Comparison of the predictive roles of CT- and MRI-based endplate regional osteoporosis status measurements for cage subsidence after posterior lumbar interbody fusion.
Aug 2026· Journal of Neurosurgery : Spine· pp.
1-10
· 0 citations· 44 references
Medicine
TL;DR
Endplate HU values indicated a relatively higher predictive performance for CS compared with EBQ scores and served as the most discriminative BMD indicator in patients who underwent PLIF.
Abstract
Objective
This study aimed to compare the efficacy of endplate Hounsfield unit (HU) values and endplate bone quality (EBQ) scores in predicting cage subsidence (CS) after posterior lumbar interbody fusion (PLIF) in older patients and identify the most discriminative bone mineral density (BMD) assessment indicator.
Methods
This retrospective analysis included consecutive patients who underwent PLIF at the authors' institution between January 2016 and February 2024. Clinical data were collected for all patients. Propensity scores were used to match patients with and without CS, and the matched cohort was subjected to conditional logistic regression to investigate the association between radiographic factors and CS. L1 and endplate HU values were derived from CT scans, whereas vertebral bone quality (VBQ) and EBQ scores were derived from MR images. Receiver operating characteristic curve analysis was conducted to assess the predictive value of endplate HU values and EBQ scores for CS and further compare their predictive value with that of L1 HU values and VBQ scores.
Results
This study included 130 matched patients. The CS group demonstrated lower L1 (p < 0.001) and endplate HU (p < 0.001) values and higher VBQ (p = 0.002) and EBQ (p < 0.001) scores compared with the non-CS group. The conditional logistic regression analysis identified L1 HU value (OR 0.99, 95% CI 0.97-0.99; p = 0.036), endplate HU value (OR 0.99, 95% CI 0.98-0.99; p = 0.044), VBQ score (OR 2.40, 95% CI 1.34-4.32; p = 0.038), and EBQ score (OR 4.46, 95% CI 2.16-9.18; p = 0.003) as independent predictors of CS, demonstrating areas under the curve of 0.722, 0.815, 0.648, and 0.782, respectively. The optimal cutoff for the endplate HU value in predicting CS was 262.11 (sensitivity 83.08%, specificity 73.85%).
Conclusions
Endplate HU values indicated a relatively higher predictive performance for CS compared with EBQ scores and served as the most discriminative BMD indicator in patients who underwent PLIF. Measuring the endplate HU value preoperatively helps surgeons select a more appropriate surgical plan and is expected to improve patient outcomes.
The MRI-derived cervical endplate bone quality (EBQ) score has emerged as a novel indicator in predicting postoperative implant subsidence. However, limited systematic investigations have been conducted to evaluate the EBQ score profiles among patients with cervical ossification of the posterior longitudinal ligament (OPLL).
EBQ scores at each endplate were calculated. Propensity score matching (PSM) was performed to balance the clinical baseline characteristics between the two groups, and Wilcoxon’s rank-sum test was used to compare matched groups. Paired
t
-tests were used to compare EBQ scores between OPLL and other types of degenerative cervical myelopathy (DCM) patients, between genders, and superior and inferior endplates among different segments, and multiple linear regression analysis was used to identify associated factors.
Both before and after PSM, OPLL patients had significantly lower individual, segmental, and adjacent intervertebral EBQ scores than other types of DCM patients. Females showed higher EBQ scores than males at most levels. At all intervertebral levels, the EBQ scores of the cephalad endplate yielded higher EBQ scores relative to caudal endplates. EBQ scores displayed a gradual descending trend from the cephalad C2/3 segment to the caudal C7/T1 segment, with the C3 vertebral body possessing the highest segmental EBQ score. Yet, the segmental EBQ scores did not follow the same trend, as the C3 vertebra had the highest score, followed by C6, C4, C5, C7, and T1. Multiple linear regression analysis showed that older age and reduced lumbar aBMD were the two most robust, consistent independent predictors of elevated EBQ scores.
This study systematically characterized cervical EBQ in OPLL patients. Key findings include lower EBQ in OPLL vs. other types of DCM, gender-related disparities, superior-inferior endplate differences, and specific segmental EBQ trends. Accordingly, MRI-based EBQ assessment should serve as an essential adjunct to systemic bone mineral density screening via DEXA in the preoperative workup of OPLL. This combined strategy enables more precise evaluation of the implant–bone interface, thereby optimizing surgical decision-making and perioperative risk stratification.
Wenjun Fan, Cen Liang, Bin Shi et al.· European Journal of Medical...· 0 citations
The nomogram developed based on conventional clinical data in this study, has undergone internal validation and demonstrated efficacy in predicting NVCF following PVP, and serves as a valuable decision-making tool for clinicians.
Yi-Qi Wu, Qing Song, Canwei Hu et al.· Frontiers in Medicine· 0 citations
Results suggest that T1-VBQFAT may serve as a potential adjunct for predicting PSL in patients with LSS, and HU values and several modified VBQ scores showed numerically higher AUCs without statistical significance.
Haoxiang Yang, Yichao Mao, Wu Ye et al.· Academic Radiology· 0 citations
Among lipid parameters evaluated, only high-density lipoprotein cholesterol (HDLC) was positively associated with VBQ scores; however, this weak association did not significantly compromise the diagnostic performance of VBQ for osteoporosis.
Fangke Hu, Da-Peng Yu, Penghe Li et al.· Asian Spine Journal· 0 citations
Aim: To examine whether computed tomography (CT)-derived cross-sectional area (CSA) and radiodensity (Hounsfield units, HU) of the psoas, gluteus maximus, and gluteus medius-minimus are associated with postoperative function in women aged ≥65 years treated with a proximal femoral nail (PFN) for intertrochanteric fracture.Materials and Methods: Sixty-three women aged ≥65 years undergoing PFN fixation for intertrochanteric fracture were analyzed retrospectively. Muscle measurements were obtained on standardized axial CT slices by manual tracing. Function was assessed with the Functional Ambulation Classification (FAC), Parker Mobility Score, Barthel Index, and modified Harris Hip Score (mHHS). Analyses included Spearman correlations with Benjamini-Hochberg false discovery rate (FDR) correction (24 comparisons in a predefined plan), HC3 robust linear regression adjusted for age and ASA, and area under the receiver-operating-characteristic curve (AUC) at clinically meaningful thresholds.Results: The median age was 74 years (IQR 67.5-82.0); median follow-up nine months. Gluteus maximus CSA correlated with Barthel (rho=0.34, p=0.007) and FAC (rho=0.30, p=0.015); an exploratory gluteal CSA composite showed a slightly stronger correlation with Barthel (rho=0.35, p=0.005). Gluteus maximus CSA discriminated community ambulators (FAC≥4) with AUC=0.71 (95% CI 0.55-0.85), and gluteus medius-minimus CSA discriminated Barthel≥90 with AUC=0.73 (0.60-0.85). No association survived FDR correction. Added to age, ASA, and pre-fracture ambulation, the gluteal CSA composite contributed only 0.5-2.2% incremental R².Conclusions: CT-derived gluteal muscle quantity showed the most consistent nominal association with function after PFN, but no association survived FDR correction and incremental value beyond routine clinical predictors was limited. The proposed cut-offs are hypothesis-generating and require prospective validation.
Fatih Erdem, Mustafa Çeltik· Ege Tıp Dergisi· 0 citations
Previous studies have demonstrated that a spongy cement distribution pattern is associated with superior clinical and radiological outcomes in patients with osteoporotic vertebral compression fractures (OVCFs). However, the relationship between MRI-based vertebral bone quality (VBQ) score and spongy cement distribution pattern remains unclear. This study aimed to evaluate the predictive value of the VBQ score for achieving a spongy cement distribution following percutaneous vertebral augmentation (PVA) and to identify independent influencing factors.
We retrospectively reviewed patients with single-level OVCFs who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) from January 2020 to December 2024. Patients were divided into spongy distribution group (Spongy group, n=94) and non-spongy distribution group (Non-spongy group, n=142) based on postoperative anteroposterior and lateral X-rays. Potential factors, including age, sex, body mass index (BMI), bone mineral density (BMD), hypertension, diabetes, serum uric acid levels, smoking history, glucocorticoid use, fractured vertebral level, injected cement volume, surgical technique (PVP or PKP), VBQ score, intravertebral vacuum cleft (IVC), vertebral compression ratio (VCR), local cobb angle (LCA), and bone cement leakage, were collected and analyzed. Clinical outcomes, including visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, were recorded and compared between groups at multiple postoperative time points. Complications such as adjacent vertebral fracture (AVF) and bone cement displacement (BCD) were recorded. Logistic regression analysis was performed to identify independent factors associated with the spongy cement distribution pattern. The predictive performance of VBQ score was evaluated by receiver operating characteristic (ROC) curve analysis.
A total of 236 patients were included. Univariate analysis revealed significant differences between the two groups in age, serum uric acid level, VBQ score, BMD T-score, cement volume, presence of IVC, VCR, LCA, and surgical technique (all
P
< 0.05). Binary logistic regression demonstrated that VBQ score (OR = 0.179, 95% CI 0.053–0.602,
P
= 0.005), VCR (OR = 0.770, 95% CI 0.677–0.875,
P
= 0.001), LCA (OR = 0.750, 95% CI 0.667–0.884,
P
= 0.001), IVC (OR = 0.171, 95% CI 0.045–0.648,
P
= 0.009), and cement volume (OR = 0.247, 95% CI 0.142–0.430,
P
= 0.001) were associated with a lower likelihood of achieving a spongy pattern, whereas higher BMD T-score (OR = 6.101, 95% CI 2.097-17.750,
P
= 0.001) and the PVP (OR = 4.914, 95% CI 1.374-17.574,
P
= 0.014) surgical technique were associated with a higher likelihood. The VBQ score demonstrated good predictive ability, with an area under the ROC curve (AUC) of 0.759 (95% CI: 0.697-0.821) and an optimal cut-off value of 3.155 (sensitivity: 72.3%, specificity: 73.2%). Patients with spongy cement distribution showed significantly better pain relief and functional improvement, as well as a lower incidence of complications (all
P
< 0.05).
The preoperative VBQ score is a simple, non-invasive, and reliable predictor of spongy cement distribution pattern following PVA in patients with OVCFs. The VBQ score, LCA, VCR, IVC, and higher cement volume were associated with a lower likelihood of achieving a spongy pattern, whereas higher BMD T-score and the PVP technique were associated with a higher likelihood. These findings may assist surgeons in preoperative risk stratification and surgical planning.
Heng Wu, Wen-Jun Shen, Bin Hu et al.· Frontiers in Endocrinology· 0 citations
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