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

Abstract

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.

MRI Vertebral Bone Quality Correlates With Interbody Cage Subsidence After Anterior Cervical Discectomy and Fusion

“…Hu et al correlated VBQ scores with subsidence and showed that VBQ scores were moderately correlated with DXA T-scores for the total hip and lumbar spine ( P <0.001), had a moderate correlation with the amount of cage subsidence ( P <0.001), and were able to significantly predict cage subsidence with an accuracy of 85.6% after transforaminal lumbar interbody fusion (TLIF) 6 . VBQ has since been shown to be significantly associated with cage subsidence after oblique lumbar interbody fusion (OLIF) 5 . There has been 1 previous study assessing cervical VBQ and subsidence; however, those authors measured subsidence on postoperative x-rays rather than CT scans 20 .…”

“…A common complication of interbody fusion is subsidence, defined as the sinking of the interbody cage into 1 or both of the adjacent vertebral bodies 1–4 . Risk factors for subsidence include older patient age, 5 endplate morphology, 5 excessive endplate removal and incidental fracture, 6,7 cage position and height, 6,8 lower screw tip-to-vertebral body height 7 and graft-to-endplate surface area ratios, 8 smoking, 9 and low bone mineral density (BMD) 10,11 . The existing body of literature contains conflicting reports on the clinical effects of subsidence.…”

“…Recently, an MRI-based vertebral bone quality score (VBQ) developed by Ehresman et al has been shown to correlate with other measurements of bone density such as DXA BMD and CT HU 19 . Prior literature on the lumbar spine has shown that higher VBQ scores can independently predict postoperative cage subsidence in patients undergoing lumbar interbody fusion surgeries and is a valuable tool for assessing preoperative bone quality 5,6,13,20 . The purpose of this study was to evaluate VBQ as a predictor of interbody subsidence following anterior cervical discectomy and fusion (ACDF) and to determine threshold values that predict increased risk of subsidence.…”

Opportunistic prediction of osteoporosis in patients with degenerative lumbar diseases: a simplified T12 vertebral bone quality approach

“…The study found a significant correlation between VBQ and BMD [ 16 ]. Many researchers have used VBQ as an indicator to assess cage subsidence and recurrence after lumbar fusion surgery [ 7 , 17 ]. However, deformities, fractures, hemangiomas and local infections of the lumbar spine may affect the L1-4VBQ score.…”