Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2020 Aug;140:e247-e252. doi: 10.1016/j.wneu.2020.05.020. Epub 2020 May 13.
Poor bone quality is a known risk factor for hardware failure and adjacent segment disease after lumbar fusion. One new method of analyzing bone quality is the vertebral bone quality (VBQ) score, which can be obtained from preoperative lumbar magnetic resonance imaging (MRI) scans. We decided to evaluate whether patients' VBQ scores were associated with reoperation after lumbar fusion.
We queried records of patients who underwent elective lumbar fusion for degenerative conditions between 2012 and 2017. Patients who required reoperations after lumbar fusions because of symptomatic hardware failure or adjacent segment disease were combined into a case group and compared with a matched control group.
Of the 46 patients who underwent elective lumbar fusions and required reoperation, 30 met the inclusion criteria. A 2:1 control group of 60 individually age-, body mass index-, and sex-matched patients who did not require reoperation was then created. The reoperation group had significantly lower degrees of postoperative lumbar lordosis. There were no significant differences regarding other spinopelvic parameters, adjacent Pfirrmann scores, or dual energy x-ray absorptiometry (DXA) T scores. There was, however, a significant difference in VBQ scores between the groups, with the reoperation group having a higher VBQ score.
This study found that bone quality, according to the VBQ score rather than the DXA T score, is an important risk factor for reoperation after lumbar fusion surgery. Therefore, this MRI-based tool may be used to assist surgeons in preoperative planning for spine surgeries with the goal of reducing the risk of requiring reoperation.
骨质量差是腰椎融合术后内固定失败和相邻节段疾病的已知危险因素。一种新的分析骨质量的方法是椎体骨质量（VBQ）评分，可从术前腰椎磁共振成像（MRI）扫描中获得。我们决定评估患者的 VBQ 评分是否与腰椎融合后再次手术有关。
我们查询了 2012 年至 2017 年间因退行性疾病接受选择性腰椎融合术的患者记录。因症状性内固定失败或相邻节段疾病而需要再次进行腰椎融合术的患者被归入病例组，并与匹配的对照组进行比较。
在 46 例行选择性腰椎融合术且需要再次手术的患者中，有 30 名符合纳入标准。然后创建了一个 2:1 的对照组，共 60 名患者，年龄、体重指数和性别与未进行再次手术的患者相匹配。再次手术组术后腰椎前凸角度明显较小。其他脊柱骨盆参数、相邻 Pfirrmann 评分或双能 X 线吸收法（DXA）T 评分均无显著差异。然而，两组之间的 VBQ 评分存在显著差异，再次手术组的 VBQ 评分更高。
本研究发现，根据 VBQ 评分而非 DXA T 评分，骨质量是腰椎融合术后再次手术的一个重要危险因素。因此，这种基于 MRI 的工具可能有助于外科医生进行脊柱手术的术前规划，以降低需要再次手术的风险。
