Utilizing MRI and CT to identify risk factors associated with cage subsidence
Abstract Objectives To identify risk factors associated with cage subsidence (CS) following single segment transforaminal lumbar interbody fusion (TLIF) and unilateral biportal endoscopic lumbar interbody fusion (ULIF) and to compare the predictive performance of various bone quality assessment meth...
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BMC
2025-07-01
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| Series: | European Journal of Medical Research |
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| Online Access: | https://doi.org/10.1186/s40001-025-02797-9 |
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| author | Chaohui Ding Changnan Xie Jinwei Ying Mengxian Jia Ziwei Fan Xiang Fang Xianghe Wang Honglin Teng |
| author_facet | Chaohui Ding Changnan Xie Jinwei Ying Mengxian Jia Ziwei Fan Xiang Fang Xianghe Wang Honglin Teng |
| author_sort | Chaohui Ding |
| collection | DOAJ |
| description | Abstract Objectives To identify risk factors associated with cage subsidence (CS) following single segment transforaminal lumbar interbody fusion (TLIF) and unilateral biportal endoscopic lumbar interbody fusion (ULIF) and to compare the predictive performance of various bone quality assessment methods using MRI and CT images. Methods A total of 226 patients from 2021 to 2023 who underwent ULIF/TLIF because of lumbar disc herniation and lumbar spinal stenosis were enrolled. The subsidence of the cage into the vertebral body exceeding 2 mm was defined as CS and diagnosed using CT scans. Immediate endplate destruction (IED) was defined by CT and VBQ was measured through T1-weighted lumbar MRI. The independent sample t-test was employed to examine the risk factors associated with CS. Additionally, risk factors associated with CS were identified using logistic regression analysis. Lastly, the comparative predictive values were assessed through ROC curve analysis. Results Logistic regression analysis revealed that increased postoperative posterior disc height (PPDH), higher segmental VBQ scores, higher mean VBQ (M-VBQ) scores, decreased segmental HU values, decreased mean HU (M-HU) values and immediate endplate destruction (IED) were associated with the occurrence of CS. The area under the curve (AUC) of the VBQ score was higher than that of the HU value, both in segment and in average. Conclusions The incidence of CS was lower in ULIF compared to TLIF. High VBQ scores, low HU values, high PPDH and the presence of IED were associated with an increased risk of CS. Notably, the predictive value of both VBQ scores and HU values were high for CS, with the former potentially outperforming the latter. |
| format | Article |
| id | doaj-art-b2dc3c1ee7194388acb7aa2d7a2edff8 |
| institution | DOAJ |
| issn | 2047-783X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj-art-b2dc3c1ee7194388acb7aa2d7a2edff82025-08-20T03:03:27ZengBMCEuropean Journal of Medical Research2047-783X2025-07-0130111010.1186/s40001-025-02797-9Utilizing MRI and CT to identify risk factors associated with cage subsidenceChaohui Ding0Changnan Xie1Jinwei Ying2Mengxian Jia3Ziwei Fan4Xiang Fang5Xianghe Wang6Honglin Teng7Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical UniversityDepartment of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical UniversityDepartment of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical UniversityDepartment of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical UniversityDepartment of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical UniversityDepartment of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical UniversityDepartment of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical UniversityDepartment of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical UniversityAbstract Objectives To identify risk factors associated with cage subsidence (CS) following single segment transforaminal lumbar interbody fusion (TLIF) and unilateral biportal endoscopic lumbar interbody fusion (ULIF) and to compare the predictive performance of various bone quality assessment methods using MRI and CT images. Methods A total of 226 patients from 2021 to 2023 who underwent ULIF/TLIF because of lumbar disc herniation and lumbar spinal stenosis were enrolled. The subsidence of the cage into the vertebral body exceeding 2 mm was defined as CS and diagnosed using CT scans. Immediate endplate destruction (IED) was defined by CT and VBQ was measured through T1-weighted lumbar MRI. The independent sample t-test was employed to examine the risk factors associated with CS. Additionally, risk factors associated with CS were identified using logistic regression analysis. Lastly, the comparative predictive values were assessed through ROC curve analysis. Results Logistic regression analysis revealed that increased postoperative posterior disc height (PPDH), higher segmental VBQ scores, higher mean VBQ (M-VBQ) scores, decreased segmental HU values, decreased mean HU (M-HU) values and immediate endplate destruction (IED) were associated with the occurrence of CS. The area under the curve (AUC) of the VBQ score was higher than that of the HU value, both in segment and in average. Conclusions The incidence of CS was lower in ULIF compared to TLIF. High VBQ scores, low HU values, high PPDH and the presence of IED were associated with an increased risk of CS. Notably, the predictive value of both VBQ scores and HU values were high for CS, with the former potentially outperforming the latter.https://doi.org/10.1186/s40001-025-02797-9Unilateral biportal endoscopic lumbar interbody fusion immediate endplate destructionCage subsidenceVertebral bone qualityHounsfield units |
| spellingShingle | Chaohui Ding Changnan Xie Jinwei Ying Mengxian Jia Ziwei Fan Xiang Fang Xianghe Wang Honglin Teng Utilizing MRI and CT to identify risk factors associated with cage subsidence European Journal of Medical Research Unilateral biportal endoscopic lumbar interbody fusion immediate endplate destruction Cage subsidence Vertebral bone quality Hounsfield units |
| title | Utilizing MRI and CT to identify risk factors associated with cage subsidence |
| title_full | Utilizing MRI and CT to identify risk factors associated with cage subsidence |
| title_fullStr | Utilizing MRI and CT to identify risk factors associated with cage subsidence |
| title_full_unstemmed | Utilizing MRI and CT to identify risk factors associated with cage subsidence |
| title_short | Utilizing MRI and CT to identify risk factors associated with cage subsidence |
| title_sort | utilizing mri and ct to identify risk factors associated with cage subsidence |
| topic | Unilateral biportal endoscopic lumbar interbody fusion immediate endplate destruction Cage subsidence Vertebral bone quality Hounsfield units |
| url | https://doi.org/10.1186/s40001-025-02797-9 |
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