Research on the predictive efficacy of MRI-based endplate bone quality and vertebral body bone quality scores for adjacent segment degeneration after lumbar spinal fusion.

OBJECTIVE

This study aims to evaluate the predictive significance of scores relating to endplate bone quality (EBQ) and vertebral body bone quality (VBQ) as assessed by MRI for adjacent segment degeneration (ASD) following posterior lumbar interbody fusion (PLIF).

METHODS

In this retrospective analysis, we examined 236 patients with degenerative conditions of the lumbar spine who had undergone PLIF between 2018 and 2022. Participants were categorized into groups based on radiographic ASD (RASD), symptomatic ASD (SASD), and no ASD (NASD). Preoperative MRI images were utilized to derive EBQ and VBQ scores, which were then evaluated alongside imaging features (such as lumbar lordosis angle and disc degeneration grade) and clinical factors (including age and diabetes status). Both univariate and multivariate logistic regression analyses were conducted to identify risk factors, with the receiver operating characteristic curve (ROC) employed to assess the efficiency of these scores.

RESULTS

The rates of incidence for RASD and SASD were found to be 38.1% and 18.5%, respectively. The multivariate analysis revealed that EBQ (OR = 7.586, 95% CI: 2.379-24.159, P = 0.001) and VBQ (OR = 7.847, 95% CI: 2.737-22.494, P < 0.001) stand as independent predictors for RASD; similarly, EBQ (OR = 11.838, 95% CI: 2.836-49.418, P = 0.001) and VBQ (OR = 15.496, 95% CI: 4.263-56.306, P < 0.001) were identified as independent predictors for SASD. The ROC analysis demonstrated that EBQ exhibited superior predictive efficiency for RASD (AUC = 0.707 vs VBQ = 0.703), whereas VBQ showed a heightened predictive value for SASD (AUC = 0.793 vs EBQ = 0.772). Furthermore, factors such as older age,preoperative degeneration of adjacent discs (Pfirrmann grade ≥ III) and preoperative disk bulge were also recognized as independent risk factors for ASD (P < 0.05).

CONCLUSION

Both EBQ and VBQ scores possess a notable capability to forecast the likelihood of ASD post-lumbar spinal fusion, although their predictive efficacy varies depending on the ASD category. EBQ is particularly effective for risk stratification concerning radiographic degeneration, while VBQ provides a stronger predictive advantage for symptomatic degeneration. Future prospective studies are warranted to confirm the clinical applicability of these scores.