基于 MRI 的终板骨质量评分预测斜外侧腰椎椎间融合术后 cage 下沉。
MRI-based endplate bone quality score predicts 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, Sichuan, China.
Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
出版信息
Spine J. 2024 Oct;24(10):1922-1928. doi: 10.1016/j.spinee.2024.05.002. Epub 2024 May 15.
BACKGROUND CONTEXT
Cage subsidence is a common complication after lumbar interbody fusion surgery, with low bone mineral density (BMD) being a significant risk factor. Endplate bone quality (EBQ) obtained from clinical MRI scans has been deemed reliable in determining regional BMD. However, the association between EBQ score and cage subsidence following oblique lumbar interbody fusion (OLIF) has not been clearly established.
PURPOSE
This study aims to assess the relationship between EBQ score and cage subsidence in patients who underwent single-level OLIF.
STUDY DESIGN/SETTING: A retrospective study.
PATIENT SAMPLE
The study included adults with degenerative spinal conditions who underwent single-level OLIF at our institution.
OUTCOME MEASURES
Cage subsidence, disc height, EBQ score, fusion rate.
METHODS
This retrospective study analyzed data from patients who underwent single-level OLIF surgery at our institution between October 2017 and August 2022. Postoperative CT scans were used to measure cage subsidence, while the EBQ score was calculated using preoperative noncontrast T1-weighted MRI. To determine the predictive ability of the EBQ score, receiver operating characteristic (ROC) curve analysis was conducted. Additionally, univariable and multivariable logistic regression analyses were performed.
RESULTS
In this study, a total of 88 patients were included and followed up for an average of 15.8 months. It was observed that 32.9% (n=29/88) of the patients experienced cage subsidence. The postsurgery disc height was significantly higher in patients who experienced subsidence compared to those who did not. The mean EBQ scores for patients with nonsubsidence and subsidence were 2.31±0.6 and 3.48±1.2, respectively, and this difference was statistically significant. The ROC curve analysis showed that the AUC for the EBQ score was 0.811 (95% CI: 0.717-0.905). The most suitable threshold for the EBQ score was determined to be 2.318 (sensitivity: 93.1%, specificity: 55.9%). Additionally, the multivariate logistic regression analysis revealed a significant association between a higher EBQ score and an increased risk of subsidence (odds ratio [OR]=6.204, 95% CI=2.520-15.272, p<.001).
CONCLUSIONS
Our findings indicate that higher preoperative EBQ scores are significantly linked to cage subsidence following single-level OLIF. Preoperative measurement of MRI can serve as a valuable tool in predicting cage subsidence.
背景
腰椎体间融合术后， cage 沉降是一种常见并发症，骨密度（BMD）低是一个显著的危险因素。从临床 MRI 扫描中获得的终板骨质量（EBQ）被认为是确定局部 BMD 的可靠方法。然而，EBQ 评分与斜侧腰椎体间融合（OLIF）术后 cage 沉降之间的关系尚未明确。
目的
本研究旨在评估单节段 OLIF 术后 EBQ 评分与 cage 沉降的关系。
研究设计/地点：回顾性研究。
患者样本
该研究纳入了在我院接受单节段 OLIF 治疗的成人退行性脊柱疾病患者。
研究终点
cage 沉降、椎间盘高度、EBQ 评分、融合率。
方法
这项回顾性研究分析了 2017 年 10 月至 2022 年 8 月在我院接受单节段 OLIF 手术的患者数据。术后 CT 扫描用于测量 cage 沉降，而 EBQ 评分则使用术前非对比 T1 加权 MRI 计算。为了确定 EBQ 评分的预测能力，进行了接收者操作特征（ROC）曲线分析。此外，还进行了单变量和多变量逻辑回归分析。
结果
本研究共纳入 88 例患者，平均随访 15.8 个月。研究发现，32.9%（n=29/88）的患者出现 cage 沉降。与未出现沉降的患者相比，出现沉降的患者术后椎间盘高度明显更高。无沉降和有沉降患者的 EBQ 评分均值分别为 2.31±0.6 和 3.48±1.2，差异具有统计学意义。ROC 曲线分析显示，EBQ 评分的 AUC 为 0.811（95% CI：0.717-0.905）。确定 EBQ 评分的最佳截断值为 2.318（灵敏度：93.1%，特异性：55.9%）。此外，多变量逻辑回归分析显示，较高的 EBQ 评分与 cage 沉降的风险增加显著相关（比值比[OR]=6.204，95% CI=2.520-15.272，p<.001）。
结论
本研究结果表明，单节段 OLIF 术后，术前 EBQ 评分较高与 cage 沉降显著相关。术前 MRI 测量可作为预测 cage 沉降的有价值工具。
Zotero 插件