MRI-based L1 Vertebral Bone Quality Scores Predict Cage Subsidence Following Transforaminal Lumbar Interbody Fusion Similar to L1 CT Hounsfield Units

Abstract

Background

Cage subsidence is one of the most common complications after transforaminal lumbar interbody fusion (TLIF) and correlates with inferior bone quality. Studies have reported L1 vertebral bone quality score (VBQ) based on MRI to be a promising alternative to evaluating preoperative bone quality. However, to the knowledge of the authors, no study has examined the correlation between L1 VBQ scores and cage subsidence after TLIF.

Purpose

The purpose of the study was (1) to assess the interrelation between the L1 VBQ score and cage subsidence after TLIF; and (2) to compare L1 VBQ and L1 CT Hounsfield Unit (HU) values in predicting cage subsidence after TLIF.

Methods

We reviewed patients who had undergone TLIF at one institution between 2012 to 2021. Cage subsidence was measured using postoperative lumbar CT based on cage protrusion through the endplates at more than 2 mm. The L1 VBQ score was calculated by dividing mean L1 signal intensity (SI) by mean SI of the cerebrospinal fluid (CSF) at L1. The L1 HU value representing bone mineral density (BMD) was measured using computed tomography. We then performed Student’s t-test for independent samples and logistic regression analyses for statistical analysis. We also conducted receiver operating characteristic (ROC) analysis to assess the predictive ability of the L1 VBQ score and L1 CT HU.

Results

Of 233 participants, cage subsidence was observed in 41 patients (17.6%). Comparison between the characteristics of patients between the group with subsidence and the group without subsidence revealed significant differences in the age, VBQ score, and L1 CT HU. Multivariate logistic regression showed that higher L1 VBQ score (OR = 2.499, 95% CI: 1.205–5.180, p = 0.014) and lower L1 CT HU (OR = 0.960, 95% CI: 0.933–0.987, p = 0.005) were associated with an increased rate of cage subsidence. Area under the curve (AUC) analysis of the L1 VBQ score returned 0.735 (95% CI: 0.620–0.850) and the suitable threshold was 3.424 (sensitivity: 82.9%, specificity: 70.7%). The AUC of L1 CT HU was 0.747 (95% CI: 0.642–0.852) and the suitable threshold was 136.5 (sensitivity: 85.4%, specificity: 56.1%).

Conclusions

The present study demonstrates that L1 VBQ score and L1 CT HU are reliable predictors with similar performance for cage subsidence after TLIF.

Zusammenfassung

Hintergrund

Cage-Sinterung ist eine der häufigsten Komplikationen nach transforaminaler lumbaler interkorporeller Fusion (TLIF) und korreliert mit minderwertiger Knochenqualität. Studien haben gezeigt, dass der L1-Wirbelknochen-Qualitätsscore (VBQ) basierend auf MRT als vielversprechende Alternative zur Beurteilung der präoperativen Knochenqualität berichtet wurde. Allerdings wurde nach dem Wissen der Autoren keine Korrelation zwischen L1-VBQ-Scores und Cage-Sinterung nach TLIF untersucht.

Zweck

Beurteilung (1) des Zusammenhangs zwischen dem L1-VBQ-Score und Cage-Sinterung nach TLIF; (2) Vergleich der Werte von L1-VBQ und L1-CT-Hounsfield Unit (HU) bei der Vorhersage der Cage-Sinterung nach TLIF.

Methoden

Wir untersuchten Patienten, die zwischen 2012 und 2021 an einer Institution einer TLIF unterzogen wurden. Die Cage-Sinterung wurde mittels postoperativer Lumbal-CT gemessen, basierend auf Cage-Protrusion durch die Endplatten von mehr als 2 mm. Der L1-VBQ-Score wurde berechnet, indem die mittlere L1-Signalintensität (SI) durch die mittlere SI des Liquors (CSF) bei L1 dividiert wurde. Der L1-HU-Wert für die Knochenmineraldichte (BMD) der L1-Lendenwirbelsäule wurde mittels Computertomografie gemessen. Es wurden unabhängige Student’s t-Tests und logistische Regressionsanalysen durchgeführt. Darüber hinaus wurde eine ROC-Analyse (ROC: Receiver Operating Curve) durchgeführt, um die Vorhersagefähigkeit des L1-VBQ-Scores und der L1-CT-HU zu beurteilen.

Ergebnisse

Bei 233 Teilnehmern wurde Cage-Sinterung bei 41 Patienten beobachtet (17,6%). Beim Vergleich der Merkmale der Patienten zwischen der Gruppe mit Cage-Sinterung und der Gruppe ohne Cage-Sinterung wurden signifikante Unterschiede bezüglich Alter, VBQ-Score und L1-CT-HU festgestellt. Multivariate logistische Regressionen zeigten, dass ein höherer L1-VBQ-Score (OR = 2,499, 95%-KI: 1,205–5,180; p = 0,014) und eine niedrigere L1-CT-HU (OR = 0,960, 95%-KI: 0,933–0,987; p = 0,005) mit einer erhöhten Rate der Cage-Sinterung assoziiert waren. Die AUC-Analyse (AUC: Bereich unter der Kurve) des L1-VBQ-Scores betrug 0,735 (95%-KI: 0,620–0,850) und der geeignete Schwellenwert war 3,424 (Sensitivität: 82,9%, Spezifität: 70,7%). Die AUC der L1-CT-HU betrug 0,747 (95%-KI: 0,642–0,852) und der geeignete Schwellenwert war 136,5 (Sensitivität: 85,4%, Spezifität: 56,1%).

Schlussfolgerungen

Diese Studie zeigt, dass sowohl der L1-VBQ-Score als auch der L1-CT-HU zuverlässige Prädiktoren für Cage-Sinterung nach TLIF sind. Diese beiden Messmethoden sind ähnlich leistungsfähig bei der Vorhersage der Cage-Sinterung.

Keywords

lumbar degenerative disease - VBQ score - CT HU - TLIF - cage subsidence

Schlüsselwörter

lumbaldegenerative Erkrankung - VBQ-Punktzahl - CT HU - TLIF - Käfigabsenkung

Publication History

Received: 05 November 2024

Accepted after revision: 03 March 2025

Article published online:
03 April 2025

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