Yang Zijian, Liang Jie, Shi Dawei, Tuo Can, Wu Yu, Zhang Fan
The First College of Clinical Medical Science, China Three Gorges University, Yichang, China.
Yichang Central People's Hospital, Yichang, China.
Sci Rep. 2025 Jul 29;15(1):27712. doi: 10.1038/s41598-025-13217-7.
As the global population continues to age, the prevalence of lumbar degenerative disease (LDD) has increased. Meanwhile, the clinical efficacy of LDD conventional management remains limited. Posterior lumbar interbody fusion (PLIF) has become the standard surgical intervention. However, cage subsidence (CS) following PLIF poses a persistent clinical challenge. CS has been associated with several risk factors, including age, sex, low bone mineral density (BMD), endplate damage, muscle condition, and cage design. Although muscle health has recently drawn greater attention concerning surgical outcomes and BMD, dependable predictors of subsidence are still lacking. While low BMD is a recognized contributor to CS, the reliability of dual-energy X-ray absorptiometry (DEXA) is debatable. Although quantitative computed tomography (QCT) offers improved accuracy, it can be compromised by calcified structures. Similarly, fat infiltration and inflammation may affect vertebral bone quality (VBQ) and endplate bone quality (EBQ) scores. In this context, the paraspinal muscle index (PMI) and Goutallier classification (GC), both derived from magnetic resonance imaging (MRI), may serve as useful indicators of muscle quality while avoiding radiation exposure and vertebral interference. This study aimed to evaluate the predictive value of PMI and GC for CS after PLIF and compare their performance with other established imaging and bone quality markers. A retrospective review was conducted on 165 patients who underwent single-level PLIF between February 2022 and February 2024. All participants underwent preoperative MRI to assess PMI and GC and evaluate VBQ and EBQ. BMD was quantified using QCT. Patients were categorized into CS and non-CS groups based on postoperative imaging findings. Logistic regression analysis was used to identify risk factors for CS, and the predictive performance of each parameter was evaluated using receiver operating characteristic (ROC) curves, with the area under the curve (AUC) indicating diagnostic accuracy. Of the 165 patients, 45 (27.3%) developed cage subsidence. Those in the CS group were significantly older on average (70.4 ± 6.99 vs. 64.02 ± 8.24 years, p < 0.001) and had a higher proportion of female patients (p = 0.023). A lower body mass index (BMI ≤ 25 kg/m²) was less frequently observed in the CS group (p = 0.002), while no significant differences were noted for diabetes status or surgical indications. Multivariate analysis identified a lower PMI and higher GC as independent predictors of CS. ROC analysis demonstrated strong predictive performance for PMI (AUC = 0.826), GC (AUC = 0.786), QCT (AUC = 0.894), VBQ (AUC = 0.814), and EBQ (AUC = 0.719), with QCT yielding the highest diagnostic accuracy. PMI was inversely correlated with the extent of subsidence and positively associated with BMD. MRI-based assessments of muscle quality, including PMI and GC, offer reliable and non-invasive predictors of cage subsidence following PLIF. These measures may serve as practical tools in preoperative planning, enhancing risk stratification while minimizing radiation exposure.
随着全球人口持续老龄化，腰椎退行性疾病（LDD）的患病率不断上升。与此同时，LDD传统治疗的临床疗效仍然有限。后路腰椎椎间融合术（PLIF）已成为标准的手术干预方式。然而，PLIF术后的椎间融合器下沉（CS）仍然是一个持续存在的临床挑战。CS与多种风险因素相关，包括年龄、性别、低骨密度（BMD）、终板损伤、肌肉状况和椎间融合器设计。尽管最近肌肉健康在手术结果和BMD方面受到了更多关注，但仍然缺乏可靠的下沉预测指标。虽然低BMD是CS的一个公认因素，但双能X线吸收法（DEXA）的可靠性存在争议。尽管定量计算机断层扫描（QCT）的准确性有所提高，但钙化结构可能会影响其结果。同样，脂肪浸润和炎症可能会影响椎体骨质量（VBQ）和终板骨质量（EBQ）评分。在这种情况下，源自磁共振成像（MRI）的椎旁肌指数（PMI）和Goutallier分级（GC），可以作为肌肉质量的有用指标，同时避免辐射暴露和椎体干扰。本研究旨在评估PMI和GC对PLIF术后CS的预测价值，并将它们的表现与其他已确立的影像学和骨质量标志物进行比较。对2022年2月至2024年2月期间接受单节段PLIF的165例患者进行了回顾性研究。所有参与者均接受术前MRI检查，以评估PMI和GC，并评估VBQ和EBQ。使用QCT对BMD进行量化。根据术后影像学结果将患者分为CS组和非CS组。采用逻辑回归分析确定CS的风险因素，并使用受试者工作特征（ROC）曲线评估每个参数的预测性能，曲线下面积（AUC）表示诊断准确性。在165例患者中，45例（27.3%）发生了椎间融合器下沉。CS组患者的平均年龄显著更大（70.4±6.99岁 vs. 64.02±8.24岁，p<0.001），女性患者比例更高（p=0.023）。CS组中体重指数较低（BMI≤25kg/m²）的情况较少见（p=0.002），而糖尿病状态或手术指征方面未观察到显著差异。多变量分析确定较低的PMI和较高的GC是CS的独立预测因素。ROC分析显示PMI（AUC=0.826）、GC（AUC=0.786）、QCT（AUC=0.894）、VBQ（AUC=0.814）和EBQ（AUC=0.719）具有较强的预测性能，其中QCT的诊断准确性最高。PMI与下沉程度呈负相关，与BMD呈正相关。基于MRI的肌肉质量评估，包括PMI和GC，为PLIF术后的椎间融合器下沉提供了可靠且无创的预测指标。这些指标可作为术前规划的实用工具，在最小化辐射暴露的同时加强风险分层。
