A comparative study of the predictive efficacies of preoperative cervical vertebral bone quality score and endplate bone quality score on cage subsidence risk after anterior cervical discectomy and fusion surgery
10.3969/j.issn.1004-406X.2025.10.02
- VernacularTitle:术前颈椎椎体与终板骨质量评分预测颈椎前路融合术后融合器沉降风险效能的对比研究
- Author:
Yifei JIN
1
;
Mengyang PU
;
Zhiheng QIAN
Author Information
1. 苏州大学附属第二医院脊柱外科 215000 苏州市
- Publication Type:Journal Article
- Keywords:
Anterior cervical discectomy and fusion;
Cervical endplate bone quality score;
Cervical vertebral bone quality score;
Zero-Profile;
Cage subsidence
- From:
Chinese Journal of Spine and Spinal Cord
2025;35(10):1019-1026
- CountryChina
- Language:Chinese
-
Abstract:
Objectives:To evaluate the clinical values of cervical vertebral bone quality(CVBQ)score and cervical endplate bone quality(CEBQ)score in predicting the settlement of Zero Profile(Zero-P)cage after an-terior cervical discectomy and fusion(ACDF).Methods:A retrospective analysis was performed on 72 patients who underwent ACDF with Zero-P cage in the Second Affiliated Hospital of Soochow University.General pa-tient information(including sex,age,comorbidity),laboratory parameters(such as blood calcium and blood glu-cose),surgical details(surgical level and cage type),and imaging data(preoperative cervical MRI and anteropos-terior and lateral X-rays within one week and after more than three months)were collected.On the lateral X-rays taken within one week and＞3 months postoperatively,the heights of the upper and lower margins of vertebrae were measured,and the difference between was defined as the cage subsidence distance.Patients with a subsidence distance ≥ 2mm were assigned to the subsidence group,and those with＜2mm subsidence distance were divided to the non-subsidence group.On preoperative cervical sagittal T1-weighted MRI,plac-ing regions of interest(ROIs)in the medullary region of adjacent vertebral bodies,the subchondral bone region of the endplates,and the cerebrospinal fluid(CSF)in the cerebellomedullary cistern.CVBQ and CEBQ values were the ratios of the average signal intensity of the medullary region of the surgical adjacent vertebral bodies(for CVBQ)and the subchondral bone region of the endplates(for CEBQ)to the signal intensity of the cere-brospinal fluid in the cerebellomedullary cistern.A stratified analysis by gender was conducted to further clarify whether the predictive value of bone quality scores for subsidence is influenced by gender factors.The Pearson correlation coefficient was used to assess the relationship of CVBQ and CEBQ with cage subsidence distance.Receiver operating characteristic(ROC)curves were applied to evaluate the diagnostic efficacy of CVBQ and CEBQ for cage subsidence.Univariate logistic regression analysis was performed to screen for po-tential risk factors,after that age and diabetes,which showed statistical significance,along with CVBQ and CEBQ,were incorporated into the multivariate analysis to assess their independent effects.Results:Cage sub-sidence occurred in 14 patients(subsidence rate:19.4％).Compared with the non-subsidence group,the subsi-dence group of patients was older(male:61.4±16.5 years vs 51.1±10.8 years,P=0.049;female:62.6±13.1 years vs 51.2±7.8 years,P=0.005)and had a higher proportion of patients with diabetes(male:42.9％vs 3.4％,P=0.018;female:42.9％vs 6.9％,P=0.040).Both CVBQ and CEBQ were significantly higher in the subsidence group(CVBQ-male:2.75±0.73 vs 2.02±0.53,P=0.004;female:2.84±0.69 vs 2.00±0.40,P=0.005;CEBQ-male:2.82±0.688 vs 2.05±0.56,P=0.004;female:2.94±0.68 vs 2.05±0.42,P=0.002).Pearson correlation analysis re-vealed a moderate positive correlation between both CVBQ(r=0.58,P＜0.001)and CEBQ(r=0.59,P＜0.001)with subsidence distance.ROC curve analysis indicated that both CVBQ(AUC=0.83)and CEBQ(AUC=0.85)had good predictive values for subsidence,with CEBQ showing slightly better predictive performance.Univariate logistic regression analysis identified age,diabetes,CEBQ,and CVBQ as risk factors for subsidence(P＜0.05).Multivariate analysis showed that after adjusting for age and diabetes,both CEBQ(OR=11.466,P=0.004)and CVBQ(OR=8.804,P=0.005)remained independent risk factors for subsidence,while age and diabetes lost in-dependent significance.The strength of association with subsidence was greater in CEBQ than in CVBQ.Conclusions:Patients with higher CVBQ and CEBQ scores are more likely to experience fusion cage subsi-dence,and both CEBQ and CVBQ can be used to predict cage subsidence in patients after single-level ACDF,CEBQ has better predictive ability than CVBQ.
