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Evaluation of the modified MRI vertebral bone quality score for bone quality in lumbar degenerative disorders

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Abstract

Objective

The traditional VBQ scoring method may lead to overestimation due to the concentration of intravertebral fat and vascular structures in the posterior half of vertebral bodies, potentially resulting in false-positive outcomes. This study aims to modify the measurement method of VBQ score (Modified-VBQ) and evaluate its effectiveness in evaluating bone quality of lumbar degenerative diseases.

Methods

Retrospective analysis was conducted on clinical data from patients undergoing lumbar surgery for degenerative diseases between September 2022 and September 2023. Preoperative lumbar t1-weighted Magnetic resonance imaging was used for both modified and traditional VBQ scoring. Computed tomography (CT) images and dual-energy X-ray absorptiometry (DEXA) data were collected through the picture archiving and communication system. The effectiveness of the modified VBQ score was evaluated, considering P < 0.05 as statistically significant.

Results

The study included 212 patients, revealing a significant difference between the modified VBQ and VBQ scores (P < 0.0001). Notably, patients with a history of hyperlipidemia exhibited a significant difference between the two scores (P = 0.0037). The area under the ROC curve (AUC) for the modified VBQ was 0.86, surpassing the VBQ score (AUC = 0.74). Linear regression analysis demonstrated a moderate to strong correlation between the modified VBQ and DEXA T-score (r = − 0.49, P < 0.0001) and a high correlation with CT Hounsfield units (HU) values (r = − 0.60, P < 0.0001).

Conclusion

The modified VBQ score provides a simple, effective, and relatively accurate means of assessing bone quality in lumbar degenerative diseases. Preoperative implementation of the modified VBQ score facilitates rapid screening for patients with abnormal bone quality.

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Abbreviations

VBQ:

Vertebral bone quality score

MRI:

Magnetic resonance imaging

CT:

Computed tomography

DEXA:

Dual-energy x-ray absorptiometry

PACS:

Picture archiving and communication system

ROI:

Region of interests

LDDs:

Lumbar degenerative diseases

BMD:

Bone mineral density

OVCF:

Osteoporotic vertebral compression fracture

HU:

Hounsfield units

CSF:

Cerebrospinal fluid

AUC:

Area under the curve

References

  1. Reid PC, Morr S, Kaiser MG (2019) State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease. J Neurosurg Spine 31:1–14. https://doi.org/10.3171/2019.4.Spine18915

    Article  PubMed  Google Scholar 

  2. Hyun SJ, Kim YJ, Rhim SC (2016) Patients with proximal junctional kyphosis after stopping at thoracolumbar junction have lower muscularity, fatty degeneration at the thoracolumbar area. Spine J 16:1095–1101. https://doi.org/10.1016/j.spinee.2016.05.008

    Article  PubMed  Google Scholar 

  3. Halvorson TL, Kelley LA, Thomas KA, Whitecloud TS, Cook SD (1994) Effects of bone mineral density on pedicle screw fixation. Spine (Phila Pa 1976) 19:2415–2420. https://doi.org/10.1097/00007632-199411000-00008

    Article  CAS  PubMed  Google Scholar 

  4. Soshi S, Shiba R, Kondo H, Murota K (1991) An experimental study on transpedicular screw fixation in relation to osteoporosis of the lumbar spine. Spine (Phila Pa 1976) 16:1335–1341. https://doi.org/10.1097/00007632-199111000-00015

    Article  CAS  PubMed  Google Scholar 

  5. Reitman CA, Nguyen L, Fogel GR (2004) Biomechanical evaluation of relationship of screw pullout strength, insertional torque, and bone mineral density in the cervical spine. J Spinal Disord Tech 17:306–311. https://doi.org/10.1097/01.bsd.0000090575.08296.9d

    Article  PubMed  Google Scholar 

  6. Pinter ZW, Monsef JB, Salmons HI, Sebastian AS, Freedman BA, Currier BL, Elder BD, Nassr AN (2022) Does preoperative bone mineral density impact fusion success in anterior cervical spine surgery? A prospective cohort study. World Neurosurg 164:e830–e834. https://doi.org/10.1016/j.wneu.2022.05.058

    Article  PubMed  Google Scholar 

  7. Karikari IO, Metz LN (2018) Preventing pseudoarthrosis and proximal junctional kyphosis: how to deal with the osteoporotic spine. Neurosurg Clin N Am 29:365–374. https://doi.org/10.1016/j.nec.2018.03.005

    Article  PubMed  Google Scholar 

  8. Celi M, Rao C, Scialdoni A, Tempesta V, Gasbarra E, Pistillo P, Tarantino U (2013) Bone mineral density evaluation in osteoporosis: why yes and why not? Aging Clin Exp Res 25(Suppl 1):S47-49. https://doi.org/10.1007/s40520-013-0074-1

    Article  PubMed  Google Scholar 

  9. Messina C, Sconfienza LM, Bandirali M, Guglielmi G, Ulivieri FM (2016) Adult dual-energy x-ray absorptiometry in clinical practice: how i report it. Semin Musculoskelet Radiol 20:246–253. https://doi.org/10.1055/s-0036-1592370

    Article  PubMed  Google Scholar 

  10. Salzmann SN, Okano I, Jones C, Zhu J, Lu S, Onyekwere I, Balaji V, Reisener MJ, Chiapparelli E, Shue J, Carrino JA, Girardi FP, Cammisa FP, Sama AA, Hughes AP (2022) Preoperative MRI-based vertebral bone quality (VBQ) score assessment in patients undergoing lumbar spinal fusion. Spine J 22:1301–1308. https://doi.org/10.1016/j.spinee.2022.03.006

    Article  PubMed  Google Scholar 

  11. Tang GY, Lv ZW, Tang RB, Liu Y, Peng YF, Li W, Cheng YS (2010) Evaluation of MR spectroscopy and diffusion-weighted MRI in detecting bone marrow changes in postmenopausal women with osteoporosis. Clin Radiol 65:377–381. https://doi.org/10.1016/j.crad.2009.12.011

    Article  CAS  PubMed  Google Scholar 

  12. Shen W, Scherzer R, Gantz M, Chen J, Punyanitya M, Lewis CE, Grunfeld C (2012) Relationship between MRI-measured bone marrow adipose tissue and hip and spine bone mineral density in African-American and Caucasian participants: the CARDIA study. J Clin Endocrinol Metab 97:1337–1346. https://doi.org/10.1210/jc.2011-2605

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ehresman J, Pennington Z, Schilling A, Lubelski D, Ahmed AK, Cottrill E, Khan M, Sciubba DM (2020) Novel MRI-based score for assessment of bone density in operative spine patients. Spine J 20:556–562. https://doi.org/10.1016/j.spinee.2019.10.018

    Article  PubMed  Google Scholar 

  14. Ehresman J, Schilling A, Pennington Z, Gui C, Chen X, Lubelski D, Ahmed AK, Cottrill E, Khan M, Redmond KJ, Sciubba DM (2019) A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis. J Neurosurg Spine. https://doi.org/10.3171/2019.9.Spine19954

    Article  PubMed  Google Scholar 

  15. Jones C, Okano I, Arzani A, Dodo Y, Moser M, Reisener MJ, Chiapparelli E, Adl Amini D, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP (2022) The predictive value of a novel site-specific MRI-based bone quality assessment, endplate bone quality (EBQ), for severe cage subsidence among patients undergoing standalone lateral lumbar interbody fusion. Spine J 22:1875–1883. https://doi.org/10.1016/j.spinee.2022.07.085

    Article  PubMed  Google Scholar 

  16. Shah LM, Hanrahan CJ (2011) MRI of spinal bone marrow: part I, techniques and normal age-related appearances. AJR Am J Roentgenol 197:1298–1308. https://doi.org/10.2214/ajr.11.7005

    Article  PubMed  Google Scholar 

  17. Schilling AT, Ehresman J, Pennington Z, Cottrill E, Feghali J, Ahmed AK, Hersh A, Planchard RF, Jin Y, Lubelski D, Khan M, Redmond KJ, Witham T, Lo SL, Sciubba DM (2021) Interrater and intrarater reliability of the vertebral bone quality score. World Neurosurg 154:e277–e282. https://doi.org/10.1016/j.wneu.2021.07.020

    Article  PubMed  Google Scholar 

  18. Vande Berg BC, Lecouvet FE, Galant C, Simoni P, Malghem J (2009) Normal variants of the bone marrow at MR imaging of the spine. Semin Musculoskelet Radiol 13:87–96. https://doi.org/10.1055/s-0029-1220879

    Article  PubMed  Google Scholar 

  19. Zou D, Li W, Xu F, Du G (2019) Use of Hounsfield units of S1 body to diagnose osteoporosis in patients with lumbar degenerative diseases. Neurosurg Focus 46:E6. https://doi.org/10.3171/2019.2.Focus18614

    Article  PubMed  Google Scholar 

  20. Weir CB, Jan A (2023) BMI Classification Percentile And Cut Off Points. In: StatPearls. StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC., Treasure Island (FL).

  21. Aynaszyan S, Devia LG, Udoeyo IF, Badve SA, DelSole EM (2022) Patient physiology influences the MRI-based vertebral bone quality score. Spine J 22:1866–1874. https://doi.org/10.1016/j.spinee.2022.06.003

    Article  PubMed  Google Scholar 

  22. Huang W, Gong Z, Wang H, Zheng C, Chen Y, Xia X, Ma X, Jiang J (2023) Use of MRI-based vertebral bone quality score (VBQ) of S1 body in bone mineral density assessment for patients with lumbar degenerative diseases. Eur Spine J 32:1553–1560. https://doi.org/10.1007/s00586-023-07643-2

    Article  PubMed  Google Scholar 

  23. Wang L, Yu W, Yin X, Cui L, Tang S, Jiang N, Cui L, Zhao N, Lin Q, Chen L, Lin H, Jin X, Dong Z, Ren Z, Hou Z, Zhang Y, Zhong J, Cai S, Liu Y, Meng R, Deng Y, Ding X, Ma J, Xie Z, Shen L, Wu W, Zhang M, Ying Q, Zeng Y, Dong J, Cummings SR, Li Z, Xia W (2021) Prevalence of osteoporosis and fracture in china: the china osteoporosis prevalence study. JAMA Netw Open 4:e2121106. https://doi.org/10.1001/jamanetworkopen.2021.21106

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kim DK, Kim JY, Kim DY, Rhim SC, Yoon SH (2017) Risk factors of proximal junctional kyphosis after multilevel fusion surgery: more than 2 years follow-up data. J Korean Neurosurg Soc 60:174–180. https://doi.org/10.3340/jkns.2016.0707.014

    Article  PubMed  PubMed Central  Google Scholar 

  25. Link TM (2012) Osteoporosis imaging: state of the art and advanced imaging. Radiology 263:3–17. https://doi.org/10.1148/radiol.2633201203

    Article  PubMed  PubMed Central  Google Scholar 

  26. Schreiber JJ, Anderson PA, Hsu WK (2014) Use of computed tomography for assessing bone mineral density. Neurosurg Focus 37:E4. https://doi.org/10.3171/2014.5.Focus1483

    Article  PubMed  Google Scholar 

  27. Xu F, Zou D, Li W, Sun Z, Jiang S, Zhou S, Li Z (2020) Hounsfield units of the vertebral body and pedicle as predictors of pedicle screw loosening after degenerative lumbar spine surgery. Neurosurg Focus 49:E10. https://doi.org/10.3171/2020.5.Focus20249

    Article  PubMed  Google Scholar 

  28. Xi Z, Mummaneni PV, Wang M, Ruan H, Burch S, Deviren V, Clark AJ, Berven SH, Chou D (2020) The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion. Neurosurg Focus 49:E8. https://doi.org/10.3171/2020.5.Focus20169

    Article  PubMed  Google Scholar 

  29. Boutin RD, Kaptuch JM, Bateni CP, Chalfant JS, Yao L (2016) Influence of IV contrast administration on CT measures of muscle and bone attenuation: implications for sarcopenia and osteoporosis evaluation. AJR Am J Roentgenol 207:1046–1054. https://doi.org/10.2214/ajr.16.16387

    Article  PubMed  Google Scholar 

  30. Meunier P, Aaron J, Edouard C, Vignon G (1971) Osteoporosis and the replacement of cell populations of the marrow by adipose tissue. A quantitative study of 84 iliac bone biopsies. Clin Orthop Relat Res 80:147–154. https://doi.org/10.1097/00003086-197110000-00021

    Article  CAS  PubMed  Google Scholar 

  31. Ehresman J, Schilling A, Yang X, Pennington Z, Ahmed AK, Cottrill E, Lubelski D, Khan M, Moseley KF, Sciubba DM (2021) Vertebral bone quality score predicts fragility fractures independently of bone mineral density. Spine J 21:20–27. https://doi.org/10.1016/j.spinee.2020.05.540

    Article  PubMed  Google Scholar 

  32. Ehresman J, Ahmed AK, Lubelski D, Schilling A, Pennington Z, Cottrill E, McCracken J, Khan M, Witham T, Sciubba DM (2020) Vertebral bone quality score and postoperative lumbar lordosis associated with need for reoperation after lumbar fusion. World Neurosurg 140:e247–e252. https://doi.org/10.1016/j.wneu.2020.05.020

    Article  PubMed  Google Scholar 

  33. Soliman MAR, Aguirre AO, Kuo CC, Ruggiero N, Azmy S, Khan A, Ghannam MM, Almeida ND, Jowdy PK, Mullin JP, Pollina J (2022) Vertebral bone quality score independently predicts cage subsidence following transforaminal lumbar interbody fusion. Spine J 22:2017–2023. https://doi.org/10.1016/j.spinee.2022.08.002

    Article  PubMed  Google Scholar 

  34. Kim AYE, Lyons K, Sarmiento M, Lafage V, Iyer S (2023) MRI-based score for assessment of bone mineral density in operative spine patients. Spine (Phila Pa 1976) 48:107–112. https://doi.org/10.1097/brs.0000000000004509

    Article  PubMed  Google Scholar 

  35. Roch PJ, Çelik B, Jäckle K, Reinhold M, Meier MP, Hawellek T, Kowallick JT, Klockner FS, Lehmann W, Weiser L (2023) Combination of vertebral bone quality scores from different magnetic resonance imaging sequences improves prognostic value for the estimation of osteoporosis. Spine J 23:305–311. https://doi.org/10.1016/j.spinee.2022.10.013

    Article  PubMed  Google Scholar 

  36. Roldan-Valadez E, Piña-Jimenez C, Favila R, Rios C (2013) Gender and age groups interactions in the quantification of bone marrow fat content in lumbar spine using 3T MR spectroscopy: a multivariate analysis of covariance (Mancova). Eur J Radiol 82:e697-702. https://doi.org/10.1016/j.ejrad.2013.07.012

    Article  PubMed  Google Scholar 

  37. Bianco P, Riminucci M, Gronthos S, Robey PG (2001) Bone marrow stromal stem cells: nature, biology, and potential applications. Stem Cells 19:180–192. https://doi.org/10.1634/stemcells.19-3-180

    Article  CAS  PubMed  Google Scholar 

  38. Adams JE (2009) Quantitative computed tomography. Eur J Radiol 71:415–424. https://doi.org/10.1016/j.ejrad.2009.04.074

    Article  PubMed  Google Scholar 

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Funding

This work was supported by the National Key Research and Development Plan, Ministry of Science and Technology of the People's Republic of China (2022YFC2407203); the National Natural Science Foundation of China, China (81972093 and 81871552); the Advanced and Appropriate Technology Promotion Project of Shanghai Municipal Health Commission, Shanghai, China (2019SY023); the Young Health Talents of Shanghai Municipal Health Commission, Shanghai, China (2022YQ011); and Hospital New Stars—Young Medical Talents (3030289002).

Author information

Author notes

  1. Dachuan Li, Xiao Lu, Zhaoyang Gong and Xuesen Zhang have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing’an District, Shanghai, 200040, China

    Dachuan Li, Xiao Lu, Zhaoyang Gong, Siyang Liu, Guangyu Xu, Hongli Wang, Feizhou Lu, Xinlei Xia, Jianyuan Jiang, Fei Zou & Xiaosheng Ma

  2. Department of Orthopedics, Wuzhong People’s Hospital, 143 Xinmin Road, Litong District, Wuzhong, 751100, Ningxia, China

    Xuesen Zhang

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  1. Dachuan Li
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Contributions

DL and XL performed the experiments and wrote the original manuscript. ZG analyzed the data and prepared the figures. SL, GX, HW, FL, XX, and JJ have revised the manuscript. XZ, FZ, and XM conceived and designed the experiments and provided funding. All authors reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Guangyu Xu, Fei Zou or Xiaosheng Ma.

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None of the authors have potential conflicts of interest to be disclosed. The authors alone are responsible for the content and writing of this paper.

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This study protocol was approved by the Ethics Committee of Huashan Hospital (Fudan University, Shanghai, China), and informed consent was obtained from all participants.

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Li, D., Lu, X., Gong, Z. et al. Evaluation of the modified MRI vertebral bone quality score for bone quality in lumbar degenerative disorders. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08228-3

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