Opportunistic prediction of osteoporosis in patients with degenerative lumbar diseases: a simplified T12 vertebral bone quality approach

Xue et al. Journal of Orthopaedic Surgery and Research https://doi.org/10.1186/s13018-024-04782-0 Journal of Orthopaedic Surgery and Research (2024) 19:296 Open Access RESEARCH ARTICLE Opportunistic prediction of osteoporosis in patients with degenerative lumbar diseases: a simplified T12 vertebral bone quality approach Congyang Xue1,2, Xiaopei Lu2, Guangda Sun1,2, Nan Wang1,2, Ganshen He1,2, Wenqiang Xu1, Zhipeng Xi1 and Lin Xie1* Abstract Background Osteoporosis is one of the risk factors for screw loosening after lumbar fusion. However, the probability of preoperative osteoporosis screening in patients with lumbar degenerative disease is low. Therefore, the aim of this study was to investigate whether a simplified vertebral bone quality (VBQ) score based on T12 T1-MRI could opportunistically predict osteoporosis in patients with degenerative lumbar spine diseases. Methods We retrospectively analyzed cases treated for lumbar degenerative diseases at a single institution between August 2021 and June 2022. The patients were divided into three groups by the lowest T-score: osteoporosis group, osteopenia group, and normal bone mineral density (BMD) group. The signal intensity based on the T12 vertebral body divided by the signal intensity of the cerebrospinal fluid was calculated to obtain the simplified VBQ score, as well as the CT-based T12HU value and the traditional L1-4VBQ score. Various statistical analyses were used to compare VBQ, HU and DEXA, and the optimal T12VBQ threshold for predicting osteoporosis was obtained by plotting the receiver operating curve (ROC) analysis. Results Total of 166 patients were included in this study. There was a statistically significant difference in T12VBQ scores between the three groups (p < 0.001). Pearson correlation showed that there was a moderate correlation between T12VBQ and T-score (r=-0.406, p < 0.001). The AUC value of T12VBQ, which distinguishes between normal and low BMD, was 0.756, and the optimal diagnostic threshold was 2.94. The AUC value of T12VBQ, which distinguishes osteoporosis from non-osteoporosis, was 0.634, and the optimal diagnostic threshold was 3.18. Conclusion T12VBQ can be used as an effective opportunistic screening method for osteoporosis in patients with lumbar degenerative diseases. It can be used as a supplement to the evaluation of DEXA and preoperative evaluation. Trial registration retrospectively registered number:1502-009-644; retrospectively registered number date:27 oct 2022. Keywords Osteoporosis, Vertebral bone quality, Hounsfield units, Thoracic vertebra, MRI *Correspondence: Lin Xie 1 Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province 210028, P.R. China 2 Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Xue et al. Journal of Orthopaedic Surgery and Research (2024) 19:296 Introduction Degenerative diseases of the lumbar spine are characterized by low back and leg pain as the main clinical symptom [1]. Its prevalence gradually increases over time; without timely intervention, symptoms gradually worsen. The main common lumbar degenerative diseases include discogenic low back pain, lumbar disc herniation [2], lumbar spinal stenosis [3, 4] and lumbar spondylolisthesis [5]. It is one of the major causes of disability in elderly patients. Currently, most of the severe degenerative lumbar spine diseases are treated surgically. Approximately 600,000 lumbar spinal stenosis surgeries are performed annually in the United States [4]. Some patients are in need of lumbar spinal stenosis fusion surgery [6]. Osteoporosis was found to be a risk factor for cage settlement after lumbar fusion [7] and one of the main risk factors for pedicle screw loosening [8]. Therefore, early identification of patients with bone abnormalities facilitates the optimization of the choice of surgical approach and postoperative care, and reduces the incidence of associated complications. However, the probability of screening for osteoporosis in patients with degenerative lumbar spine disease is low. A previous survey of clinicians found that only 47% of clinicians screened patients for osteoporosis before surgery [9]. Although, DEXA test is the gold standard for diagnosing osteoporosis [10]. But due to many factors [11] (such as vertebral compression fractures, degenerative joint disease, scoliosis and vascular calcification, etc.), it does not detect osteoporosis effectively. In the clinic, osteoporosis is found in patients mostly after the first fracture. One study [12] found that more than 50% of patients with osteoporotic fractures had T-score > -2.5. In contrast, q-CT, although better able to assess a patient’s bone density, is expensive and has high radiation and low clinical utilisation. As a result, this has prompted researchers to look for other ways to predict the bone density of vertebrae. The investigators developed methods to opportunistically screen patients for osteoporosis based on imaging data from their preoperative evaluation [13, 14]. Currently, T12HU values based on CT measurements are effective in assessing patient bone quality [15]. MRIbased vertebral bone quality scores for the prediction of osteoporosis have been proposed with the ability to assess the quality of bone trabeculae and the degree of fat infiltration. The study found a significant correlation between VBQ and BMD [16]. Many researchers have used VBQ as an indicator to assess cage subsidence and recurrence after lumbar fusion surgery [7, 17]. However, deformities, fractures, hemangiomas and local infections of the lumbar spine may affect the L1-4VBQ score. Therefore, we were curious if MRI data of the T12 could Page 2 of 7 be used to simplify the VBQ score, which was not mentioned in previous studies. The (...truncated)