was 3.424 (sensitivity: 82.9%, specificity: 70.7%). The AUC of L1 CT HU was 0.747 (95% CI: 0.642-0.852) and the suitable threshold was 136.5 (sensitivity: 85.4%, specificity: 56.1%).The present study demonstrates that L1 VBQ score and L1 CT HU are reliable predictors with similar performance for cage subsidence after TLIF.

MRI-Based Cervical VBQ Scores as Predictors of Cage Subsidence in Cervical Spine Surgery: A Meta-Analysis

Study DesignSystematic review and meta-analysis.ObjectivePoor bone quality is a major risk factor for complications after cervical spine surgery. The MRI-based cervical vertebral bone quality (C-VBQ) score is a reliable tool for assessing bone quality. This study systematically evaluates, for the first time, the predictive value of C-VBQ for cage subsidence risk in cervical spine surgery patients using meta-analysis.MethodsWe conducted a comprehensive search of relevant literature in electronic databases up to October 16, 2024, to systematically assess the quality of included studies. Publication bias was evaluated by comparing C-VBQ between groups and calculating pooled sensitivity, specificity, and summary receiver operating characteristic (SROC) curves.Results7 studies involving 681 patients were included. Using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool, the studies were deemed high quality with low risk of bias. High C-VBQ scores were significantly associated with fusion subsidence, with a pooled odds ratio of 2.98 (95% CI: 1.68-5.30). The C-VBQ cut-off value was 2.94 ± 0.32, and the combined sensitivity and specificity for diagnosing postoperative complications were 0.78 and 0.87, respectively, with an area under the curve of 0.90 (95% CI: 0.87-0.92).ConclusionIn patients undergoing degenerative cervical spine surgery, higher C-VBQ scores were significantly associated with an increased risk of cage subsidence. The C-VBQ score is a reliable tool for preoperative bone quality assessment and serves as an independent predictor of cage subsidence risk following cervical spine surgery.

Would Roussouly classification affect the diagnostic efficiency of vertebral bone quality score for assessing osteopenia or osteoporosis in lumbar degenerative disease?

PURPOSE

The aim of this study is to estimate the diagnostic efficiency of VBQ score for assessing osteopenia and osteoporosis in different Roussouly types in lumbar degenerative disease.

METHODS

We reviewed the preoperative data of 501 patients with lumbar degenerative diseases who underwent lumbar spine surgery between July 2019 and December 2022 with available T1-weighted magnetic resonance imaging and dual-energy X-ray absorptiometry. Receiver operating characteristic (ROC) curves were plotted to analyze the diagnostic performance of VBQ score in different Roussouly classifications. For each Roussouly type, one-way ANOVA was applied to compare VBQ score across different lumbar segments. Statistical significance was set at P < 0.05.

RESULTS

No statistical difference was found between the VBQ score of L1, L2, L3 and L4. Lumbar lordosis and sacral slope were not independently associated with VBQ score. According to the ROC curve, Roussouly type 1 to 4 showed AUC of 0.738, 0.799, 0.764 and 0.817, respectively, in diagnosing osteopenia. Roussouly type 1 to 4 showed AUC of 0.690, 0.703, 0.851 and 0.643, respectively, in diagnosing osteoporosis.

CONCLUSIONS

Different Roussouly types would not affect the diagnosis efficiency of VBQ score in diagnosing osteopenia. However, VBQ score showed better performance in diagnosing osteoporosis for Roussouly type 3. When VBQ score was applied as opportunistic screening method for osteoporosis, choosing appropriate patients was important to improve the diagnostic accuracy.

MRI-based endplate bone quality score independently predicts cage subsidence after anterior cervical corpectomy fusion

BACKGROUND

To reduce the amount of radiation that patients receive during surgery, surgeons can evaluate the quality of the bone prior to surgery using computed tomography (CT) or dual-energy X-ray absorptiometry. Recently, lumbar spine vertebral bone quality has been evaluated using an MRI-based scoring system. However, few studies have investigated the connection between cage subsidence in patients following cervical interbody fusion and site-specific MRI bone evaluation. It is unknown how cage subsidence following anterior cervical corpectomy decompression and fusion is related to MRI-based endplate bone quality assessment.

PURPOSE

To create a similar MRI-based cervical spine scoring system (C-EBQ) and to investigate the predictive value of the MRI cervical endplate bone quality (C-EBQ) score for cage subsidence after ACCF.

METHODS

The patients' demographic, surgical, and radiological data were collected. Cage subsidence was defined as fusion segment height loss ≥ 3 mm. Multivariate logistic regression models were developed to determine correlations between potential risk factors and subsidence, and simple linear regression analyses of statistically significant indicators were performed.

RESULTS

Among the patients who underwent single-level ACCF, 72 met the requirements for inclusion. The C-VBQ scores also improved from 2.28 ± 0.12, indicating no subsidence, to 3.27 ± 0.35, which indicated subsidence, and the C-EBQ scores improved in both the nonsubsidence group (1.95 ± 0.80) and the subsidence group (2.38 ± 0.54). There was a statistically significant difference (p < 0.05) among the groups. Higher C-EBQ scores were strongly correlated with subsidence in the multivariate analysis (odds ratio [OR] = 17.249, 95% CI = 2.269 to 7.537, P < 0.001), and the C-VBQ score was the major independent predictor of subsidence following ACCF ([OR] = 4.752, 95% CI = 3.824 to 8.781, P < 0.05). The C-EBQ score outperformed the C-VBQ score (75.6%) in terms of predictive accuracy, with a ROC curve indicating an 89.4% score.

CONCLUSIONS

After ACCF, cage subsidence was strongly correlated with higher C-EBQ scores on preoperative MRI. Assessing C-EBQ before ACCF may be a useful way to estimate the likelihood of postoperative subsidence.

Simultaneous comparison of three methods for bone quality assessment

PURPOSE

The study aims to investigate the correlations between the T score, Hounsfield units (HU) value, and vertebral bone quality (VBQ) score, and to compare their discrimination capability for patients with osteoporotic vertebral compression fracture (OVCF).

METHODS

One hundred and sixty-three eligible participants were enrolled (49 OVCF group,114 non-OVCF group). The T score, HU value, and VBQ score were collected retrospectively. Then, those three parameters were compared between the OVCF and non-OVCF groups and the correlations among the three were assessed. Finally, the discrimination capability of those parameters was compared by the receiver operating characteristic (ROC) curves.

RESULTS

The OVCF group showed a lower T score, lower HU value, and higher VBQ score (all P < 0.001) than the non-OVCF group. Correlations were observed among the T score, HU value, and VBQ score (all P < 0.001, HU VS. mean T score, r = 0.66; HU VS. minimum T score, r = 0.67; VBQ VS. mean/ minimum T score, r=-0.33; VBQ VS. HU, r=-0.45). The HU value indicated the maximum area under curve (AUC), followed by the VBQ score and then the T score. Moreover, the AUC of combining the VBQ score and the HU value was similar to that of the HU value.

CONCLUSIONS

Both the HU value and the VBQ score had superior discrimination capability for patients with OVCF compared to the T score, especially for the HU value. For patients with routinely performed lumbar MRI or CT scans, the HU value or the VBQ score may provide alternative options for assessing the bone condition.

Bone Density of Vertebral Bodies and Ossified Masses in Cervical Ossification of the Posterior Longitudinal Ligament: An Imaging Study Based on MRI, CT, and DEXA

Complications from anterior decompression fusion for cervical ossification of the posterior longitudinal ligament (OPLL) are often related to the bone mineral density (BMD) of vertebral bodies and ossified masses. The aim of this study was to clarify whether dual-energy X-ray absorptiometry (DEXA) T-scores reliably predict BMD in these structures, and whether vertebral bone quality (VBQ) and Hounsfield units (HU) can be effectively used to screen for osteopenia and osteoporosis. A total of 122 patients with cervical OPLL and 105 non-OPLL patients were included. Vertebral BMD was assessed by VBQ and HU, and ossified mass BMD was assessed by ossified mass bone quality (OMBQ) and ossification mass HU (OMHU). Overall, VBQ scores and HU values demonstrated weaker correlations with T-scores in the OPLL group compared with the non-OPLL group. Receiver operating characteristic curve analyses showed that VBQ and HU effectively discriminated osteopenia/osteoporosis in the OPLL cohort, with area under the curve values ranging from 0.763 to 0.827, similar to the non-OPLL. No significant differences in BMD were observed between the OPLL and non-OPLL groups based on the common assessment of VBQ, HU and DEXA-derived BMD (p > 0.05). Both OMBQ and OMHU showed good reliability and were significantly correlated with T-scores (p < 0.05). In patients with cervical OPLL, VBQ and HU remain effective screening tools for osteopenia/osteoporosis, potentially guiding or obviating the need for further DEXA scans. Additionally, our findings suggest that patients with lower T-scores may exhibit reduced BMD in both vertebral bodies and ossified masses.

An analysis of different modalities of bone mineral densitometry evaluation in cage subsidence in anterior cervical discectomy and fusion

Objective

To compare the effectiveness of different measurement methods on bone miner density (BMD), including cervical HU of CT, MRI-based cervical vertebral bone quality (C-VBQ), and T value of DEXA, for predicting cage subsidence after single-level ACDF.

Methods

This is a retrospective study, and patients who underwent single-level ACDF from June 2019 to June 2022 were recruited. We collected preoperative total segmental vertebral height (pre-TSVH), cage subsidence height, cervical angle (CA), T1-slope, straight or reverse cervical curvature, mean HU value of C3-7 (C-HU), mean HU of segment (seg-HU), C-VBQ, segmental C-VBQ (seg-VBQ), and total lumbar T value (T value). The variables between the two groups were compared by Student's t test or chi-square test. Logistic regression was used to determine the independent risk factors for subsidence. The ROC curve was used to analyze the predictive efficiency of C-HU, seg-HU, C-VBQ, seg-VBQ and T value for cage subsidence. Finally, the correlations of C-HU, seg-HU, C-VBQ, seg-VBQ, T value and subsidence height were analyzed.

Results

A total of 320 patients were included in this study, and 97 patients (30.31%) had cage subsidence at the last follow-up. The subsidence height was 4.25 ± 0.937 mm in the subsidence group and 1.40 ± 0.726 mm in the nonsubsidence group. There were statistically significant differences between the two groups in bone mineral density-related indexes, including C-HU, seg-HU, C-VBQ, seg-VBQ, and T value (p < 0.05). Logistic regression analysis showed that C-HU was an independent risk factor for vertebral subsidence after single-level ACDF. ROC curve analysis showed that C-HU had the largest AUC of 0.897 (0.862, 0.933) in predicting vertebral subsidence. Correlation analysis showed that C-HU had a high correlation with the T value (r = 0.662, p < 0.001), while C-VBQ had a low correlation with the T value (r = -0.173, p = 0.002), and C-VBQ had a low correlation with subsidence height (r = 0.135, p = 0.016).

Conclusion

Our study showed that compared with the C-VBQ and T value, C-HU is more effective for predicting cage subsidence after ACDF. Using the segmental index of C-VBQ or HU could not improve predictive effectiveness. C-VBQ may be insufficient in predicting cage subsidence and estimating BMD.

Low bone mineral density: a primer for the spine surgeon

Within spinal surgery, low bone mineral density is associated with several postoperative complications, such as proximal junctional kyphosis, pseudoarthrosis, and screw loosening. Although modalities such as CT and MRI can be utilized to assess bone quality, DEXA scans, the "Gold Standard" for diagnosing osteoporosis, is not routinely included in preoperative workup. With an increasing prevalence of osteoporosis in an aging population, it is critical for spine surgeons to understand the importance of evaluating bone mineral density preoperatively to optimize postoperative outcomes. The purpose of this state-of-the-art review is to provide surgeons a summary of the evaluation, treatment, and implications of low bone mineral density in patients who are candidates for spine surgery.

[Correlation of Vertebral Bone Quality and Paraspinal Muscle Changes With Adjacent Segment Degeneration After Transforaminal Lumbar Interbody Fusion Operation]

Objective

To investigate the correlation of vertebral bone quality (VBQ) and paraspinal muscle changes with adjacent segment degeneration (ASD) after transforaminal lumbar interbody fusion (TLIF) through a retrospective analysis of patients who have undergone TLIF for lumbar degenerative diseases (LDD).

Methods

A total of 98 patients who underwent TLIF surgical treatment for LDD between January 2016 and December 2022 at Shenzhen People's Hospital were selected. Well-established follow-up imaging data were available for all subjects who were divided into two groups, the ASD group (n=43) and the non-ASD (N-ASD) group (n=55), according to whether they met the ASD evaluation criteria. Data on the basic characteristics of the patients in both groups were collected, and the relevant parameters, including VBQ and the total cross-sectional area (TCSA) and the functional cross-sectional area (FCSA) of psoas major (PM), erector spinae (ES), and multifidus (MF), were measured by magnetic resonance imaging of the lumbar spine performed preoperatively and at the last follow-up. Then, the relative fat infiltration (RFI) was calculated from the above metrics accordingly. Logistic regression analysis was conducted to investigate the risk factors for ASD.

Results

The incidence of ASD was 43.9% (n=43) at the final follow-up. The mean follow-up time was (27.23±4.15) months. The age, body mass index (BMI), preoperative bone mineral density (BMD), preoperative VBQ, ΔRFIPM, and ΔRFIES+MF showed significant differences between the ASD and N-ASD groups (P<0.05). According to the results of the logistic regression analysis, BMI (odds ratio [OR]=1.450, 95% confidence interval [CI]: 1.081-1.945, P=0.013), preoperative VBQ (OR=6.191, 95% CI: 1.692-22.657, P=0.006), and ΔRFIES+MF (OR=1.117, 95% CI: 1.007-1.238, P=0.037) were independent risk factors for ASD.

Conclusion

The incidence of postoperative ASD in patients who have undergone TLIF for LDD was found to be associated with higher BMI, preoperative VBQ, and increased postoperative relative fat infiltration of the ES and MF muscles. Consequently, it is advisable to prioritize the intraoperative protection of the paraspinal muscles during TLIF. In the postoperative period, it is essential to strengthen exercises of the lower back muscles and to optimize bone mass and weight management, which is conducive to reducing the risk of ASD in the postoperative period.

A novel cervical vertebral bone quality score can independently predict cage subsidence after anterior cervical corpectomy and fusion

OBJECTIVES

To optimize cervical vertebral bone quality (C-VBQ) score and explore its effectiveness in predicting cage subsidence in Anterior Cervical Corpectomy and Fusion (ACCF) and identify a new method for evaluating subsidence without different equipment and image scale interference.

METHODS

Collecting demographic, imaging, and surgical related information. Measuring Cage Subsidence with a new method. Multifactorial logistic regression was used to identify risk factors associated with subsidence. Pearson's correlation was used to determine the relationship between C-VBQ and computed tomography (CT) Hounsfield units (HU). The receiver operating characteristic (ROC) curve was used to assess C-VBQ predictive ability. Correlations between demographics and C-VBQ scores were analyzed using linear regression models.

RESULTS

92 patients were included in this study, 36 (39.1%) showed subsidence with a C-VBQ value of 2.05 ± 0.45, in the no-subsidence group C-VBQ Value was 3.25 ± 0.76. The multifactorial logistic regression showed that C-VBQ is an independent predictor of cage subsidence with a predictive accuracy of 93.4%. Pearson's correlation analysis showed a negative correlation between C-VBQ and HU values. Linear regression analysis showed a positive correlation between C-VBQ and cage subsidence. Univariate analyses showed that only age was associated with C-VBQ.

CONCLUSIONS

The C-VBQ values obtained using the new measurements independently predicted postoperative cage subsidence after ACCF and showed a negative correlation with HU values. By adding the measurement of non-operated vertebral heights as a control standard, the results of cage subsidence measured by the ratio method are likely to be more robust, perhaps can exclude unavoidable errors caused by different equipment and proportional.

Prediction of proximal junctional kyphosis and failure after corrective surgery for adult spinal deformity: an MRI-based model combining bone and paraspinal muscle quality metrics

BACKGROUND

Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common complications observed after adult spinal deformity (ASD) surgery and major cause for unplanned reoperations. In addition to spinal alignment, osteoporosis and paraspinal muscle (PSM) degeneration are reportedly indispensable factors that account for PJK/PJF.

PURPOSE

To investigate the utility of the preoperative risk assessment model using MRI-based skeletomuscular metrics in predicting PJK and/or PJF(PJK/PJF) after ASD correction.

STUDY DESIGN

Retrospective case-control study.

PATIENT SAMPLE

Consecutive series of 149 patients at a single academic institution.

OUTCOME MEASURES

MRI-based measurements of vertebral bone quality at upper instrumented vertebra (VBQ-U) score and fat infiltration rate (FI%) of paraspinal muscle (PSM).

METHODS

We performed a retrospective analysis of patients with ASD who underwent ≥5-segment fusion. The vertebral bone quality (VBQ) scoring system was used to assess the bone quality. The PSM quality including FI% and cross-sectional area (CSA) was evaluated. Multivariate logistic regression was performed to determine potential risk factors of PJK/PJF.

RESULTS

Of 149 patients who underwent ASD surgery, PJK/PJF was found in 45(30.2%). Mean VBQ-U scores were 3.45±0.64 and 3.00±0.56 for patients with and without PJK/PJF (p<.001). Mean FI% of PSM(L3/L4) was 27.9±12.8 and 20.7±13.3 for patients with and without PJK/PJF (p<.001). On multivariate analysis, the VBQ-U score and FI% of PSM were significant independent predictors of PJK/PJF. The AUC for the novel risk assessment model is 0.806, with a predictive accuracy of 86.7%.

CONCLUSION

In patients undergoing ASD correction, paraspinal muscle and vertebral bone quality significantly outweigh radiographic alignment parameters in predicting PJK/PJF. The MRI-based risk assessment model offers a valuable tool for early assessing individualized risk for PJK/PJF.

Vertebral Bone Quality Score as a Predictor of Adjacent Segment Disease After Lumbar Interbody Fusion

BACKGROUND AND OBJECTIVE

With lumbar spine fusion being one of the most commonly performed spinal surgeries, investigating common complications such as adjacent segment disease (ASD) is a high priority. To the authors' knowledge, there are no previous studies investigating the utility of the preoperative magnetic resonance imaging-based vertebral bone quality (VBQ) score in predicting radiographic and surgical ASD after lumbar spine fusion. We aimed to investigate the predictive factors for radiographic and surgical ASD, focusing on the predictive potential of the VBQ score.

METHODS

A single-center retrospective analysis was conducted of all patients who underwent 1-3 level lumbar or lumbosacral interbody fusion for lumbar spine degenerative disease between 2014 and 2021 with a minimum 12 months of clinical and radiographic follow-up. Demographic data were collected, along with patient medical, and surgical data. Preoperative MRI was assessed in the included patients using the VBQ scoring system to identify whether radiographic ASD or surgical ASD could be predicted.

RESULTS

A total of 417 patients were identified (mean age, 59.8 ± 12.4 years; women, 54.0%). Eighty-two (19.7%) patients developed radiographic ASD, and 58 (13.9%) developed surgical ASD. A higher VBQ score was a significant predictor of radiographic ASD in univariate analysis (2.4 ± 0.5 vs 3.3 ± 0.4; P < .001) and multivariate analysis (odds ratio, 1.601; 95% CI, 1.453-1.763; P < .001). For surgical ASD, a significantly higher VBQ score was seen in univariate analysis (2.3 ± 0.5 vs 3.3 ± 0.4; P < .001) and served as an independent risk factor in multivariate analysis (odds ratio, 1.509; 95% CI, 1.324-1.720; P < .001). We also identified preoperative disk bulge and preoperative existence of adjacent segment disk degeneration to be significant predictors of both radiographic and surgical ASD. Furthermore, 3-level fusion was also a significant predictor for surgical ASD.

CONCLUSION

The VBQ scoring system might be a useful adjunct for predicting radiographic and surgical ASD.

MRI-based vertebral bone quality score in cervical ossification of the posterior longitudinal ligament: a comparison with cervical spondylotic myelopathy using propensity score matching

BACKGROUND

Bone mineral density plays a key role in the assessment of operative instrumentation complications and clinical outcomes. The MRI-based vertebral bone quality (VBQ) score has been introduced as a novel marker of bone quality. However, few studies have investigated the relationship between VBQ score and patients associated with cervical ossification of the posterior longitudinal ligament (OPLL).

PURPOSE

The aims of the study were (1) to reveal bone mineral density between cervical OPLL and cervical spondylotic myelopathy (CSM) group by VBQ score, (2) to compare the VBQ score of cervical OPLL between male and female group, (3) to explore the relationship between segmental VBQ scores associated with OPLL.

STUDY DESIGN

Retrospective cohort study.

PATIENT SAMPLE

Consecutive series of 425 patients at a single academic institution.

OUTCOME MEASURES

MRI based measurements of C2-C7 VBQ scores.

METHODS

Preoperative noncontrast T1-weighted MRIs of the cervical spine was used to measure the VBQ score. The VBQ score was defined as the mean value of the signal intensity of the vertebrae divided by that of the cerebrospinal fluid (CSF) space at the cisterna magna. Patients with cervical OPLL and CSM were matched based on age, sex, body mass index (BMI), comorbidity, medication history, diet habit, smoking, alcohol consumption via propensity score matching (PSM). Normality of each VBQ score was tested by the Shapiro-Wilk test. Wilcoxon's rank-sum test was used to compare matched cohorts. Kruskal-Wallis test was performed to compare the VBQ scores between segments. Multivariate logistic regression analysis was used to evaluate factors associated with the development of cervical OPLL.

RESULTS

A total of 425 patients were assessed. For final analysis, 135 paired patients were compared between the cervical OPLL and CSM groups, and 22 paired patients were compared between male and female group associated with cervical OPLL. There were no statistically significant differences in age, sex, BMI, comorbidity, medication history, diet habit, smoking, alcohol between the matched cohorts. OPLL group was associated with lower VBQ score compared with CSM group at C3, while there were no differences in VBQ score for the other levels between the two groups. There were no differences between male and female group associated with OPLL in C2-C7 VBQ scores. VBQ scores of cervical OPLL are variable between segments, with significantly lower scores at C6, C7 compared with C1-C5. Multivariate logistic regression analysis showed that BMI was correlated with the development of OPLL (regression coefficient, 0.162; 95% confidence interval, 0.010-0.037). Additional risk factors included hypertension, calcium supple history and smoking.

CONCLUSIONS

This study demonstrates that cervical OPLL is associated with lower VBQ score at C3, with no differences for the other levels when compared with CSM derived from measurements on MRI. No differences were found between male and female group associated with OPLL in C2-C7 VBQ scores. Cervical OPLL were found to have smaller VBQ score at C6, C7 compared with C1-C5. Our findings provide new insight for bone density assessment in cervical OPLL patient.

A novel MRI-based Cervical-Endplate Bone Quality score independently predicts cage subsidence after Anterior Cervical Discectomy and Fusion

INTRODUCTION

Postoperative cage subsidence after Anterior Cervical Discectomy and Fusion (ACDF) often has adverse clinical consequences and is closely related to Bone Mineral Density (BMD). Previous studies have shown that cage subsidence can be better predicted by measuring site-specific bone density. MRI-based Endplate Bone Quality (EBQ) scoring effectively predicts cage subsidence after lumbar interbody fusion. However, there is still a lack of studies on the practical application of EBQ scoring in the cervical spine.

PURPOSE

To create a similar MRI-based scoring system for Cervical-EBQ (C-EBQ) and to assess the correlation of the C-EBQ with endplate Computed Tomography (CT)-Hounsfield Units (HU) and the ability of this scoring system to independently predict cage subsidence after ACDF, comparing the predictive ability of the C-EBQ with the Cervical-Vertebral Bone Quality (C-VBQ) score.

METHODS

A total of 161 patients who underwent single-level ACDF for degenerative cervical spondylosis at our institution from 2012 to 2022 were included. Demographics, procedure-related data, and radiological data were collected, and Pearson correlation test was used to determine the correlation between C-EBQ and endplate HU values. Cage subsidence was defined as fusion segment height loss of ≥ 3 mm. Receiver operating characteristic analysis and area-under-the-curve values were used to assess the predictive ability of C-EBQ and C-VBQ. A multivariate logistic regression model was developed to identify potential risk factors associated with subsidence.

RESULTS

Cage subsidence was present in 65 (40.4%) of 161 patients. The mean C-EBQ score was 1.81 ± 0.35 in the group without subsidence and 2.59 ± 0.58 in the group with subsidence (P < 0.001). Multivariate analysis showed that a higher C-EBQ score was significantly associated with subsidence (OR = 5.700; 95%CI = 3.435-8.193; P < 0.001), was the only independent predictor of cage subsidence after ACDF, had a predictive accuracy of 93.7%, which was superior to the C-VBQ score (89.2%), and was significantly negatively correlated with the endplate HU value (r = -0.58, P < 0.001).

CONCLUSIONS

Higher C-EBQ scores were significantly associated with postoperative cage subsidence after ACDF. There was a significant negative correlation between C-EBQ and endplate HU values. The C-EBQ score may be a promising tool for assessing preoperative bone quality and postoperative cage subsidence and is superior to the C-VBQ.

Bone Quality as Measured by Hounsfield Units More Accurately Predicts Proximal Junctional Kyphosis than Vertebral Bone Quality Following Long-Segment Thoracolumbar Fusion

OBJECTIVE

To compare the prognostic power of Hounsfield units (HU) and Vertebral Bone Quality (VBQ) score for predicting proximal junctional kyphosis (PJK) following long-segment thoracolumbar fusion to the upper thoracic spine (T1-T6).

METHODS

Vertebral bone quality around the upper instrumented vertebrae (UIV) was measured using HU on preoperative CT and VBQ on preoperative MRI. Spinopelvic parameters were also categorized according to the Scoliosis Research Society-Schwab classification. Univariable analysis to identify predictors of the occurrence of PJK and survival analyses with Kaplan-Meier method and Cox regression were performed to identify predictors of time to PJK (defined as ≥10° change in Cobb angle of UIV+2 and UIV). Sensitivity analyses showed thresholds of HU < 164 and VBQ > 2.7 to be most predictive for PJK.

RESULTS

Seventy-six patients (mean age 66.0 ± 7.0 years; 27.6% male) were identified, of whom 15 suffered PJK. Significant predictors of PJK were high postoperative pelvic tilt (P = 0.038), high postoperative T1-pelvic angle (P = 0.041), and high postoperative PI-LL mismatch (P = 0.028). On survival analyses, bone quality, as assessed by the average HU of the UIV and UIV+1 was the only significant predictor of time to PJK (odds ratio [OR] 3.053; 95% CI 1.032-9.032; P = 0.044). VBQ measured using the UIV, UIV+1, UIV+2, and UIV-1 vertebrae approached, but did not reach significance (OR 2.913; 95% CI 0.797-10.646; P = 0.106).

CONCLUSIONS

In larger cohorts, VBQ may prove to be a significant predictor of PJK following long-segment thoracolumbar fusion. However, Hounsfield units on CT have greater predictive power, suggesting preoperative workup for long-segment thoracolumbar fusion benefits from computed tomography versus magnetic resonance imaging alone to identify those at increased risk of PJK.

Application of a Magnetic Resonance Imaging-Based Lumbar Vertebral Bone Quality Scoring System in Patients with Degenerative Lumbar Scoliosis

BACKGROUND

Although dual-energy X-ray absorptiometry is still the gold standard for diagnosing osteoporosis, it can lead to inaccurate bone mineral density measurements due to lumbar degeneration and scoliosis. Many researchers have investigated diagnostic methods for osteoporosis in patients with degenerative lumbar scoliosis (DLS). This study aimed to investigate the differences between conventional vertebral bone quality (VBQ) scores and modified VBQ scores in patients with DLS and the influence of lumbar scoliosis on VBQ scores.

METHODS

We retrospectively collected the clinical and radiological data of 68 patients with DLS admitted to Sun Yat-sen Memorial Hospital from July 2018 to April 2023. The patients were classified into one of 2 groups based on the T score of the left femoral neck. VBQ scores relative to cerebrospinal fluid at different levels, VBQ scores on different planes and single-level VBQ scores were compared. Receiver operating characteristic analysis was also performed. Different modified VBQ scores were compared between the moderate scoliosis group (10°

RESULTS

There were no significant differences in VBQ scores relative to cerebrospinal fluid at different levels (P = 0.983), on different planes (P = 0.832) or at single-level (P = 0.996). All the VBQ scores were negatively correlated with the T score of the left femoral neck. There were no significant differences in the modified VBQ scores between the moderate and severe scoliosis groups.

CONCLUSIONS

Different modified VBQ scores can be used as supplementary methods for diagnosing osteoporosis in patients with DLS. Lumbar scoliosis may not significantly affect the VBQ score.

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Key Words

• Bone mineral density
• Degenerative lumbar scoliosis
• Magnetic resonance imaging
• Osteoporosis
• Vertebral bone quality score

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MESH Headings

• Humans
• Scoliosis/diagnostic imaging
• Female
• Lumbar Vertebrae/diagnostic imaging
• Male
• Aged
• Retrospective Studies
• Middle Aged
• Magnetic Resonance Imaging/methods
• Bone Density
• Absorptiometry, Photon/methods
• Osteoporosis/diagnostic imaging
• Osteoporosis/complications
• Aged, 80 and over

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Affiliation(s)

Wanli Zheng Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
Weitao Han Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Song Jin Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
Mingxi Zhu Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
Zhengqi Huang Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Tianyu Qin Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
Ming Shi Department of Spine Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
Bo Gao Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
Wei Ye Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.

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MRI Vertebral Bone Quality Correlates With Interbody Cage Subsidence After Anterior Cervical Discectomy and Fusion

STUDY DESIGN

Retrospective observational study of consecutive patients.

OBJECTIVE

The purpose of the study was to evaluate VBQ as a predictor of interbody subsidence and to determine threshold values that portend increased risk of subsidence.

SUMMARY OF BACKGROUND DATA

Many risk factors have been reported for the subsidence of interbody cages in anterior cervical discectomy and fusion (ACDF). MRI Vertebral Bone Quality (VQB) is a relatively new radiographic parameter that can be easily obtained from preoperative MRI and has been shown to correlate with measurements of bone density such as DXA and CT Hounsfield Units.

METHODS

All patients who underwent 1- to 3-level ACDF using titanium interbodies with anterior plating between the years 2018 and 2020 at our tertiary referral center were included. Subsidence measurements were performed by 2 independent reviewers on CT scans obtained 6 months postoperatively. VBQ was measured on pre-operative sagittal T1 MRI by 2 independent reviewers, and values were averaged.

RESULTS

Eight-five fusion levels in 44 patients were included in the study. There were 32 levels (38%) with moderate subsidence and 12 levels with severe subsidence (14%). The average VBQ score in those patients with severe subsidence was significantly higher than those without subsidence (3.80 vs. 2.40, P<0.01). A threshold value of 3.2 was determined to be optimal for predicting subsidence (AUC=0.99) and had a sensitivity of 100% and a specificity of 94.1% in predicting subsidence.

CONCLUSIONS

VBQ strongly correlates with the subsidence of interbody grafts after ACDF. A threshold VBQ score value of 3.2 has excellent sensitivity and specificity for predicting subsidence. Spine surgeons can use VBQ as a readily available screening tool to identify patients at higher risk for subsidence.

LEVEL OF EVIDENCE

Level-IV.

Comparison of the predictive values of MRI-based vertebral bone quality scores for the determination of osteoporosis in different diseases

PURPOSE

The study aimed to examine the consistency of vertebral bone quality (VBQ) scores for assessing osteoporosis across different etiologies and explore the predictive value of various VBQ scores for fragility vertebral fractures.

METHODS

Patients with fragility fractures were matched by age and sex to patients with lumbar degeneration. VBQ scores were calculated in T1- and T2-weighted magnetic resonance imaging. Differential analysis of bone quality was performed based on etiology.

RESULTS

A total of 96 inpatients were retrospectively enrolled. VBQT1 scores were only sensitive to osteoporotic bone in degenerative group (p < 0.01), failing to identify osteoporosis in fractured group (p > 0.05). For the degenerative group, the area under the curve (AUC) using the VBQT1 scores to differentiate osteoporosis was 0.72. After controlling the confounding variables, only VBQT2 scores were significantly higher in fractured group than degenerative group, with a greater AUC of 0.82 predicting fragility fractures. VBQT1 scores moderately correlated with femoral neck T-scores in degenerative group (r = -0.45, p < 0.01) but not in fractured group (r = -0.24, p > 0.05). VBQT2 scores were not associated with femoral neck T-scores (p > 0.05).

CONCLUSION

This study is the first to evaluate the effectiveness of VBQs scores in assessing osteoporosis post-fracture. Only non-fractured patients' bone quality is fully susceptible to VBQT1 scores. While VBQT1 scores may not correlate with fragility fractures, VBQT2 scores present a viable alternative.

Comparative Analysis of the 3 Cervical Vertebral Bone Quality (C-VBQ) Score Methodologies and Their Correlations to the Lumbar Vertebral Bone Quality (VBQ) Score

OBJECTIVE

Common complications after spinal fusion, such as pseudoarthrosis, cage subsidence, or instrumentation failure, are affected by patients' bone quality. The cervical-vertebral bone quality (C-VBQ) score, a magnetic resonance imaging (MRI)-based adaption of the lumbar vertebral bone quality (VBQ) score, was developed by 3 separate research groups simultaneously to evaluate bone quality in cervical spinal fusion patients. We present the first analysis comparing these scoring methods to the well-validated VBQ score.

METHODS

A retrospective analysis of data for consecutive patients who underwent spine surgery at a single institution was completed. The VBQ score was calculated using the Ehresman et al.

METHOD

The C-VBQ scores, named according to placement of the region of interest within the cerebral spinal fluid, were calculated separately using the methods of Soliman et al. (C2-VBQ), Razzouk et al. (C5-VBQ), and Huang et al. (T1-VBQ). Linear regression models were utilized to evaluate correlations to the VBQ score.

RESULTS

A total of 105 patients were identified (mean age, 57.0 ± 11.9 years; women, 50.5%). Mean scores were C2-VBQ, 2.37 ± 0.55; C5-VBQ, 2.36 ± 0.61; and T1-VBQ, 2.64 ± 0.68. The C-VBQ scores for the C2 level were significantly higher than those for the C3-C6 levels (3.18 ± 0.96 vs. 2.63 ± 0.77, P < 0.001), whereas the C7 level was found to have significantly lower C-VBQ scores (2.42 ± 0.78 vs. 2.63 ± 0.77, P = 0.04). The C2-VBQ (r = 0.63) score had the strongest correlation to the VBQ score, compared to C5-VBQ (r = 0.41) and T1-VBQ (r = 0.43) (P < 0.001).

CONCLUSIONS

This study demonstrates that the C2-VBQ had the strongest correlation to the lumbar VBQ score among all C-VBQ scores.

Cervical Vertebral Bone Quality Score Independently Predicts Distal Junctional Kyphosis After Posterior Cervical Fusion

BACKGROUND AND OBJECTIVE

Posterior cervical fusion is the surgery of choice when fusing long segments of the cervical spine. However, because of the limited presence of this pathology, there is a paucity of data in the literature about the postoperative complications of distal junctional kyphosis (DJK). We aimed to identify and report potential associations between the preoperative cervical vertebral bone quality (C-VBQ) score and the occurrence of DJK after posterior cervical fusion.

METHODS

The authors retrospectively reviewed records of patients who underwent posterior cervical fusion at a single hospital between June 1, 2010, and May 31, 2020. Patient data were screened to include patients who were >18 years old, had baseline MRI, had baseline standing cervical X-ray, had immediate postoperative standing cervical X-ray, and had clinical and radiographic follow-ups of >1 year, including a standing cervical X-ray at least 1 year postoperatively. Univariate analysis was completed between DJK and non-DJK groups, with multivariate regression completed for relevant clinical variables. Simple linear regression was completed to analyze correlation between the C-VBQ score and total degrees of kyphosis angle change.

RESULTS

Ninety-three patients were identified, of whom 19 (20.4%) had DJK and 74 (79.6%) did not. The DJK group had a significantly higher C-VBQ score than the non-DJK group (2.97 ± 0.40 vs 2.26 ± 0.46; P < .001). A significant, positive correlation was found between the C-VBQ score and the total degrees of kyphosis angle change (r 2 = 0.26; P < .001). On multivariate analysis, the C-VBQ score independently predicted DJK (odds ratio, 1.46; 95% CI, 1.27-1.67; P < .001).

CONCLUSION

We found that the C-VBQ score was an independent predictive factor of DJK after posterior cervical fusion.

Cervical Vertebral Bone Quality Score Independently Predicts Zero-Profile Cage Subsidence After Single-Level Anterior Cervical Discectomy and Fusion

OBJECTIVE

This is the first study to evaluate the predictive value of the cervical vertebral bone quality (VBQ) score on zero-profile cage (ZPC)subsidence after anterior cervical discectomy and fusion (ACDF) using the Hounsfield units (HU) value of computed tomography as the reference.

METHODS

A total of 89 patients with at least 1 year of follow-up who underwent single-level ACDF with ZPC were retrospectively and consecutively included. VBQ and HU value were determined from preoperative T1-weighted magnetic resonance imaging and computed tomography. Subsidence was defined as ≥2 mm of migration of the cage into the superior or inferior endplate or both using lateral cervical spine radiography. The results were subjected to statistical analysis.

RESULTS

Subsidence was observed among 16 of the 89 study patients (Subsidence rate: 18.0%). The mean VBQ score was 2.94 ± 0.820 for patients with subsidence and 2.33 ± 0.814 for patients without subsidence. The multivariable analysis demonstrated that only an increased VBQ score (odds ratio: 1.823, 95% confidence interval : 0.918,3.620, P = 0.001) was associated with an increased rate of cage subsidence. There was a significant and moderate correlation between HU and VBQ (r = -0.507, P < 0.001). Using receiver operating characteristic curves, the area under the curve was 0.785, and the most appropriate threshold of VBQ was 2.68 (sensitivity 72.7%, specificity 82.1%).

CONCLUSIONS

The VBQ score may be a valuable tool for independently predicting ZPC subsidence after single-level ACDF.

The Association between High Preoperative MRI-based Vertebral Bone Quality (VBQ) Score and Titanium Mesh Cage Subsidence after Anterior Cervical Corpectomy and Fusion

OBJECTIVE

Recently, the MRI-based vertebral bone quality (VBQ) score has been shown to correlate with Hounsfeld units (HU) value, dual-energy X-ray absorptiometry (DEXA) T-score and predict osteoporotic fractures. Preoperative cervical HU value is an independent correlative factor for early titanium mesh cage (TMC) subsidence after anterior cervical corpectomy and fusion (ACCF). However, to date the direct association between cervical VBQ score and TMC subsidence has not been studied. This study aims to investigate the predictive effect of cervical VBQ score derived from sagittal non-contrast-enhanced T1-weighted MRI on the early TMC subsidence after ACCF.

METHODS

Patients who underwent one-level ACCF from January 2016 to January 2020 were included. We retrospectively collected baseline data on age, sex, body mass index (BMI), disease type, level of surgery and radiology parameters. The cervical VBQ score was measured using preoperative non-contrast-enhanced T1-weighted MRI. Univariate and multivariate logistic regression analysis were performed to screen the independent risk factors of TMC subsidence. The receiver operating characteristic (ROC) curve and area under curve (AUC) were performed to assess the predictive ability of TMC subsidence based on the cervical VBQ score. Spearman correlation analysis was used to determine the correlations between the cervical VBQ score and TMC subsidence.

RESULTS

A total of 134 patients who underwent one-level ACCF were included in this study, and 46 (34.33%) patients had TMC subsidence. Univariable analyses demonstrated that the age, TMC placement depth and VBQ score were associated with subsidence. The cervical VBQ score in the subsidence group was significantly higher than that in the no subsidence group (3.75 ± 0.45 vs. 3.20 ± 0.42, p < 0.001). The multivariate logistic regression analysis proved that the higher VBQ score (odds ratio[OR] = 13.563, 95% confidence interval [CI] 4.968 - 37.031, p < 0.001) was the only variable that significantly predicted subsidence. Using a VBQ score cutoff value of 3.445, the cervical VBQ score yielded a sensitivity of 69.6% and a specificity of 85.2% with an AUC of 0.810 to differentiate patients with subsidence and with no subsidence.

CONCLUSION

Preoperative higher cervical VBQ score is an independent risk factor for TMC subsidence after ACCF. The cervical VBQ score may be a valuable tool for assisting in distinguishing the presence of TMC subsidence.