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Wang Y, Song N, Zhang J, Li J, Li R, Wang L. Systematic evaluation of vertebral bone quality score as an opportunistic screening method for BMD in spine surgery patients. Eur Spine J 2024:10.1007/s00586-024-08284-9. [PMID: 38671248 DOI: 10.1007/s00586-024-08284-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE This study aimed to evaluate and compare the predictive value of vertebral bone quality (VBQ) score for low BMD and osteoporosis. Furthermore, we sought to enhance diagnostic effectiveness by integrating VBQ with easily accessible patient-specific factors. METHODS We retrospectively analyzed data from 180 patients. VBQ was obtained by preoperative MRI. Low BMD was classified as meeting the standards for either osteopenia or osteoporosis. The receiver operating characteristic curve analysis and multivariate logistic regression were used to detect the ability of variables to assess BMD. The z-test was used to compare the area under the curves of different variables. RESULTS VBQ was more effective in identifying low BMD than osteoporosis (AUC, 0.768 vs. 0.613, p = 0.02). Elevated VBQ (OR 6.912, 95% CI 2.72-17.6) and low BMI (0.858, 0.76-0.97) were risk factors for low BMD, while the risk factor for osteoporosis was age (1.067, 1.02-1.12), not VBQ. ROC analysis showed that AUCs were 0.613 for VBQ and 0.665 for age when screening for osteoporosis. The combined variable of VBQ, sex, age, and BMI obtained by logistic regression significantly improved the efficacy of BMD screening, with an AUC of 0.824 for low BMD and 0.733 for osteoporosis. CONCLUSION VBQ is better at detecting low BMD than identifying osteoporosis. The ability of VBQ to predict osteoporosis is limited, and a similar diagnostic efficacy can be achieved with age. Incorporating VBQ alongside demographic data enhances the efficiency of BMD assessment. With the development of artificial intelligence in medicine, this simple method is promising.
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Affiliation(s)
- Yunsheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Ning Song
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
- Department of Operating Room, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jiali Zhang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jia Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Ruoyu Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China.
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China.
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Li D, Lu X, Gong Z, Liu S, Xu G, Wang H, Lu F, Xia X, Jiang J, Zhang X, Zou F, Ma X. Evaluation of the modified MRI vertebral bone quality score for bone quality in lumbar degenerative disorders. Eur Spine J 2024:10.1007/s00586-024-08228-3. [PMID: 38602526 DOI: 10.1007/s00586-024-08228-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/12/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE The traditional VBQ scoring method may lead to overestimation due to the concentration of intravertebral fat and vascular structures in the posterior half of vertebral bodies, potentially resulting in false-positive outcomes. This study aims to modify the measurement method of VBQ score (Modified-VBQ) and evaluate its effectiveness in evaluating bone quality of lumbar degenerative diseases. METHODS Retrospective analysis was conducted on clinical data from patients undergoing lumbar surgery for degenerative diseases between September 2022 and September 2023. Preoperative lumbar t1-weighted Magnetic resonance imaging was used for both modified and traditional VBQ scoring. Computed tomography (CT) images and dual-energy X-ray absorptiometry (DEXA) data were collected through the picture archiving and communication system. The effectiveness of the modified VBQ score was evaluated, considering P < 0.05 as statistically significant. RESULTS The study included 212 patients, revealing a significant difference between the modified VBQ and VBQ scores (P < 0.0001). Notably, patients with a history of hyperlipidemia exhibited a significant difference between the two scores (P = 0.0037). The area under the ROC curve (AUC) for the modified VBQ was 0.86, surpassing the VBQ score (AUC = 0.74). Linear regression analysis demonstrated a moderate to strong correlation between the modified VBQ and DEXA T-score (r = - 0.49, P < 0.0001) and a high correlation with CT Hounsfield units (HU) values (r = - 0.60, P < 0.0001). CONCLUSION The modified VBQ score provides a simple, effective, and relatively accurate means of assessing bone quality in lumbar degenerative diseases. Preoperative implementation of the modified VBQ score facilitates rapid screening for patients with abnormal bone quality.
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Affiliation(s)
- Dachuan Li
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Xiao Lu
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Zhaoyang Gong
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Siyang Liu
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Guangyu Xu
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China.
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Feizhou Lu
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Xinlei Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Xuesen Zhang
- Department of Orthopedics, Wuzhong People's Hospital, 143 Xinmin Road, Litong District, Wuzhong, 751100, Ningxia, China
| | - Fei Zou
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China.
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China.
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Zheng W, Han W, Jin S, Zhu M, Huang Z, Qin T, Shi M, Gao B, Ye W. Application of a Magnetic Resonance Imaging-Based Lumbar Vertebral Bone Quality Scoring System in Patients with Degenerative Lumbar Scoliosis. World Neurosurg 2024:S1878-8750(24)00238-9. [PMID: 38354770 DOI: 10.1016/j.wneu.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
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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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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Wang J, Zhu C, Ding H, Huang Y, Chen Q, Ai Y, Feng G, Liu L, Song Y. Simplified S1 vertebral bone quality (vbq) score to assess proximal junctional kyphosis after Lenke 5 adolescent idiopathic scoliosis surgery. Eur Spine J 2024; 33:732-738. [PMID: 37889326 DOI: 10.1007/s00586-023-07993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/23/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Proximal junctional kyphosis (PJK) is a common complication following corrective surgery for adolescent idiopathic scoliosis (AIS) with a Lenke 5 curve. Previous studies have suggested that PJK may be associated with osteopenia, which is prevalent in AIS patients. MRI-based vertebral bone quality (VBQ) scores have been proposed as a valuable tool to assess preoperative bone quality. However, accurately measuring VBQ scores in Lenke 5 AIS patients with a structural lumbar curve can be challenging. Recently, a simplified S1 VBQ score has been proposed as an alternative method when the traditional VBQ score is not applicable. This study aims to evaluate the predictive value of the simplified S1 VBQ score in predicting the occurrence of PJK after corrective surgery for Lenke 5 AIS. METHODS We conducted a retrospective analysis of patient data to assess the predictive utility of the S1 VBQ score for PJK in Lenke 5 AIS patients. Demographic, radiographic, and surgical data were collected, and S1 VBQ scores were calculated based on preoperative T1-weighted MRI images. Univariate analysis, linear regression, and multivariate logistic regression were performed to identify potential risk factors for PJK and to assess the correlation between other variables and the S1 VBQ score. Receiver operating characteristic analysis and area under the curve values were used to evaluate the predictive efficiency of the S1 VBQ score for PJK. RESULTS A total of 105 patients (aged 15.50 ± 2.36 years) were included in the analysis, of whom 24 (22.9%) developed PJK. S1 VBQ scores were significantly higher in the PJK group compared to the non-PJK group (2.83 ± 0.44 vs. 2.48 ± 0.30, P < 0.001), and there was a significant positive correlation between the S1 VBQ score and proximal junctional angle (PJA) (r = 0.46, P < 0.0001). Multivariate analysis revealed that the S1 VBQ scores and preoperative thoracic kyphosis (TK) were significant predictors of PJK. CONCLUSION This study provided evidence that higher S1 VBQ scores were independently associated with PJK occurrence following corrective surgery for Lenke 5 AIS. Preoperative measurement of the S1 VBQ score on MRI may serve as a valuable tool in planning surgical correction for Lenke 5 AIS.
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Affiliation(s)
- Juehan Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Ce Zhu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Hong Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Yong Huang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Qian Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Youwei Ai
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Ganjun Feng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China.
| | - Yueming Song
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
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Wang Z, Huang Y, Chen Q, Liu L, Song Y, Feng G. Cervical Vertebral Bone Quality Score Independently Predicts Zero-Profile Cage Subsidence After Single-Level Anterior Cervical Discectomy and Fusion. World Neurosurg 2024; 182:e377-e385. [PMID: 38040332 DOI: 10.1016/j.wneu.2023.11.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
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.
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Affiliation(s)
- Zhe Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Orthopaedics and Laboratory of Biological Tissue, Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Ai Y, Zhu C, Chen Q, Huang Y, Wang J, Ding H, Deng W, Song Y, Feng G, Liu L. Comparison of predictive value for cage subsidence between MRI-based endplate bone quality and vertebral bone quality scores following transforaminal lumbar interbody fusion: a retrospective propensity-matched study. Spine J 2024:S1529-9430(24)00037-8. [PMID: 38301901 DOI: 10.1016/j.spinee.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/15/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND CONTEXT Cage subsidence after lumbar fusion can lead to many adverse outcomes. Low bone mineral density (BMD) is a widely recognized risk factor for cage subsidence. Conventional methods can predict and evaluate BMD, but there are many shortcomings. Recently, MRI-based assessment of bone quality in specific parts of the vertebral body has been proposed, including scores for vertebral bone quality (VBQ) and endplate bone quality (EBQ). However, the predictive accuracy of the two scoring systems for cage subsidence after transforaminal lumbar interbody fusion (TLIF) remains unknown. Therefore, we investigated MRI-based VBQ and EBQ scores for assessing bone quality and compared their predictive value for cage subsidence after TLIF. PURPOSE To compare the predictive value between MRI-based VBQ and EBQ scores for cage subsidence after TLIF. STUDY DESIGN/SETTING A retrospective case-control study PATIENTS SAMPLE: Patients with degenerative lumbar diseases underwent single-level TLIF at our medical center between 2014 and 2020, all of whom had preoperative MRIs available. OUTCOMES MEASURES Cage subsidence, disc height, VBQ score, EBQ score, upper and lower vertebral body bone quality (UL-VBQ) score. METHODS Data were retrospectively examined for a consecutive sample of 346 patients who underwent TLIF at our medical center between 2014 and 2020. Patients who subsequently experienced cage subsidence or not were matched to each other based on propensity scoring, and the two matched groups (52 patients each) were compared using conditional logistic regression to investigate the association between the potential radiographic factors and cage subsidence. Scores for VBQ and EBQ were assessed for their ability to predict cage subsidence in the matched patients based on the area under the receiver operative characteristic curve (AUC). RESULTS Among matched patients, those who suffered cage subsidence had significantly higher VBQ score (3.7 vs. 3.1, p<.001) and EBQ score (5.0 vs. 4.3, p<.001), and regression linked greater risk of subsidence to higher VBQ score (OR 4.557, 95% CI 1.076-19.291, p=.039) and higher EBQ score (OR 5.396, 95% CI 1.158-25.146, p=.032). A cut-off VBQ score of 3.4 predicted the cage subsidence among matched patients with an AUC of 0.799, sensitivity of 84.6%, and specificity of 69.2%. A cut-off EBQ score of 4.7 predicted subsidence with an AUC of 0.829, sensitivity of 76.9%, and specificity of 82.7%. CONCLUSION Higher VBQ and EBQ scores are associated with a greater risk of cage subsidence following TLIF, and EBQ may perform better because of greater specificity.
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Affiliation(s)
- Youwei Ai
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd Chengdu 610041, Sichuan, China
| | - Ce Zhu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd Chengdu 610041, Sichuan, China
| | - Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd Chengdu 610041, Sichuan, China; Department of Orthopaedics and Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Rd, Nanchong, Sichuan, China
| | - Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd Chengdu 610041, Sichuan, China
| | - Juehan Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd Chengdu 610041, Sichuan, China
| | - Hong Ding
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd Chengdu 610041, Sichuan, China
| | - Wei Deng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd Chengdu 610041, Sichuan, China; Department of Orthopedics, Pidu District People's Hospital, the Third Affiliated Hospital of Chengdu Medical College, No. 666 Deyuan North Rd, Chengdu 611730, Sichuan, China
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd Chengdu 610041, Sichuan, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd Chengdu 610041, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd Chengdu 610041, Sichuan, China.
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Özmen E, Biçer O, Meriç E, Circi E, Barış A, Yüksel S. Vertebral bone quality score for opportunistic osteoporosis screening: a correlation and optimal threshold analysis. Eur Spine J 2023; 32:3906-3911. [PMID: 37661227 DOI: 10.1007/s00586-023-07912-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/21/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE This study investigated the vertebral bone quality (VBQ) score as a potential tool for opportunistic osteoporosis screening and its correlation with dual-energy X-ray absorptiometry (DXA) values. METHODS In a single-center retrospective cohort of 130 patients, VBQ and DXA measures were compared using various statistical analyses. The optimal VBQ threshold for predicting osteoporosis was determined using receiver operating characteristic (ROC) analysis. RESULTS VBQ exhibited a significant negative association with DXA values, suggesting that higher VBQ scores are indicative of lower bone density. Age and VBQ were significant predictors of osteoporosis, with both increasing the log-odds of the condition. An optimal VBQ threshold of 2.7 was determined, demonstrating fair discriminatory power and high negative predictive value. CONCLUSION The study highlighted the potential of VBQ as a diagnostic tool for osteoporosis with high intra- and inter-observer reliability. The optimal VBQ threshold of 2.7 can aid in ruling out osteoporosis and identifying individuals for further evaluation.
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Affiliation(s)
- Emre Özmen
- Orthopedics and Traumatology, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Adnan Kahveci Blv. No: 145, 34186, Bahçelievler, Istanbul, Turkey.
| | - Ozancan Biçer
- Orthopedics and Traumatology, SBU Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Emre Meriç
- Orthopedics and Traumatology, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Esra Circi
- Orthopedics and Traumatology, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Adnan Kahveci Blv. No: 145, 34186, Bahçelievler, Istanbul, Turkey
| | - Alican Barış
- Orthopedics and Traumatology, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Adnan Kahveci Blv. No: 145, 34186, Bahçelievler, Istanbul, Turkey
| | - Serdar Yüksel
- Orthopedics and Traumatology, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital, Adnan Kahveci Blv. No: 145, 34186, Bahçelievler, Istanbul, Turkey
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Wang J, Chen Q, Ai Y, Huang Y, Zhu C, Ding H, Feng G, Liu L, Song Y. Vertebral bone quality score as a novel predictor of proximal junctional kyphosis after thoracic adolescent idiopathic scoliosis surgery. Eur Spine J 2023; 32:3996-4002. [PMID: 37606725 DOI: 10.1007/s00586-023-07894-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Proximal junctional kyphosis (PJK) is one of the most common complications after thoracic AIS surgery. Previous studies reported that the etiology of PJK was associated with osteopenia and meanwhile the AIS patients were found osteopenia which could persist into adulthood. Recently, an MRI-based vertebral bone quality score (VBQ) was reported to be a promising tool which can assess preoperative bone quality. OBJECTIVE This study aims to evaluate the utility of VBQ score in predicting PJK after corrective surgery for thoracic AIS (Lenke 1 and 2). METHODS We conducted a retrospective study to identify the predictive efficiency of VBQ score for PJK in thoracic AIS patients. Demographic, radiographic parameters, and surgical variables were collected. VBQ score was calculated using preoperative T1-weighted MRI. Univariate analysis, linear regression, and multivariate logistic regression were performed to determine potential risk factors of PJK and correlation between other parameters and VBQ score. Receiver operating characteristic analysis and area under the curve values were utilized to evaluate the predictive efficiency of VBQ score for PJK. RESULTS A total of 206 patients (aged 14.4 ± 2.3 years) were included, of which 33 (16.0%) developed PJK. VBQ scores were significantly different between the PJK and non-PJK groups (2.8 ± 0.2 vs 2.5 ± 0.2, P < 0.01). A significant positive correlation was found between VBQ score and PJA (R2 = 0.1728, P < 0.01).On multivariate analysis, VBQ score was the only significant predictor of PJK (odds ratio = 2.178, 95% CI = 1.644-2.885, P < 0.001), with a predictive accuracy of 83%. CONCLUSION Higher VBQ scores were independently associated with PJK occurrence after corrective surgery for thoracic AIS. Preoperative measurement of VBQ score on MRI may serve as a valuable tool in planning thoracic AIS surgery.
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Affiliation(s)
- Juehan Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Youwei Ai
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Ce Zhu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Hong Ding
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China.
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
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Ai Y, Chen Q, Huang Y, Ding H, Wang J, Zhu C, Song Y, Feng G, Liu L. 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 2023; 32:3167-3175. [PMID: 37479921 DOI: 10.1007/s00586-023-07854-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/23/2023]
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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Affiliation(s)
- Youwei Ai
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Orthopaedics and Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hong Ding
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Juehan Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ce Zhu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Li W, Zhu H, Liu J, Tian H, Li J, Wang L. Characteristics of MRI‑based vertebral bone quality scores in elderly patients with vertebral fragility fractures. Eur Spine J 2023; 32:2588-2593. [PMID: 37133764 DOI: 10.1007/s00586-023-07744-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/17/2023] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To explore the characteristics of vertebral bone quality (VBQ) scores in patients with vertebral fragility fractures, including VBQ score and single-level VBQ score, and evaluate their effectiveness as predictors. METHODS The VBQ scores were measured using T1-weighted MRI images. VBQ scores were compared in patients with different times of previous fragility fractures. In addition, patients with fractures were matched for age and sex with patients without fractures, and VBQ scores were compared between the two groups. Finally, the predictive efficiency of VBQ scores for vertebral fragility fractures was analyzed by the receiver-operator curve (ROC). RESULTS The average VBQ score and single-level VBQ score in patients with fractures were 3.48 ± 0.56 and 3.60 ± 0.60 and no difference among patients with different times of previous fractures. As for the age- and sex-matched patients, fracture patients had higher VBQ scores (VBQ score: 3.48 ± 0.56 vs. 2.88 ± 0.40, p < 0.001; single-level VBQ score: 3.60 ± 0.60 vs. 2.95 ± 0.44, p < 0.001). The AUCs using the VBQ score and single-level VBQ score to predict fragility fractures were 0.815 and 0.817, respectively. The optimal thresholds of the VBQ score and single-level VBQ score for predicting fragility fractures were 3.22 and 3.16, respectively. CONCLUSION MRI‑based VBQ scores are important predictors of vertebral fragility fracture but have no predictive value for the recurrence of fractures in patients with a history of fragility fractures. The VBQ score of 3.22 and single-level VBQ score of 3.16 are optimal thresholds that can be used when using lumbar MRI scans to identify individuals at high risk for fragility fractures.
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Affiliation(s)
- Wenshuai Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Houze Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Junchuan Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Hongsen Tian
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Jia Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China.
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
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Huang Y, Chen Q, Liu L, Feng G. Vertebral bone quality score to predict cage subsidence following oblique lumbar interbody fusion. J Orthop Surg Res 2023; 18:258. [PMID: 36991489 DOI: 10.1186/s13018-023-03729-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Current evidence suggests that the magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score is a good parameter for evaluating bone quality. We aimed to assess whether the VBQ score can predict the occurrence of postoperative cage subsidence after oblique lumbar interbody fusion (OLIF) surgery. METHODS Patients (n = 102) who had undergone single-level OLIF with a minimal follow-up for 1 year were reviewed in this study. Demographic and radiographic data of these patients were collected. Cage subsidence was defined as ≥ 2 mm of cage migration into the inferior endplate, superior endplate, or both. Further, the MRI-based VBQ score was measured on T1-weighted images. Moreover, univariable and multivariable binary logistic regression analyses were performed. Meanwhile, Pearson analysis was used to evaluate the correlation among the VBQ score, average lumbar dual-energy X-ray absorptiometry (DEXA) T-score, and degree of cage subsidence. Furthermore, ad-hoc analysis was used along with receiver operating characteristic curve analysis to assess the predictive ability of the VBQ score and average lumbar DEXA T-score. RESULTS Of 102 participants, cage subsidence was observed in 39 (38.24%) patients. According to the univariable analysis, patients with subsidence had older age, higher antiosteoporotic drug use, larger disk height change, a more concave morphology of inferior and superior endplates, higher VBQ score, and lower average lumbar DEXA T-score compared to patients without subsidence. In the multivariable logistic regression analysis, a higher VBQ score was significantly associated with an increased risk of subsidence (OR = 23.158 ± 0.849, 95% CI 4.381-122.399, p < 0.001), and it was the only significant and independent predictor of subsidence after OLIF. Moreover, the VBQ score was moderately correlated with the average lumbar DEXA T-score (r = - 0.576, p < 0.001) and the amount of cage subsidence (r = 0.649, p < 0.001). Furthermore, this score significantly predicted cage subsidence with an accuracy of 83.9%. CONCLUSIONS The VBQ score can independently predict postoperative cage subsidence in patients undergoing OLIF surgery.
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Affiliation(s)
- Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Huang W, Gong Z, Wang H, Zheng C, Chen Y, Xia X, Ma X, Jiang J. Use of MRI-based vertebral bone quality score (VBQ) of S1 body in bone mineral density assessment for patients with lumbar degenerative diseases. Eur Spine J 2023; 32:1553-1560. [PMID: 36935451 DOI: 10.1007/s00586-023-07643-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/23/2023] [Accepted: 03/05/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE To evaluate the use of the modified and simplified vertebral bone quality (VBQ) method based on T1-weighted MRI images of S1 vertebrae in assessing bone mineral density (BMD) for patients with lumbar degenerative diseases. METHODS We reviewed the preoperative data of patients with lumbar degenerative diseases undergoing lumbar spine surgery between January 2019 and June 2022 with available non-contrast T1-weighted magnetic resonance imaging (MRI), computed tomography (CT) images and dual-energy X-ray absorptiometry (DEXA). S1 vertebral bone quality scores (S1 VBQ) and S1 CT Hounsfield units were measured with picture archiving and communication system (PACS). One-way ANOVA was applied to present the discrepancy between the S1 VBQ of patients with normal bone density (T-score ≥ - 1.0), osteopenia (- 2.5 < T-score < - 1.0) and osteoporosis (T-score ≤ - 2.5). The receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic performance of S1 VBQ in distinguishing low BMD. Statistical significance was set at p < 0.05. RESULTS A total of 207 patients were included. The S1 VBQ were significantly different between groups (p < 0.001). Interclass correlation coefficient for inter-rater reliability was 0.86 (95% CI 0.78-0.94) and 0.94(95% CI 0.89-0.98) for intra-rater reliability. According to the linear regression analysis, the S1 VBQ has moderate-to-strong correlations with DEXA T-score (r = - 0.48, p < 0.001). The area under the ROC curve indicated a predictive accuracy of 82%. A sensitivity of 77.25% with a specificity of 70% could be achieved for distinguishing low BMD by setting the S1 VBQ cutoff as 2.93. CONCLUSIONS The S1 VBQ was a promising tool in distinguishing poor bone quality in patients with lumbar degenerative diseases, especially in cases where the previously reported VBQ method based on L1-L4 was not available. S1 VBQ score could be useful as opportunistic assessment for screening and complementary evaluation to DEXA T-score before surgery.
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Affiliation(s)
- Weibo Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Zhaoyang Gong
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Chaojun Zheng
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Yu Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Xinlei Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China.
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Kuo CC, Soliman MAR, Aguirre AO, Ruggiero N, Kruk M, Khan A, Hess RM, Smolar DE, Mullin JP, Pollina J. Strong Correlation between the Vertebral Bone Quality Score and the Cervical-Vertebral Bone Quality Score in Spine Surgery Patients. World Neurosurg 2023:S1878-8750(23)00262-0. [PMID: 36870445 DOI: 10.1016/j.wneu.2023.02.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE Osteoporosis is a burgeoning public health problem for over 44 million people in the United States. The magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score and cervical VBQ (C-VBQ) score are two novel approaches that use data routinely gathered during preoperative evaluation to assess bone quality. The goal of this study was to investigate the relationship between the VBQ and C-VBQ scores. METHODS We performed a retrospective review of chart data for patients who underwent spine surgery for degenerative conditions between 2015 and 2022. Patients eligible for study inclusion had preoperative T1-weighted MRI of the lumbar and cervical spine available for review. Demographics of each patient were collected. The VBQ score was determined by dividing the median signal intensity (SI) of the L1-L4 vertebral bodies by the SI of the cerebrospinal fluid (CSF) at L3. The C-VBQ score was calculated by dividing the median SI of the C3-C6 vertebral bodies by the SI of the C2 CSF space. Pearson's correlation test was utilized to evaluate the association between the scores. RESULTS We identified 171 patients, with a mean age of 57.44±11.79 years. The interrater reliability of the VBQ and C-VBQ measurements was excellent (intraclass correlation-coefficients 0.89 and 0.84, respectively). A statistically significant, positive correlation was found between the VBQ score and the C-VBQ score (r=0.757,p<0.001). CONCLUSIONS This is the first study, to our knowledge, to assess the degree to which the newly developed C-VBQ score correlates with the VBQ score. We found a strong positive correlation between the scores.
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Soliman MAR, Aguirre AO, Kuo CC, Ruggiero N, Azmy S, Khan A, Ghannam MM, Almeida ND, Jowdy PK, Mullin JP, Pollina J. Vertebral bone quality score independently predicts cage subsidence following transforaminal lumbar interbody fusion. Spine J 2022; 22:2017-2023. [PMID: 35961523 DOI: 10.1016/j.spinee.2022.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/07/2022] [Accepted: 08/02/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cage subsidence following transforaminal lumbar interbody fusion (TLIF) has been associated with poor bone quality. Current evidence suggests that the magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score correlates with poor bone quality. PURPOSE To our knowledge, this is the first study to assess whether the VBQ score can predict the occurrence of postoperative cage subsidence after TLIF surgery. DESIGN/SETTING Retrospective single-center cohort. PATIENT SAMPLE Patients undergoing single-level TLIF for degenerative spine disease between February 2014 and October 2021. OUTCOME MEASURES Extent of subsidence. METHODS Demographic, procedure-related, and radiographic data were collected for study patients. VBQ scores were determined from preoperative T1-weighted MRI. Subsidence was defined as ≥2 mm of migration of the cage into the superior or inferior end plate or both. Univariate and multivariate logistic regression were used to determine the correlation between potential risk factors for subsidence and actual subsidence rates. RESULTS Subsidence was observed among 42 of the 74 study patients. The mean VBQ scores were 2.9±0.5 for patients with subsidence and 2.5±0.5 for patients without subsidence. The difference among groups was significant (p=.003). On multivariate logistic regression, a higher VBQ score was significantly associated with an increased risk of subsidence (OR=1.5, 95% CI=1.160-1.973, p=.004) and was the only significant independent predictor of subsidence after TLIF. CONCLUSION We found that a higher VBQ score was significantly associated with cage subsidence following TLIF. The MRI-VBQ score may be a valuable tool for assisting in identifying patients at risk of cage subsidence following TLIF.
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Affiliation(s)
- Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, 100 High St, Suite B4, Buffalo, NY, USA; Department of Neurosurgery, Faculty of Medicine, Cairo University, Al Kasr Al Aini, Old Cairo, Cairo Governorate 4240310, Egypt
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Nicco Ruggiero
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Shady Azmy
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, 100 High St, Suite B4, Buffalo, NY, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, 955 Main Street, Buffalo NY 14214, USA
| | - Moleca M Ghannam
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, 100 High St, Suite B4, Buffalo, NY, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, 955 Main Street, Buffalo NY 14214, USA
| | - Neil D Almeida
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, 100 High St, Suite B4, Buffalo, NY, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, 955 Main Street, Buffalo NY 14214, USA
| | - Patrick K Jowdy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, 100 High St, Suite B4, Buffalo, NY, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, 955 Main Street, Buffalo NY 14214, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, 100 High St, Suite B4, Buffalo, NY, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, 955 Main Street, Buffalo NY 14214, USA; Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, 100 High St, Suite B4, Buffalo, NY, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, 955 Main Street, Buffalo NY 14214, USA; Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA.
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