Modified vertebral bone quality score is a better predictor of cage subsidence after transforaminal lumbar interbody fusion and is superior to vertebral bone quality score

Purpose This study aimed to compare the effectiveness of the modified vertebral bone quality (MVBQ) score and the traditional vertebral bone quality (VBQ) score in predicting cage subsidence following transforaminal lumbar interbody fusion (TLIF), using quantitative computed tomography (QCT) for validation. Methods W We performed a retrospective analysis of patients who underwent single-level TLIF surgery for spinal degeneration between 2014 and 2022. VBQ and MVBQ scores are calculated based on T1-weighted MRI. Standard L1/2 volume bone mineral density (vBMD) was measured using preoperative lumbar CT images. Disc height and cage sinking were measured using mid-sagittal CT images. All patients were divided into cage sedimentation group and non-sedimentation group, and statistical analysis was performed. Results A total of 359 patients were included in the study, and 55 (15.3%) experienced cage sedimentation. There were significant differences in gender, QCT, VBQ, and MVBQ scores between the cage subsidence and no cage subsidence groups. Multivariate logistic regression analysis revealed that gender, QCT-vBMD, VBQ score, and MVBQ score were important factors for cage subsidence. Both VBQ and MVBQ scores were inversely correlated with QCT - vBMD, with MVBQ showing a better correlation (r = -0.300 p < 0.001 vs r = -0.376 p < 0.001). ROC analysis showed that the MVBQ score was superior to the VBQ score in predicting cage subsidence (AUC 0.802vs 0.780). Conclusion Both MVBQ and VBQ scores are effective in predicting postoperative cage subsidence after TLIF and can serve as simple, convenient, and reliable preoperative assessment tools. The MVBQ score demonstrates a relatively better predictive effect than the VBQ score.