椎体骨质量评分预测斜外侧腰椎椎间融合术后椎间融合器下沉。
Vertebral bone quality score to predict cage subsidence following oblique lumbar interbody fusion.
机构信息
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.
出版信息
J Orthop Surg Res. 2023 Mar 30;18(1):258. doi: 10.1186/s13018-023-03729-1.
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.
背景
目前的证据表明，磁共振成像（MRI）为基础的椎体骨质量（VBQ）评分是评估骨质量的一个很好的参数。我们旨在评估 VBQ 评分是否能预测斜侧腰椎椎间融合术（OLIF）术后发生 cage 下沉。
方法
本研究回顾性分析了 102 例接受单节段 OLIF 手术并至少随访 1 年的患者。收集这些患者的人口统计学和影像学数据。Cage 下沉定义为 cage 向下方终板、上方终板或两者迁移≥2mm。此外，在 T1 加权图像上测量基于 MRI 的 VBQ 评分。进一步进行单变量和多变量二元逻辑回归分析。同时，采用 Pearson 分析评估 VBQ 评分、平均腰椎双能 X 线吸收测定法（DEXA）T 评分和 cage 下沉程度之间的相关性。此外，采用专门分析和接收者操作特征曲线分析来评估 VBQ 评分和平均腰椎 DEXA T 评分的预测能力。
结果
在 102 名参与者中，39 名（38.24%）患者出现 cage 下沉。根据单变量分析，与无下沉的患者相比，下沉患者的年龄更大，使用抗骨质疏松药物更多，椎间盘高度变化更大，下方和上方终板的形态更凹，VBQ 评分更高，平均腰椎 DEXA T 评分更低。在多变量逻辑回归分析中，较高的 VBQ 评分与增加的下沉风险显著相关（OR=23.158±0.849，95%CI 4.381-122.399，p<0.001），并且是 OLIF 后下沉的唯一显著且独立的预测因子。此外，VBQ 评分与平均腰椎 DEXA T 评分（r=-0.576，p<0.001）和 cage 下沉量（r=0.649，p<0.001）中度相关。此外，该评分对 cage 下沉的预测准确性为 83.9%。
结论
VBQ 评分可独立预测接受 OLIF 手术的患者术后 cage 下沉。
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