NLR and PLR as Adjunctive Markers of MRI-Derived Vertebral Bone Quality in a Preoperative Lumbar Cohort.

BACKGROUND

MRI-derived vertebral bone quality (VBQ) rises with marrow fat and denotes poorer bone integrity. We examined whether simple inflammatory ratios-neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR)-relate to VBQ in degenerative lumbar disease.

METHODS

We retrospectively studied 200 patients aged ≥50 years who underwent surgery between January 2022 and January 2024. VBQ was calculated on mid-sagittal T1-weighted MRI using vertebral and cerebrospinal-fluid regions of interest. Associations were tested with Spearman correlations and multivariable linear regression adjusting for age, sex, smoking, diabetes, and body mass index (BMI).

RESULTS

Among 200 patients (mean age = 64.8 ± 8.7 years), those with higher VBQ values (indicating poorer bone quality) were older and had higher NLR and PLR (all p<0.001). VBQ showed significant positive correlations with age (ρ = 0.650), NLR (ρ = 0.534), and PLR (ρ = 0.452) (all p<0.001). In multivariable regression, age, NLR, and PLR remained independently associated with higher VBQ, whereas BMI, sex, smoking, and diabetes were not significant (adjusted R2=0.520; all VIF≤2.26). Standardized effect sizes indicated moderate independent contributions (β_std = 0.151 for NLR; β_std = 0.303 for PLR), corresponding to roughly 0.020-unit and 0.075-unit increases in VBQ per 1-unit NLR and 50-unit PLR increments, respectively.

CONCLUSION

Preoperative NLR and PLR were independently associated with higher MRI-derived VBQ and may aid imaging-based risk stratification; prospective validation with calibrated thresholds is needed.