• World Neurosurg · Aug 2020

    Vertebral bone quality score and postoperative lumbar lordosis associated with need for reoperation after lumbar fusion.

    • Jeff Ehresman, A Karim Ahmed, Daniel Lubelski, Andrew Schilling, Zach Pennington, Ethan Cottrill, Julie McCracken, Majid Khan, Timothy Witham, and Daniel M Sciubba.
    • Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
    • World Neurosurg. 2020 Aug 1; 140: e247-e252.

    BackgroundPoor bone quality is a known risk factor for hardware failure and adjacent segment disease after lumbar fusion. One new method of analyzing bone quality is the vertebral bone quality (VBQ) score, which can be obtained from preoperative lumbar magnetic resonance imaging (MRI) scans. We decided to evaluate whether patients' VBQ scores were associated with reoperation after lumbar fusion.MethodsWe queried records of patients who underwent elective lumbar fusion for degenerative conditions between 2012 and 2017. Patients who required reoperations after lumbar fusions because of symptomatic hardware failure or adjacent segment disease were combined into a case group and compared with a matched control group.ResultsOf the 46 patients who underwent elective lumbar fusions and required reoperation, 30 met the inclusion criteria. A 2:1 control group of 60 individually age-, body mass index-, and sex-matched patients who did not require reoperation was then created. The reoperation group had significantly lower degrees of postoperative lumbar lordosis. There were no significant differences regarding other spinopelvic parameters, adjacent Pfirrmann scores, or dual energy x-ray absorptiometry (DXA) T scores. There was, however, a significant difference in VBQ scores between the groups, with the reoperation group having a higher VBQ score.ConclusionsThis study found that bone quality, according to the VBQ score rather than the DXA T score, is an important risk factor for reoperation after lumbar fusion surgery. Therefore, this MRI-based tool may be used to assist surgeons in preoperative planning for spine surgeries with the goal of reducing the risk of requiring reoperation.Copyright © 2020 Elsevier Inc. All rights reserved.

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