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

• Published in: Orthopaedic surgery 2024-02, Vol.16 (2), p.303-311
• Main Authors: Li, Qiujiang, Zhu, Ce, Xia, Qinghong, Yang, Huiliang, Liu, Limin, Feng, Ganjun, Song, Yueming
• Format: Article
• Language: English
• Subjects: Anterior cervical corpectomy and fusion; Bone mineral density; Cage subsidence; Cerebrospinal fluid; Magnetic resonance imaging; MRI; Orthopedics; Osteoporosis; Patients; Risk factors; Statistical analysis; Surgeons; Surgery; Titanium; Variance analysis; Vertebrae; Vertebral bone quality
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.13931

Objective Recently, 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. Methods Patients 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. Results A 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