Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA.
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo , New York , USA.
Neurosurgery. 2024 Aug 1;95(2):284-296. doi: 10.1227/neu.0000000000002864. Epub 2024 Feb 9.
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.
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.
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.
The VBQ scoring system might be a useful adjunct for predicting radiographic and surgical ASD.
腰椎融合术是最常施行的脊柱手术之一，因此研究常见并发症，如邻近节段疾病（ASD），是当务之急。据作者所知，目前尚无研究探讨基于术前磁共振成像的椎体骨质量（VBQ）评分在预测腰椎融合术后影像学和手术 ASD 方面的作用。本研究旨在探讨影像学和手术 ASD 的预测因素，重点关注 VBQ 评分的预测潜力。
回顾性分析了 2014 年至 2021 年间在单中心行 1-3 个节段腰椎或腰骶段椎间融合术治疗腰椎退行性疾病的所有患者，所有患者均有至少 12 个月的临床和影像学随访。收集患者的人口统计学数据、患者的医疗和手术数据。对纳入患者的术前 MRI 进行评估，采用 VBQ 评分系统评估其影像学 ASD 或手术 ASD 是否可以预测。
共纳入 417 例患者（平均年龄 59.8±12.4 岁；女性 54.0%）。82 例（19.7%）患者发生影像学 ASD，58 例（13.9%）患者发生手术 ASD。单因素分析显示，VBQ 评分较高是影像学 ASD 的显著预测因素（2.4±0.5 比 3.3±0.4；P<0.001），多因素分析显示，VBQ 评分较高是影像学 ASD 的独立危险因素（比值比 1.601；95%置信区间 1.453-1.763；P<0.001）。单因素分析显示，VBQ 评分较高也是手术 ASD 的显著预测因素（2.3±0.5 比 3.3±0.4；P<0.001），在多因素分析中也是手术 ASD 的独立危险因素（比值比 1.509；95%置信区间 1.324-1.720；P<0.001）。本研究还发现术前椎间盘膨出和术前邻近节段椎间盘退变是影像学和手术 ASD 的显著预测因素。此外，3 节段融合也是手术 ASD 的显著预测因素。
VBQ 评分系统可能是预测影像学和手术 ASD 的有用辅助手段。
