Zheng Shuxin, Wang Linnan, Li Junhu, Li Qiujiang, Deng Zhipeng, Wang Lei, Song Yueming
Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, 610041, Chengdu, China.
Eur Spine J. 2025 Jan;34(1):86-95. doi: 10.1007/s00586-024-08511-3. Epub 2024 Oct 4.
To reduce the amount of radiation that patients receive during surgery, surgeons can evaluate the quality of the bone prior to surgery using computed tomography (CT) or dual-energy X-ray absorptiometry. Recently, lumbar spine vertebral bone quality has been evaluated using an MRI-based scoring system. However, few studies have investigated the connection between cage subsidence in patients following cervical interbody fusion and site-specific MRI bone evaluation. It is unknown how cage subsidence following anterior cervical corpectomy decompression and fusion is related to MRI-based endplate bone quality assessment.
To create a similar MRI-based cervical spine scoring system (C-EBQ) and to investigate the predictive value of the MRI cervical endplate bone quality (C-EBQ) score for cage subsidence after ACCF.
The patients' demographic, surgical, and radiological data were collected. Cage subsidence was defined as fusion segment height loss ≥ 3 mm. Multivariate logistic regression models were developed to determine correlations between potential risk factors and subsidence, and simple linear regression analyses of statistically significant indicators were performed.
Among the patients who underwent single-level ACCF, 72 met the requirements for inclusion. The C-VBQ scores also improved from 2.28 ± 0.12, indicating no subsidence, to 3.27 ± 0.35, which indicated subsidence, and the C-EBQ scores improved in both the nonsubsidence group (1.95 ± 0.80) and the subsidence group (2.38 ± 0.54). There was a statistically significant difference (p < 0.05) among the groups. Higher C-EBQ scores were strongly correlated with subsidence in the multivariate analysis (odds ratio [OR] = 17.249, 95% CI = 2.269 to 7.537, P < 0.001), and the C-VBQ score was the major independent predictor of subsidence following ACCF ([OR] = 4.752, 95% CI = 3.824 to 8.781, P < 0.05). The C-EBQ score outperformed the C-VBQ score (75.6%) in terms of predictive accuracy, with a ROC curve indicating an 89.4% score.
After ACCF, cage subsidence was strongly correlated with higher C-EBQ scores on preoperative MRI. Assessing C-EBQ before ACCF may be a useful way to estimate the likelihood of postoperative subsidence.
为减少患者在手术期间接受的辐射量，外科医生可在手术前使用计算机断层扫描（CT）或双能X线吸收法评估骨质质量。最近，已使用基于磁共振成像（MRI）的评分系统评估腰椎椎体骨质质量。然而，很少有研究调查颈椎椎间融合术后患者椎间融合器下沉与特定部位MRI骨质评估之间的联系。目前尚不清楚颈椎前路椎体次全切除减压融合术后椎间融合器下沉与基于MRI的终板骨质质量评估之间有何关联。
创建一个类似的基于MRI的颈椎评分系统（C-EBQ），并研究MRI颈椎终板骨质质量（C-EBQ）评分对颈椎前路椎体次全切除减压融合术（ACCF）后椎间融合器下沉的预测价值。
收集患者的人口统计学、手术和放射学数据。椎间融合器下沉定义为融合节段高度丢失≥3mm。建立多因素逻辑回归模型以确定潜在危险因素与下沉之间的相关性，并对具有统计学意义的指标进行简单线性回归分析。
在接受单节段ACCF的患者中，72例符合纳入要求。C-VBQ评分也从表示无下沉的2.28±0.12提高到表示有下沉的3.27±0.35，并且在无下沉组（1.95±0.80）和下沉组（2.38±0.54）中C-EBQ评分均有所提高。各组之间存在统计学显著差异（p<0.05）。在多因素分析中，较高的C-EBQ评分与下沉密切相关（优势比[OR]=17.249，95%可信区间[CI]=2.269至7.537，P<0.001），并且C-VBQ评分是ACCF术后下沉的主要独立预测因素（[OR]=4.752，95%CI=3.824至8.781，P<0.05）。C-EBQ评分在预测准确性方面优于C-VBQ评分（75.6%），ROC曲线显示评分达到89.4%。
ACCF术后，椎间融合器下沉与术前MRI上较高的C-EBQ评分密切相关。在ACCF术前评估C-EBQ可能是估计术后下沉可能性的一种有用方法。
