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

Abstract

To investigate the association between MRI-based pedicle bone quality (PBQ) score and cage subsidence in patients undergoing single-level OLIF, and to evaluate the diagnostic performance of PBQ as a preoperative predictor. This retrospective study analyzed data from patients who underwent single-level L4-L5 OLIF-AF between October 2017 and May 2023. PBQ scores were measured on preoperative T1-weighted sagittal MRI. Logistic regression analysis was used to identify independent risk factors, and receiver operating characteristic (ROC) curve analysis was performed to determine the predictive ability of PBQ. Of the 73 patients, 23 (31.5%) developed cage subsidence. The PBQ score was significantly higher in the subsidence group than in the non-subsidence group (p < 0.001). Multivariable logistic regression confirmed PBQ as an independent risk factor for cage subsidence (OR = 3.321, 95% CI: 1.836-6.008, p < 0.001). ROC curve analysis demonstrated good diagnostic performance of PBQ, with an AUC of 0.844 (95% CI: 0.745-0.944) and an optimal cutoff value of 3.575 (sensitivity: 82.6%, specificity: 78.0%). Elevated MRI-based PBQ scores are significantly associated with an increased risk of cage subsidence following single-level OLIF. The PBQ score may serve as a reliable preoperative imaging parameter for guiding surgical planning.