MRI-based endplate bone quality scores outperform vertebral bone quality scores in predicting adjacent segment disease following transforaminal lumbar interbody fusion.

Abstract

This study aims to (1) evaluate whether the endplate bone quality (EBQ) scores can independently predict adjacent segment disease (ASD); and (2) judge the predictive value of EBQ compared to vertebral bone quality (VBQ) for ASD after single-level transforaminal lumbar interbody fusion (TLIF). A single-center retrospective analysis was conducted of patients undergoing single-level TLIF for degenerative spinal disease from 2014 to 2020. Demographic, surgery, and radiographic data were collected. Logistic regression was used to identify independent risk factors for ASD. Furthermore, a receiver operating curve (ROC) analysis was conducted to evaluate the predictive efficacy of the EBQ score and VBQ score. The rate of ASD was 16.4% at a minimum 24-month follow-up. Significant risk factors for ASD were higher VBQ score (OR = 3.418, 95%CI: 1.297-9.008, P = 0.013), higher EBQ score (OR = 2.469, 95%CI: 1.085-5.621, P = 0.031), and higher adjacent segment Pfirrmann grade (OR = 2.866, 95%CI: 1.765-4.653, P<0.001). The diagnostic accuracy of VBQ and EBQ for distinguishing ASD were 0.806 (95%CI: 0.728-0.883) and 0.835 (95%CI: 0.757-0.912). The optimal threshold of VBQ scores was 2.926 (sensitivity: 90.6%, specificity: 62.0%) and of EBQ was 3.511 (sensitivity: 90.6%, specificity: 71.8%). Higher VBQ and EBQ scores are both independent risk factors of ASD after single-segment TLIF surgery, and EBQ scores perform better in predicting ASD. When EBQ > 3.511, there is a considerable risk of ASD.