Eur Spine J. 2025 Nov 30. doi: 10.1007/s00586-025-09646-7. Online ahead of print.
ABSTRACT
PURPOSE: Pedicle screw loosening (PSL) is a significant complication in transforaminal lumbar interbody fusion (TLIF), often associated with poor bone quality. This study evaluates the predictive value of MRI-based pedicle bone quality (PBQ) and vertebral body quality (VBQ) scores for PSL, hypothesizing that PBQ is a stronger predictor than VBQ.
METHODS: This retrospective cohort study analyzed 394 patients who underwent TLIF between January 2018 and January 2021. Preoperative PBQ and VBQ scores were derived from sagittal T1-weighted MRI images. The primary outcome measure was PSL, which was evaluated in accordance with established radiographic criteria. Secondary outcomes included fusion rates and patient-reported outcomes. Statistical analyses included receiver operating characteristic curves to determine predictive accuracy and multivariate logistic regression to identify other risk factors for PSL.
RESULTS: PBQ demonstrated superior predictive performance for PSL relative to VBQ, with higher sensitivity (75.93% vs. 50.00%) and specificity (92.31% vs. 87.06%). In addition, PBQ yielded higher positive predictive value (78.85% vs. 59.34%) and negative predictive value (91.03% vs. 82.18%). The discriminative ability of PBQ was further supported by a larger area under the ROC curve (0.894, 95% CI: 0.856-0.932) compared with VBQ (0.722, 95% CI: 0.664-0.781). Independent risk factors associated with PSL included advanced age, lower hip bone mineral density T-scores, longer fusion constructs, and reduced fusion rates. Furthermore, patients who developed PSL reported significantly higher postoperative back pain scores.
CONCLUSION: MRI-derived PBQ and VBQ scores independently predict PSL, with PBQ demonstrating superior performance. Incorporating PBQ into preoperative planning may improve surgical decision-making and potentially enhance outcomes in patients with reduced bone strength. Additionally, lower hip BMD T-scores, reduced fusion rates, longer fusion constructs, and advanced age were identified as significant risk factors for PSL.
PMID:41318873 | DOI:10.1007/s00586-025-09646-7
