MRI-based endplate bone quality score predicts cage subsidence following oblique lumbar interbody fusion

Liyu Ran; Tianhang Xie; Long Zhao; Changyi Wang; Chuan Luo; Diwei Wu; Xuanhe You; Shishu Huang; Jiancheng Zeng

doi:10.1016/j.spinee.2024.05.002

MRI-based endplate bone quality score predicts cage subsidence following oblique lumbar interbody fusion

Spine J. 2024 May 14:S1529-9430(24)00237-7. doi: 10.1016/j.spinee.2024.05.002. Online ahead of print.

Authors

Liyu Ran¹, Tianhang Xie², Long Zhao³, Changyi Wang⁴, Chuan Luo⁵, Diwei Wu⁶, Xuanhe You⁷, Shishu Huang⁸, Jiancheng Zeng⁹

Affiliations

¹ Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China. Electronic address: liyurancq@163.com.
² Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China. Electronic address: xthzjxzz@163.com.
³ Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China. Electronic address: 291723405@qq.com.
⁴ Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: changyi11@scu.edu.cn.
⁵ Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China. Electronic address: luochuan0221@163.com.
⁶ Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China. Electronic address: wudiwei@wchscu.edu.cn.
⁷ Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China. Electronic address: 873154588@qq.com.
⁸ Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China. Electronic address: h0794062@scu.edu.cn.
⁹ Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China. Electronic address: tomzeng5@vip.163.com.

PMID: 38754736
DOI: 10.1016/j.spinee.2024.05.002

Abstract

Background context: Cage subsidence is a common complication after lumbar interbody fusion surgery, with low bone mineral density (BMD) being a significant risk factor. ໿Endplate bone quality (EBQ) obtained from clinical MRI scans has been deemed reliable in determining regional BMD. However, the association between EBQ score and cage subsidence following oblique lumbar interbody fusion (OLIF) has not been clearly established.

Purpose: This study aims to assess the relationship between EBQ score and cage subsidence in patients who underwent single-level OLIF.

Study design/setting: A retrospective study.

Patient sample: The study included adults with degenerative spinal conditions who underwent single-level OLIF at our institution OUTCOME MEASURES: Cage subsidence, disc height, EBQ score, fusion rate.

Methods: This retrospective study analyzed data from patients who underwent single-level OLIF surgery at our institution between October 2017 and August 2022. Postoperative CT scans were used to measure cage subsidence, while the EBQ score was calculated using preoperative non-contrast T1-weighted MRI. To determine the predictive ability of the EBQ score, receiver operating characteristic (ROC) curve analysis was conducted. Additionally, univariable and multivariable logistic regression analyses were performed.

Results: In this study, a total of 88 patients were included and followed up for an average of 15.8 months. It was observed that 32.9% (n=29/88) of the patients experienced cage subsidence. The post-surgery disc height was significantly higher in patients who experienced subsidence compared to those who did not. The mean EBQ scores for patients with non-subsidence and subsidence were 2.31±0.6 and 3.48±1.2, respectively, and this difference was statistically significant. The ROC curve analysis showed that the AUC for the EBQ score was 0.811 (95% CI: 0.717-0.905). The most suitable threshold for the EBQ score was determined to be 2.318 (sensitivity: 93.1%, specificity: 55.9%). Additionally, the multivariate logistic regression analysis revealed a significant association between a higher EBQ score and an increased risk of subsidence (odds ratio [OR]=6.204, 95% CI=2.520-15.272, p<.001).

Conslusions: Our findings indicate that higher preoperative EBQ scores are significantly linked to cage subsidence following single-level OLIF. Preoperative measurement of MRI can serve as a valuable tool in predicting cage subsidence.

Keywords: Bone mineral density; EBQ; Endplate; MRI; OLIF; cage subsidence.