Yu Qingsong, Chen Jiabao, Wang Haidong, Ma Lei
Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Front Surg. 2024 Dec 10;11:1472080. doi: 10.3389/fsurg.2024.1472080. eCollection 2024.
To compare the effectiveness of different measurement methods on bone miner density (BMD), including cervical HU of CT, MRI-based cervical vertebral bone quality (C-VBQ), and value of DEXA, for predicting cage subsidence after single-level ACDF.
This is a retrospective study, and patients who underwent single-level ACDF from June 2019 to June 2022 were recruited. We collected preoperative total segmental vertebral height (pre-TSVH), cage subsidence height, cervical angle (CA), T1-slope, straight or reverse cervical curvature, mean HU value of C3-7 (C-HU), mean HU of segment (seg-HU), C-VBQ, segmental C-VBQ (seg-VBQ), and total lumbar value ( value). The variables between the two groups were compared by Student's test or chi-square test. Logistic regression was used to determine the independent risk factors for subsidence. The ROC curve was used to analyze the predictive efficiency of C-HU, seg-HU, C-VBQ, seg-VBQ and value for cage subsidence. Finally, the correlations of C-HU, seg-HU, C-VBQ, seg-VBQ, value and subsidence height were analyzed.
A total of 320 patients were included in this study, and 97 patients (30.31%) had cage subsidence at the last follow-up. The subsidence height was 4.25 ± 0.937 mm in the subsidence group and 1.40 ± 0.726 mm in the nonsubsidence group. There were statistically significant differences between the two groups in bone mineral density-related indexes, including C-HU, seg-HU, C-VBQ, seg-VBQ, and value ( < 0.05). Logistic regression analysis showed that C-HU was an independent risk factor for vertebral subsidence after single-level ACDF. ROC curve analysis showed that C-HU had the largest AUC of 0.897 (0.862, 0.933) in predicting vertebral subsidence. Correlation analysis showed that C-HU had a high correlation with the value ( = 0.662, < 0.001), while C-VBQ had a low correlation with the value ( = -0.173, = 0.002), and C-VBQ had a low correlation with subsidence height ( = 0.135, = 0.016).
Our study showed that compared with the C-VBQ and value, C-HU is more effective for predicting cage subsidence after ACDF. Using the segmental index of C-VBQ or HU could not improve predictive effectiveness. C-VBQ may be insufficient in predicting cage subsidence and estimating BMD.
比较不同测量方法对骨密度（BMD）的有效性，包括CT的颈椎HU值、基于MRI的颈椎骨质量（C-VBQ）以及双能X线吸收法（DEXA）的值，以预测单节段前路颈椎间盘切除融合术（ACDF）后椎间融合器下沉情况。
本研究为回顾性研究，纳入2019年6月至2022年6月期间接受单节段ACDF手术的患者。收集术前全节段椎体高度（术前TSVH）、椎间融合器下沉高度、颈椎角（CA）、T1斜率、颈椎曲度变直或反曲、C3-7平均HU值（C-HU）、节段平均HU值（节段-HU）、C-VBQ、节段C-VBQ（节段-VBQ）以及腰椎总值（值）。两组间变量采用Student's t检验或卡方检验进行比较。采用逻辑回归确定下沉的独立危险因素。利用受试者工作特征（ROC）曲线分析C-HU、节段-HU、C-VBQ、节段-VBQ和值对椎间融合器下沉的预测效率。最后，分析C-HU、节段-HU、C-VBQ、节段-VBQ、值与下沉高度之间的相关性。
本研究共纳入320例患者，97例（30.31%）在末次随访时出现椎间融合器下沉。下沉组下沉高度为4.25±0.937 mm，非下沉组为1.40±0.726 mm。两组在骨密度相关指标上存在统计学显著差异，包括C-HU、节段-HU、C-VBQ、节段-VBQ和值（P<0.05）。逻辑回归分析表明，C-HU是单节段ACDF术后椎体下沉的独立危险因素。ROC曲线分析显示，C-HU在预测椎体下沉方面的曲线下面积（AUC）最大，为0.897（0.862，0.933）。相关性分析表明，C-HU与值高度相关（r=0.662，P<0.001），而C-VBQ与值相关性较低（r=-0.173，P=0.002），C-VBQ与下沉高度相关性较低（r=0.135，P=0.016）。
我们的研究表明，与C-VBQ和值相比，C-HU在预测ACDF术后椎间融合器下沉方面更有效。使用C-VBQ或HU的节段性指标并不能提高预测效果。C-VBQ在预测椎间融合器下沉和估计骨密度方面可能不足。
