A Novel Cervical Vertebral Bone Quality Score Independently Predicts Cage Subsidence After Anterior Cervical Diskectomy and Fusion. Issue 4 (14th April 2023)

• Record Type: Journal Article
• Authors: Soliman, Mohamed A. R.; Aguirre, Alexander O.; Kuo, Cathleen C.; Ruggiero, Nicco; Khan, Asham; Ghannam, Moleca M.; Rho, Kyungduk; Jowdy, Patrick K.; Mullin, Jeffrey P.; Pollina, John
• Is Part Of: Neurosurgery. Volume 92:Issue 4(2023)
• Page Start: 779
• Page End: 786
• Publication Date: 2023-04-14
• Subjects: Anterior cervical diskectomy and fusion -- C-VBQ score -- Cage subsidence -- Cervical vertebral bone quality score -- Computed tomography -- Hounsfield unit -- MRI; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/neu.0000000000002269
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : BACKGROUND: Surgeons can preoperatively assess bone quality using dual-energy X-ray absorptiometry or computed tomography; however, this is not feasible for all patients. Recently, a MRI-based scoring system was used to evaluate the lumbar spine's vertebral bone quality. OBJECTIVE: To create a similar MRI-based scoring system for the cervical spine (C-VBQ), correlate C-VBQ scores with computed tomography-Hounsfield units (HU), and evaluate the utility of this scoring system to independently predict cage subsidence after single-level anterior cervical diskectomy and fusion (ACDF). METHODS: Demographic, procedure-related, and radiographic data were collected for patients. Pearson correlation test was used to determine the correlation between C-VBQ and HU. Cage subsidence was defined as ≥3 mm loss of fusion segmental height. A multivariate logistic regression model was built to determine the correlation between potential risk factors for subsidence. RESULTS: Of 59 patients who underwent single-level ACDF, subsidence was found in 17 (28.8%). Mean C-VBQ scores were 2.22 ± 0.36 for no subsidence levels and 2.83 ± 0.38 ( P < .001) for subsidence levels. On multivariate analysis, a higher C-VBQ score was significantly associated with subsidence (odds ratio = 1.85, 95% CI = 1.39-2.46, P < .001) and was the only significant independent predictor of subsidence after ACDF. There was a significant negative correlation between HU and C-VBQ (r 2 = −0.49, P < .001). CONCLUSION: We found that a higher C-VBQ score was significantly associated with cage subsidence after ACDF. Furthermore, there was a significant negative correlation between C-VBQ and HU. The C-VBQ score may be a valuable tool for assessing preoperative bone quality and independently predicting cage subsidence after ACDF.