Preoperative MRI-based vertebral bone quality (VBQ) score assessment in patients undergoing lumbar spinal fusion

Salzmann, Stephan N.; Okano, Ichiro; Jones, Conor; Zhu, Jiaqi; Lu, Shuting; Onyekwere, Ikenna; Balaji, Venkatesh; Reisener, Marie–Jacqueline; Chiapparelli, Erika; Shue, Jennifer; Carrino, John A.; Girardi, Federico P.; Cammisa, Frank P.; Sama, Andrew A.; Hughes, Alexander P.

doi:10.1016/j.spinee.2022.03.006

Cited by 72 publications

(48 citation statements)

References 32 publications

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“…Most importantly, it demonstrated generalizability across multiple MR systems from distinct manufacturers. 21 The current study builds on the work of Ehresman et al 21 and Salzmann et al 26 in validating the MRI VBQ scoring system against QCT measurements in a cohort of patients undergoing spine surgery. In this patient population, we defined a cutoff value for VBQ at 2.6 that can serve as a marker for higher risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…Further, this will also expand upon recent attempts in validating this novel technique using QCT measures. 26 Our group utilizes QCT as a screening technique for local BMD prior to spine surgery. Consequently, the current study sought to validate this VBQ scoring system in a more generalizable patient population, namely, those who have received routine preoperative computed tomography (CT) scans.…”

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confidence: 99%

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MRI-based Score for Assessment of Bone Mineral Density in Operative Spine Patients

Kim

Lyons

Sarmiento

et al. 2022

Spine

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Study Design. Retrospective comparison. Objective. The aim was to determine whether a previously developed magnetic resonance imaging (MRI)-derived bone mineral density (BMD) scoring system can differentiate between healthy and osteoporotic vertebrae and to validate this scoring system against quantitative computed tomography measurements. Summary of Background Data. BMD is an important preoperative consideration in spine surgery. Techniques to measure BMD are subject to falsely elevated values in the setting of spondylosis (dual-energy X-ray absorptiometry) or require significant exposure to radiation [quantitative computed tomography (QCT)]. Previous studies have shown that MRI may be utilized to measure bone quality using changes in the bone marrow signal observed on T1-weighted MRIs. Materials and Methods. Retrospective study of patients who underwent operative lumbar procedures at a single tertiary institution between 2016 and 2021 (n=61). Vertebral bone quality (VBQ) scores were measured by dividing the median signal intensities of L1–L4 by the signal intensity of cerebrospinal fluid on noncontrast T1W MRI. Demographic data, comorbidities, VBQ scores, and QCT-derived T scores and BMD of the lumbar spine were compared between healthy (T score ≥−1; n=21), osteopenic (−2.5

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

MRI-based Score for Assessment of Bone Mineral Density in Operative Spine Patients

Kim

Lyons

Sarmiento

et al. 2022

Spine

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“…The use of the VBQ score is based on the theory that more atrophy and fatty infiltration in osteoporotic trabecular bone causes higher SI on T1-weighted images. Owing to the easy-to-teach methodology and rapid results unaffected by confounding factors, the measurement of this score has shown good reproducibility and reliability, demonstrating that this is a practical tool for clinical use [ 14 , 38 ]. In previous studies, the use of the VBQ score was verified against the use of DEXA to identify osteoporotic bone and to independently predict the risk of fragility fractures, cage subsidence, and vertebral compression fracture in patients with spine metastases [ 13 , 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Vertebral bone quality score to predict cage subsidence following oblique lumbar interbody fusion

et al. 2023

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Background Current evidence suggests that the magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score is a good parameter for evaluating bone quality. We aimed to assess whether the VBQ score can predict the occurrence of postoperative cage subsidence after oblique lumbar interbody fusion (OLIF) surgery. Methods Patients (n = 102) who had undergone single-level OLIF with a minimal follow-up for 1 year were reviewed in this study. Demographic and radiographic data of these patients were collected. Cage subsidence was defined as ≥ 2 mm of cage migration into the inferior endplate, superior endplate, or both. Further, the MRI-based VBQ score was measured on T1-weighted images. Moreover, univariable and multivariable binary logistic regression analyses were performed. Meanwhile, Pearson analysis was used to evaluate the correlation among the VBQ score, average lumbar dual-energy X-ray absorptiometry (DEXA) T-score, and degree of cage subsidence. Furthermore, ad-hoc analysis was used along with receiver operating characteristic curve analysis to assess the predictive ability of the VBQ score and average lumbar DEXA T-score. Results Of 102 participants, cage subsidence was observed in 39 (38.24%) patients. According to the univariable analysis, patients with subsidence had older age, higher antiosteoporotic drug use, larger disk height change, a more concave morphology of inferior and superior endplates, higher VBQ score, and lower average lumbar DEXA T-score compared to patients without subsidence. In the multivariable logistic regression analysis, a higher VBQ score was significantly associated with an increased risk of subsidence (OR = 23.158 ± 0.849, 95% CI 4.381–122.399, p < 0.001), and it was the only significant and independent predictor of subsidence after OLIF. Moreover, the VBQ score was moderately correlated with the average lumbar DEXA T-score (r = − 0.576, p < 0.001) and the amount of cage subsidence (r = 0.649, p < 0.001). Furthermore, this score significantly predicted cage subsidence with an accuracy of 83.9%. Conclusions The VBQ score can independently predict postoperative cage subsidence in patients undergoing OLIF surgery.

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“…However, they argue that with reference to more accurate QCT measurements, the resulting bone quality score is lower than other studies predicted and that QCT may not be a widely applicable reference standard. In another study, only femoral neck and total hip T-scores were selected as reference criteria [ 12 , 31 ]. More emphasis was placed on lumbar bone density in the present study, suggesting a higher correlation with VBQ scores than in other studies, which indicates the reliability of bone quality scores.…”

Section: Discussionmentioning

confidence: 99%

“…Theoretically, it is possible to avoid the interference of degenerative changes and reflect the true level of trabecular bone. Salzmann et al studied patients undergoing lumbar spine surgery and found that VBQ had diagnostic value through quantitative computed tomography (QCT) [ 12 ]. However, QCT requires additional measurement software and investment, limiting its clinical implementation.…”

Section: Introductionmentioning

confidence: 99%

MRI-based vertebral bone quality score for the assessment of osteoporosis in patients undergoing surgery for lumbar degenerative diseases

Chen

Lei

et al. 2023

J Orthop Surg Res

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Purpose To explore the value of vertebral bone quality (VBQ) scores in diagnosing osteoporosis in patients with lumbar degeneration. Methods A retrospective analysis was conducted of 235 patients treated with lumbar fusion surgery at the age of ≥ 50; they were divided into a degenerative group and a control group according to the severity of degenerative changes on three-dimensional computed tomography. The L1-4 vertebral body and L3 cerebrospinal fluid signal intensities in the T1-weighted lumbar magnetic resonance imaging (MRI) image were recorded, and the VBQ score was calculated. Demographics, clinical data, and dual-energy X-ray absorptiometry (DXA) indicators were recorded, and the VBQ value was compared with bone density and T-score using the Pearson correlation coefficient. The VBQ threshold was obtained according to the control group and compared with the efficacy of osteoporosis diagnosis based on DXA. Results A total of 235 patients were included in the study, and the age of the degenerative group was older than that of the control group (61.8 vs. 59.4, P = 0.026). The VBQ score of the control group suggested a higher correlation with the bone mineral density (BMD) value and T-score (r = − 0.611 and − 0.62, respectively). The BMD value and T-score in the degenerative group were higher than those in the control group (P < 0.05). Receiver-operating characteristic curve analysis showed that the VBQ score had a good predictive ability for osteoporosis (AUC = 0.818), with a sensitivity of 93% and a specificity of 65.4%. Among the undiagnosed osteoporosis patients with T-score, the VBQ score after adjusting the threshold was higher in the degenerative group (46.9% vs. 30.8%). Conclusions Emerging VBQ scores can reduce the interference caused by degenerative changes compared to traditional DXA measures. Screening for osteoporosis in patients undergoing lumbar spine surgery provides new ideas.

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Preoperative MRI-based vertebral bone quality (VBQ) score assessment in patients undergoing lumbar spinal fusion

Cited by 72 publications

References 32 publications

MRI-based Score for Assessment of Bone Mineral Density in Operative Spine Patients

MRI-based Score for Assessment of Bone Mineral Density in Operative Spine Patients

Vertebral bone quality score to predict cage subsidence following oblique lumbar interbody fusion

MRI-based vertebral bone quality score for the assessment of osteoporosis in patients undergoing surgery for lumbar degenerative diseases

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