• Wu Ye, Jiaxing Wang, Xiaokun Wang, and Pengyu Tang.
• Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
• World Neurosurg. 2024 Oct 1; 190: e191e198e191-e198.

ObjectiveTo compare predictive performance for pedicle screw loosening between computed tomography (CT)-based Hounsfield units (HU) and magnetic resonance imaging (MRI)-based vertebral bone quality score (VBQ) after lumbar surgery.MethodsA retrospective study was conducted on patients who received transforaminal lumbar interbody fusion continuously at our institution from May 2018 to September 2020. On the basis of 12 months' follow-up lumbar radiographs, screw loosening was defined as a clear zone of minimal thickness of ≥1 mm around the pedicle screw on radiography. VBQ score and HU value were measured using preoperative MRI and CT, respectively. Then, we evaluated the predictive performance of these 2 parameters by comparing the receiver operating characteristic curve.ResultsIn all patients, area under the curve (AUC) of the VBQ score (AUC = 0.752; 95% confidence interval [CI] 0.663-0.841; P < 0.001) was larger than those of the CT HU value (AUC = 0.652; 95% CI 0.558-0.746; P = 0.005), but there was no significant difference between them (PAUC = 0.076). In patients with lumbar spinal stenosis, AUC of VBQ score (AUC = 0.863; 95% CI 0.764-0.961; P < 0.001) was larger than those of the CT HU value (AUC = 0.673; 95% CI 0.513-0.833; P = 0.043), with significant difference (PAUC = 0.003).ConclusionsMRI-based VBQ score and CT-based HU value have similar performance in predicting pedicle screw loosening after lumbar surgery. Furthermore, in patients with lumbar spinal stenosis, VBQ score demonstrated better predictive ability than HU value.Copyright © 2024 Elsevier Inc. All rights reserved.

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