Is Vertebral Bone Quality an Independent Predictor of Total Blood Loss in TLIF Surgery?

Objective : The purpose of this study is to determine the effect of bone mineral density (BMD), as assessed by preoperative Dual-energy X-ray Absorptiometry (DEXA) scans and MRI-based vertebral bone quality (VBQ), on intraoperative total blood loss following transforaminal lumbar interbody fusion (TLIF). Methods : Patients who received TLIF for lumbar degenerative diseases at a single academic center from 2023-2024 were included in this study. The preoperative T-score and VBQ score were recorded. Patients with liver/kidney disease or on prescription anticoagulant medication were excluded. Information about operation and blood loss were extracted. Total blood loss during postoperative 3 days was the primary indicator, and secondary indicators included length of hospitalization, hematocrit (HCT) and hemoglobin (Hb), T-score, and VBQ score. Results : A total of 247 patients (93 males and 154 females) were enrolled in this study, with a mean age of 59.59 ± 9.09 years. VBQ were measured in all patients' preoperative lumbar MRI scans. VBQ (L1-4 median), VBQ (L1-4 average), VBQ (S1) and VBQ (fixation segments) was 3.50±0.70, 3.49±0.67, 3.19±0.72, 3.42±0.71, respectively. Among them, 71 patients had preoperative DEXA of the left hip. The average lowest T-score was -2.25 ± 1.29. The T-score was significantly correlated with the VBQ score (r=-0.331 to -0.419). The average postoperative 3 days' total blood loss was 796.95±569.94ml. Controlling for age, number of fixed segments, preoperative platelet count, and coagulation testing, T-score or VBQ was not correlated with perioperative total blood loss in TLIF. Conclusions : Preoperative T-score or VBQ score was not correlated with total blood loss in TLIF. The total blood loss of TLIF in multi-segment cases was accompanied by mounts of perioperative hemorrhage, which might lead to longer hospital stays.