Wang Yongdi, Chen Qian, Zhu Ce, Ai Youwei, Wang Juehan, Ding Hong, Luo Dun, Liu Limin
Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
Z Orthop Unfall. 2025 Apr 3. doi: 10.1055/a-2550-4502.
Cage subsidence is one of the most common complications after transforaminal lumbar interbody fusion (TLIF) and correlates with inferior bone quality. Studies have reported L1 vertebral bone quality score (VBQ) based on MRI to be a promising alternative to evaluating preoperative bone quality. However, to the knowledge of the authors, no study has examined the correlation between L1 VBQ scores and cage subsidence after TLIF.The purpose of the study was (1) to assess the interrelation between the L1 VBQ score and cage subsidence after TLIF; and (2) to compare L1 VBQ and L1 CT Hounsfield Unit (HU) values in predicting cage subsidence after TLIF.We reviewed patients who had undergone TLIF at one institution between 2012 to 2021. Cage subsidence was measured using postoperative lumbar CT based on cage protrusion through the endplates at more than 2 mm. The L1 VBQ score was calculated by dividing mean L1 signal intensity (SI) by mean SI of the cerebrospinal fluid (CSF) at L1. The L1 HU value representing bone mineral density (BMD) was measured using computed tomography. We then performed Student's -test for independent samples and logistic regression analyses for statistical analysis. We also conducted receiver operating characteristic (ROC) analysis to assess the predictive ability of the L1 VBQ score and L1 CT HU.Of 233 participants, cage subsidence was observed in 41 patients (17.6%). Comparison between the characteristics of patients between the group with subsidence and the group without subsidence revealed significant differences in the age, VBQ score, and L1 CT HU. Multivariate logistic regression showed that higher L1 VBQ score (OR = 2.499, 95% CI: 1.205-5.180, p = 0.014) and lower L1 CT HU (OR = 0.960, 95% CI: 0.933-0.987, p = 0.005) were associated with an increased rate of cage subsidence. Area under the curve (AUC) analysis of the L1 VBQ score returned 0.735 (95% CI: 0.620-0.850) and the suitable threshold was 3.424 (sensitivity: 82.9%, specificity: 70.7%). The AUC of L1 CT HU was 0.747 (95% CI: 0.642-0.852) and the suitable threshold was 136.5 (sensitivity: 85.4%, specificity: 56.1%).The present study demonstrates that L1 VBQ score and L1 CT HU are reliable predictors with similar performance for cage subsidence after TLIF.
椎间融合器下沉是经椎间孔腰椎椎体间融合术(TLIF)后最常见的并发症之一,且与较差的骨质相关。研究报告称,基于磁共振成像(MRI)的L1椎体骨质量评分(VBQ)是评估术前骨质的一种很有前景的替代方法。然而,据作者所知,尚无研究探讨TLIF术后L1 VBQ评分与椎间融合器下沉之间的相关性。本研究的目的是:(1)评估TLIF术后L1 VBQ评分与椎间融合器下沉之间的相互关系;(2)比较L1 VBQ和L1 CT骨密度值(HU)在预测TLIF术后椎间融合器下沉方面的作用。我们回顾了2012年至2021年期间在某一机构接受TLIF手术的患者。基于术后腰椎CT测量椎间融合器下沉情况,测量标准为椎间融合器穿出终板超过2毫米。L1 VBQ评分通过将L1平均信号强度(SI)除以L1脑脊液(CSF)的平均SI来计算。使用计算机断层扫描测量代表骨密度(BMD)的L1 HU值。然后我们进行独立样本t检验和逻辑回归分析以进行统计分析。我们还进行了受试者工作特征(ROC)分析,以评估L1 VBQ评分和L1 CT HU的预测能力。在233名参与者中,41名患者(17.6%)出现了椎间融合器下沉。下沉组与未下沉组患者特征的比较显示,年龄、VBQ评分和L1 CT HU存在显著差异。多因素逻辑回归显示,较高的L1 VBQ评分(OR = 2.499,95% CI:1.205 - 5.180,p = 0.014)和较低的L1 CT HU(OR = 0.960,95% CI:0.933 - 0.987,p = 0.005)与椎间融合器下沉率增加相关。L1 VBQ评分的曲线下面积(AUC)分析结果为0.735(95% CI:0.620 - 0.850),合适的阈值为3.424(灵敏度:82.9%,特异性:70.7%)。L1 CT HU的AUC为0.747(95% CI:0.642 - 0.852),合适的阈值为136.5(灵敏度:85.4%,特异性:56.1%)。本研究表明,L1 VBQ评分和L1 CT HU是TLIF术后椎间融合器下沉的可靠预测指标,二者性能相似。