Predictive Value of Cervical Vertebral Bone Quality Scores for Intraoperative Blood Loss During Anterior Cervical Corpectomy and Fusion

Purpose Anterior cervical corpectomy and fusion (ACCF) is associated with a risk of significant intraoperative blood loss (IBL), yet preoperative risk stratification remains suboptimal as existing predictors overlook local bone quality. This study aimed to investigate the predictive value of cervical vertebral bone quality (C-VBQ) scores, derived from routine T1-weighted MRI, for IBL during ACCF to enhance preoperative risk assessment and surgical planning. Methods A retrospective cohort analysis was conducted on 206 patients undergoing ACCF for degenerative cervical spine disease between 2012 and 2022. Patients were stratified into four groups (A–D) based on C-VBQ score quartiles. The C-VBQ score was calculated as the ratio of mean signal intensity in the C3–C6 vertebral bodies to cerebrospinal fluid at C2 on sagittal T1-weighted MRI. IBL was quantified using the Gross formula based on pre- and postoperative hematocrit levels. Independent predictors of IBL were identified through multiple linear regression analysis. Results Mean IBL demonstrated a graded increase across ascending C-VBQ quartiles (Group A: 187.9 ± 63.0 mL; B: 201.8 ± 50.8 mL; C: 234.2 ± 63.7 mL; D: 347.2 ± 104.3 mL; p < 0.001). A strong positive correlation was observed between C-VBQ scores and IBL (r = 0.671, R²=0.450). Multiple linear regression identified C-VBQ score as an independent predictor of IBL (β = 0.581, 95% CI: 0.489–0.673, p < 0.001), along with the number of fused segments (β = 0.349, p < 0.001) and presence of ossification of the posterior longitudinal ligament (OPLL) at the surgical level (β = 0.120, p = 0.013). Patients in the highest quartile (Group D) experienced significantly longer hospital stays (10.6 ± 4.0 vs. 8.7–9.5 days, p = 0.006) and higher postoperative complication rates (17.3% vs. 0–3.9%, p = 0.002). Conclusion C-VBQ score is a reliable, non-invasive, and independent predictor of IBL during ACCF. Integrating C-VBQ assessment into routine preoperative evaluation enables identification of high-risk patients and facilitates targeted interventions to mitigate bleeding risks, ultimately optimizing surgical outcomes in anterior cervical spine surgery.