Assessing the Impact of Preoperative MRI-Based Vertebral Bone Quality Scores on 5-Year Prognosis in Lumbar Spine Surgery

Hiroshi Taniwaki; Masatoshi Hoshino; Yuki Kinoshita; Akira Matsumura; Takashi Namikawa; Minori Kato; Shinji Takahashi; Hiroaki Nakamura

doi:10.1097/BRS.0000000000005040

Assessing the Impact of Preoperative MRI-Based Vertebral Bone Quality Scores on 5-Year Prognosis in Lumbar Spine Surgery

Spine (Phila Pa 1976). 2024 May 16. doi: 10.1097/BRS.0000000000005040. Online ahead of print.

Authors

Hiroshi Taniwaki¹, Masatoshi Hoshino¹, Yuki Kinoshita¹, Akira Matsumura¹, Takashi Namikawa¹, Minori Kato², Shinji Takahashi², Hiroaki Nakamura²

Affiliations

¹ Department of Orthopedic Surgery, Osaka City General Hospital, Japan.
² Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan.

PMID: 38751301
DOI: 10.1097/BRS.0000000000005040

Abstract

Study design: Retrospective cohort study.

Objective: To assess the utility of preoperative vertebral bone quality (VBQ) scores in predicting the 5-year clinical outcomes following lumbar spine surgery.

Summary of background data: Osteoporosis poses a significant concern in older adults undergoing spinal surgery. The VBQ score, assessed through preoperative magnetic resonance imaging (MRI), is associated with subsequent osteoporotic fractures and postoperative complications. However, previous report on the impact of VBQ score on mid-term clinical outcomes after lumbar spine surgery remains lacking.

Methods: A total of 189 patients who underwent lumbar surgery (≤3-disc levels) for lumbar spinal stenosis between 2010 and 2016 were enrolled. Patients were classified into high (>3.35), middle (2.75 to 3.35), and low (<2.73) VBQ score groups based on tertiles. Clinical scores, including Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form-36 (SF-36), were recorded preoperatively and 1, 2, and 5 years postoperatively.

Results: Comparative analysis showed significant differences among the VBQ groups throughout the study period in low back pain (P=0.013), walking ability (P=0.005), social life function (P=0.010) of JOABPEQ, and physical component summary of the SF-36 (P=0.018) following lumbar spine surgery. A higher VBQ score was significantly correlated with worse 5-year postoperative outcomes for all domains except for lumbar function of the JOABPEQ using multiple linear regression analysis, adjusting for age, sex, BMI, hyperlipidemia, surgical procedures, and each preoperative score.

Conclusion: A high preoperative VBQ score is a risk factor for poor 5-year clinical outcomes after lumbar spine surgery. Evaluation of the VBQ score through routine preoperative MRI facilitates osteoporotic screening in lumbar patients without radiation exposure and healthcare costs, while also demonstrating its potential as a prognostic indicator of postoperative clinical outcomes.

Level of evidence: 3.