Wang Siyi, Wang Yongdi, Wang Zhe, Ai Youwei, Chen Qian, Zhao Yize, Wu Ruibang, Huang Yong, Zhu Ce, Liu Limin, Feng Ganjun
Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Chengdu, China.
Affiliated Hospital of North Sichuan Medical College, Nanchong, Nanchong, China.
Eur Spine J. 2025 Jul 14. doi: 10.1007/s00586-025-09142-y.
This study aimed to comprehensively evaluate the association between paraspinal muscle fat infiltration (FI) and three MRI-based vertebral bone quality indicators-Vertebral Bone Quality (VBQ), Modified VBQ (MVBQ), and Endplate Bone Quality (EBQ)-in patients with lumbar degenerative diseases (LDD), and to compare their diagnostic and prognostic implications.
A retrospective analysis included 261 patients undergoing transforaminal lumbar interbody fusion (TLIF) for LDD. Paraspinal muscle parameters-total cross-sectional area (TCSA), functional CSA (FCSA), relative FCSA (rFCSA), and fat infiltration rate (FIR)-were obtained from preoperative MRI. VBQ, MVBQ, and EBQ scores were also calculated. Patients were stratified into high and low FI groups based on FIR quartiles. Correlation and multivariable regression analyses were performed, and diagnostic performance was assessed using Receiver Operating Characteristic (ROC) curves, Clinical outcomes (Oswestry Disability Index (ODI), Visual Analogue Scale (VAS)) were followed up for 2 years.
Patients with high FI exhibited significantly elevated VBQ (3.41 vs. 3.01, p < 0.001), MVBQ (3.47 vs. 2.91, p < 0.001), and EBQ (3.31 vs. 2.97, p = 0.001) scores compared to the normal FI group. FIR correlated positively with all bone quality indices, with the strongest association for MVBQ (r = 0.432, p < 0.001). MVBQ demonstrated superior diagnostic performance (AUC = 0.70) compared to VBQ (AUC = 0.64) and EBQ (AUC = 0.53). At 2-year follow-up, high FI patients had worse ODI scores (11.61 vs. 10.57, p = 0.031), though no differences in VAS were observed.
Our study established a significant association between paraspinal muscles FI and the bone quality of various regions of the vertebrae, as well as prognosis undergoing surgery for LDD patients. MVBQ may serve as a reliable and practical preoperative marker for musculoskeletal degeneration in patients with LDD, guiding individualized risk stratification and rehabilitation planning.
本研究旨在全面评估腰椎退行性疾病（LDD）患者椎旁肌脂肪浸润（FI）与三种基于MRI的椎体骨质量指标——椎体骨质量（VBQ）、改良椎体骨质量（MVBQ）和终板骨质量（EBQ）之间的关联，并比较它们的诊断和预后意义。
一项回顾性分析纳入了261例因LDD接受经椎间孔腰椎椎间融合术（TLIF）的患者。从术前MRI中获取椎旁肌参数——总横截面积（TCSA）、功能性横截面积（FCSA）、相对FCSA（rFCSA）和脂肪浸润率（FIR）。还计算了VBQ、MVBQ和EBQ评分。根据FIR四分位数将患者分为高FI组和低FI组。进行相关性和多变量回归分析，并使用受试者工作特征（ROC）曲线评估诊断性能，对临床结局（Oswestry功能障碍指数（ODI）、视觉模拟量表（VAS））进行了2年的随访。
与正常FI组相比，高FI患者的VBQ（3.41对3.01，p < 0.001）、MVBQ（3.47对2.91，p < 0.001）和EBQ（3.31对2.97，p = 0.001）评分显著升高。FIR与所有骨质量指标呈正相关，与MVBQ的相关性最强（r = 0.432，p < 0.001）。与VBQ（AUC = 0.64）和EBQ（AUC = 0.53）相比，MVBQ表现出更好的诊断性能（AUC = 0.70）。在2年随访时，高FI患者的ODI评分更差（11.61对10.57，p = 0.031），尽管VAS没有差异。
我们的研究证实了椎旁肌FI与LDD患者椎体不同区域的骨质量以及手术预后之间存在显著关联。MVBQ可能是LDD患者肌肉骨骼退变的可靠且实用的术前标志物，有助于指导个体化的风险分层和康复计划。
