The predictive value of a novel site-specific MRI-based bone quality assessment, endplate bone quality (EBQ), for severe cage subsidence among patients undergoing standalone lateral lumbar interbody fusion

Jones, Conor; Okano, Ichiro; Arzani, Artine; Dodo, Yusuke; Moser, Manuel; Reisener, Marie–Jacqueline; Chiapparelli, Erika; Amini, Dominik Adl; Shue, Jennifer; Sama, Andrew A.; Cammisa, Frank P.; Girardi, Federico P.; Hughes, Alexander P.

doi:10.1016/j.spinee.2022.07.085

Cited by 25 publications

(13 citation statements)

References 28 publications

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“…This difference may be attributed to the fact that the VBQ score is a site-specific bone density measure that directly reflects vertebral bone quality at the weight-bearing site while excluding factors affecting whole-region standard DEXA measurement, making its assessment more precise than that of the DEXA T-score. Notably, endplate bone quality—a novel site-specific MRI-based bone quality assessment proposed by Jone et al [ 41 ] could predict severe cage subsidence after standalone lateral lumbar interbody fusion even better than the VBQ score. These findings suggest that the VBQ score should be adopted in clinical practice for patients with OLIF surgery in order to improve the efficacy and safety of treatment.…”

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…Data collected included: (1) general patient status: gender, age, BMI, disease duration, occupation, smoking history, comorbidities (e.g., hypertension, diabetes, cardiovascular disease, liver and kidney dysfunction), bone mineral density(DXA method for all vertebrae with fusion segments), Referring to previous research [20] , the VBQ score was calculated with the median of signal intensities in fusion segments vertebral bodies divided by the signal intensity of cerebrospinal uid at L3. Paravertebral muscle status range from 0-4 scores [14] (mean value of fat to muscle area ratio of the multi dus, erector spinae, and psoas major muscles at each segment of surgery).…”

Section: Relevant Factorsmentioning

confidence: 99%

A Study of Risk Factors Associated with Clinical Outcomes Following Surgery for Degenerative Lumbar Scoliosis

Zheng,

Wang,

Wang

et al. 2024

Preprint

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Objective: To investigate the risk factors for the prognosis of degenerative lumbar scoliosis after surgery. Methods: A retrospective analysis was performed to compare the preoperative and postoperative clinical data to assess the prognosis, and to evaluate the patients after surgery by combining the Oswestry Disability Index (ODI) Quality of life. Based on different surgical outcomes, we divide patients into a better prognosis group and a poor prognosis group. Comprehensive risk factors were collected which may related to clinical outcomes included three aspects: patient general status, surgery-related data and imaging parameters. All risk factors were first analyzed through single risk factor analysis, and then multiple logistic regression analysis and Receiver Operating Characteristic (ROC) curves were used to analyze factors related to prognosis after orthopedic surgery. Results: One hundred and thirty-four patients with degenerative lumbar scoliosis who undergone posterior surgery were included in this study. There were 36 men and 98 women with a mean age of 59.4±7.8 years. After identifying potential risk factors that may affect postoperative efficacy through univariate logistic regression, multivariate logistic regression analysis showed that the subcutaneous fat tissue thickness (SFTT) (OR=0.410, P=0.043) , MRI-based vertebral bone quality (VBQ) (OR=0.076, P=0.037), Quantitative Computed Tomography (QCT) (OR=1.401, P=0.008) , degree of kyphosis correction (OR=1.399, P=0.021), sagittal balance correction distance (OR=2.634, P=0.011) were independent predictors of poor prognosis. ROC curve analysis showed that correction degree of kyphosis >20.23°(AUC=0.881, P=0.001), sagittal balance correction distance >2.92CM (AUC=0.834, P=0.001) , QCT >104.6mg/cm3(AUC=0.958, P=0.001)，VBQ <2.88(AUC=0.669, P=0.001)，SFTT <13.5 mm (AUC=0.740, P=0.001) were indicating good clinical efficacy. Conclusions: In patients with degenerative lumbar scoliosis, posterior decompression and fixed fusion surgery can significantly relieve pain and improve quality of life. Among the many factors that may affect prognosis, the correction of kyphosis and sagittal balance is particularly crucial for the postoperative quality of life. Due to the impact of SFTT, VBQ, and QCT on clinical prognosis, patients are encouraged to undergo anti-osteoporosis treatment and early lumbar and dorsal muscle exercise.

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“…9 A new MRI-based vertebral bone quality (VBQ) score has emerged as an alternative to dual-energy X-ray absorptiometry (DEXA) for measuring BMD. [16][17][18][19] Recently, the MRIbased vertebral bone quality (VBQ) score has been shown to correlate with HU value, DEXA T-score and predict osteoporotic fractures. 18 Higher VBQ scores have been shown to be a risk factor for cage subsidence and reoperation after lumbar fusion.…”

Section: Introductionmentioning

confidence: 99%

“…[16][17][18][19] Recently, the MRIbased vertebral bone quality (VBQ) score has been shown to correlate with HU value, DEXA T-score and predict osteoporotic fractures. 18 Higher VBQ scores have been shown to be a risk factor for cage subsidence and reoperation after lumbar fusion. 16,17 As far as we know, no previous research has evaluated the association of VBQ score with TMC subsidence after ACCF.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have found that preoperative cervical Hounsfeld units (HU) value is an independent correlative factor for early TMC subsidence after one level ACCF 9 . A new MRI‐based vertebral bone quality (VBQ) score has emerged as an alternative to dual‐energy X‐ray absorptiometry (DEXA) for measuring BMD 16–19 . Recently, the MRI‐based vertebral bone quality (VBQ) score has been shown to correlate with HU value, DEXA T‐score and predict osteoporotic fractures 18 .…”

Section: Introductionmentioning

confidence: 99%

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The Association between High Preoperative MRI‐based Vertebral Bone Quality (VBQ) Score and Titanium Mesh Cage Subsidence after Anterior Cervical Corpectomy and Fusion

Li,

Zhu,

Xia

et al. 2023

Orthopaedic Surgery

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ObjectiveRecently, the MRI‐based vertebral bone quality (VBQ) score has been shown to correlate with Hounsfeld units (HU) value, dual‐energy X‐ray absorptiometry (DEXA) T‐score and predict osteoporotic fractures. Preoperative cervical HU value is an independent correlative factor for early titanium mesh cage (TMC) subsidence after anterior cervical corpectomy and fusion (ACCF). However, to date the direct association between cervical VBQ score and TMC subsidence has not been studied. This study aims to investigate the predictive effect of cervical VBQ score derived from sagittal non‐contrast‐enhanced T1‐weighted MRI on the early TMC subsidence after ACCF.MethodsPatients who underwent one‐level ACCF from January 2016 to January 2020 were included. We retrospectively collected baseline data on age, sex, body mass index (BMI), disease type, level of surgery and radiology parameters. The cervical VBQ score was measured using preoperative non‐contrast‐enhanced T1‐weighted MRI. Univariate and multivariate logistic regression analysis were performed to screen the independent risk factors of TMC subsidence. The receiver operating characteristic (ROC) curve and area under curve (AUC) were performed to assess the predictive ability of TMC subsidence based on the cervical VBQ score. Spearman correlation analysis was used to determine the correlations between the cervical VBQ score and TMC subsidence.ResultsA total of 134 patients who underwent one‐level ACCF were included in this study, and 46 (34.33%) patients had TMC subsidence. Univariable analyses demonstrated that the age, TMC placement depth and VBQ score were associated with subsidence. The cervical VBQ score in the subsidence group was significantly higher than that in the no subsidence group (3.75 ± 0.45 vs. 3.20 ± 0.42, p < 0.001). The multivariate logistic regression analysis proved that the higher VBQ score (odds ratio[OR] = 13.563, 95% confidence interval [CI] 4.968 ‐ 37.031, p < 0.001) was the only variable that significantly predicted subsidence. Using a VBQ score cutoff value of 3.445, the cervical VBQ score yielded a sensitivity of 69.6% and a specificity of 85.2% with an AUC of 0.810 to differentiate patients with subsidence and with no subsidence.ConclusionPreoperative higher cervical VBQ score is an independent risk factor for TMC subsidence after ACCF. The cervical VBQ score may be a valuable tool for assisting in distinguishing the presence of TMC subsidence.

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The predictive value of a novel site-specific MRI-based bone quality assessment, endplate bone quality (EBQ), for severe cage subsidence among patients undergoing standalone lateral lumbar interbody fusion

Cited by 25 publications

References 28 publications

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

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

A Study of Risk Factors Associated with Clinical Outcomes Following Surgery for Degenerative Lumbar Scoliosis

The Association between High Preoperative MRI‐based Vertebral Bone Quality (VBQ) Score and Titanium Mesh Cage Subsidence after Anterior Cervical Corpectomy and Fusion

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