The spine journal : official journal of the North American Spine Society · 2026
Predicting cage subsidence after lumbar interbody fusion: a meta-analysis of opportunistic bone quality metrics.
СтатьяМетаанализСистематический обзорОбзорНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Patel Shaan, Nischal Shiva A, Nallankuka Gargee Sree, Kale Kush M, Sarikonda Advith, Saad Hassan, Hines Kevin J, Jallo Jack, Harrop James S, Prasad Srinivas K
Аннотация
BACKGROUND CONTEXT: Cage subsidence (CS) is a frequent complication following lumbar interbody fusion and is closely linked to vertebral and endplate bone quality. Although CT- and MRI-derived bone metrics are increasingly used for preoperative risk stratification, their comparative discriminative performance for CS has not been systematically evaluated.
PURPOSE: To evaluate and compare the discriminative performance of CT- and MRI-derived bone quality metrics for CS following degenerative lumbar fusion.
STUDY DESIGN/SETTING: Systematic review and meta-analysis.
METHODS: PubMed, Embase, and CENTRAL were searched from inception to January 2026. Observational studies reporting preoperative imaging-based bone quality metrics in adult patients undergoing lumbar interbody fusion were included. Primary metrics included CT-based Hounsfield units, MRI-based vertebral bone quality (VBQ) and endplate bone quality (EBQ), and CT-derived bone mineral density (CT-BMD). Secondary outcomes included DEXA T-scores. Random-effects meta-analyses synthesized continuous inter-group differences and diagnostic accuracy parameters, summarized using pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratios, and SROC curves. Risk of bias was assessed using QUADAS-2.
RESULTS: A total of 36 studies encompassing 5482 patients were included, of whom 1679 (30.6%) developed CS. Across all metrics, patients with subsidence demonstrated poorer preoperative bone quality, including lower Hounsfield units (MD -26.9; p<.01), lower CT-BMD (MD: -33.0; p<.01), and lower DEXA T-scores (MD: -0.77; p<.01), alongside higher VBQ (MD: 0.60; p<.01) and EBQ scores (MD: 0.68; p<.01). Diagnostic accuracy was moderate-to-good, with pooled AUCs ranging from 0.77 to 0.85. Differences in discriminative performance between metrics were modest and nonsignificant on meta-regression, with nomogram analyses demonstrating risk-shifting rather than definitive rule-in or rule-out performance.
CONCLUSIONS: Imaging-derived bone quality metrics demonstrate consistent associations and moderate-to-good discrimination for CS after degenerative lumbar fusion, reflecting shared vulnerability at the cage-endplate interface and supporting their use as pragmatic tools for preoperative risk stratification and surgical planning.
PURPOSE: To evaluate and compare the discriminative performance of CT- and MRI-derived bone quality metrics for CS following degenerative lumbar fusion.
STUDY DESIGN/SETTING: Systematic review and meta-analysis.
METHODS: PubMed, Embase, and CENTRAL were searched from inception to January 2026. Observational studies reporting preoperative imaging-based bone quality metrics in adult patients undergoing lumbar interbody fusion were included. Primary metrics included CT-based Hounsfield units, MRI-based vertebral bone quality (VBQ) and endplate bone quality (EBQ), and CT-derived bone mineral density (CT-BMD). Secondary outcomes included DEXA T-scores. Random-effects meta-analyses synthesized continuous inter-group differences and diagnostic accuracy parameters, summarized using pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratios, and SROC curves. Risk of bias was assessed using QUADAS-2.
RESULTS: A total of 36 studies encompassing 5482 patients were included, of whom 1679 (30.6%) developed CS. Across all metrics, patients with subsidence demonstrated poorer preoperative bone quality, including lower Hounsfield units (MD -26.9; p<.01), lower CT-BMD (MD: -33.0; p<.01), and lower DEXA T-scores (MD: -0.77; p<.01), alongside higher VBQ (MD: 0.60; p<.01) and EBQ scores (MD: 0.68; p<.01). Diagnostic accuracy was moderate-to-good, with pooled AUCs ranging from 0.77 to 0.85. Differences in discriminative performance between metrics were modest and nonsignificant on meta-regression, with nomogram analyses demonstrating risk-shifting rather than definitive rule-in or rule-out performance.
CONCLUSIONS: Imaging-derived bone quality metrics demonstrate consistent associations and moderate-to-good discrimination for CS after degenerative lumbar fusion, reflecting shared vulnerability at the cage-endplate interface and supporting their use as pragmatic tools for preoperative risk stratification and surgical planning.