Miyazaki Takahiro, Tanioka Satoru, Yamamoto Atsushi, Maeda Masayuki, Aydin Orhun Utku, Hilbert Adam, Ikezawa Munenari, Nishikawa Hirofumi, Fujimoto Masashi, Ishida Fujimaro, Kamei Yusuke, Yoshida Koichiro, Shoda Motoi, Suzuki Hidenori, Mizuno Masaki, Frey Dietmar
Mie University, Tsu, Japan.
Charité - University Medicine Berlin, Berlin, Germany.
Eur Spine J. 2025 May 23. doi: 10.1007/s00586-025-08961-3.
To clarify the ability of the preoperative CT Hounsfield units (HU) of the vertebrae and MRI-based vertebral bone quality (VBQ) score in predicting screw loosening following lumbar interbody fusion.
Patients with lumbar degenerative disease who underwent single-level lumbar interbody fusion at five hospitals were enrolled. The HU were assessed at vertebral body and pedicle. The VBQ score was assessed on the T1-weighted sagittal image and defined as the quotient of the median signal intensity of the vertebrae from L1 to L4 divided by the signal intensity of the cerebrospinal fluid. Screw loosening was evaluated by the postoperative CT scans at 12 months or more. Patients were divided into the screw loosening group and no loosening group, and the HU and the VBQ score were compared between the groups.
A total of 107 patients (mean age, 67.8 ± 10.1 years, 62 men) were included. At the vertebral body, the HU of L1, the average HU from L1 to L4, from L1 to L5, and from L1 to S1, and the HU of the upper instrumented vertebra showed a statistically significant difference between the two groups. The average HU of the vertebral body from L1 to L4 showed the highest AUC of 0.651 and sensitivity of 0.818. No significant difference was found in the HU of the pedicle and VBQ score.
The preoperative CT HU of the vertebral bodies could reliably predict screw loosening following lumbar interbody fusion. In contrast, the VBQ score did not predict screw loosening.
阐明术前椎体CT亨氏单位（HU）及基于MRI的椎体骨质量（VBQ）评分预测腰椎椎间融合术后螺钉松动的能力。
纳入在五家医院接受单节段腰椎椎间融合术的腰椎退行性疾病患者。在椎体和椎弓根处评估HU。在T1加权矢状位图像上评估VBQ评分，其定义为L1至L4椎体的中位信号强度与脑脊液信号强度的商。通过术后12个月或更长时间的CT扫描评估螺钉松动情况。将患者分为螺钉松动组和未松动组，比较两组之间的HU和VBQ评分。
共纳入107例患者（平均年龄67.8±10.1岁，男性62例）。在椎体处，L1的HU、L1至L4、L1至L5以及L1至S1的平均HU，以及上位固定椎体的HU在两组之间存在统计学显著差异。L1至L4椎体的平均HU显示出最高的曲线下面积（AUC）为0.651，敏感度为0.818。椎弓根HU和VBQ评分未发现显著差异。
术前椎体CT的HU能够可靠地预测腰椎椎间融合术后的螺钉松动。相比之下，VBQ评分不能预测螺钉松动。
