Objective: To assess the role of vertebral bone quality (VBQ) score combined with paraspinal muscles fat infiltration in predicting adjacent segment degeneration after lower lumbar transforaminal lumbar interbody fusion.
Methods: This study respectively reviewed a consecutive series of 153 patients who had undergone transforaminal lumbar interbody fusion (TLIF) for lower lumbar degenerative diseases and had been followed at least 2 years. There were 53 patients were identified with radiographic ASD (R-ASD), 20 with symptomatic ASD (S-ASD), and 80 without ASD (Non-ASD). BMD was measured by DXA-based T-scores. The VBQ score and the cross-sectional area (CSA) and degree of fat infiltration (DFF) of the erector spinae muscle, multifidus muscle, and psoas muscle were assessed using lumbar MRI images. The correlation coefficients were calculated between the VBQ score and the parameters of BMD and DFF of paravertebral muscle. The receiver operating characteristic (ROC) curve was used to evaluated the prediction value of VBQ and DFF of paravertebral muscle.
Results: No significant differences were obeserved in age, gender, and BMI between the RASD, S-ASD and Non-ASD group. BMD T-scores and Cross-sectional area of paraspinal muscles did not significantly differ between groups. The VBQ score showed a negative correlation with the lumbar, hip, and femoral neck T-score (r =-0.469, p<0.001; r =-0.410, p<0.001; r =-0.412, p<0.001, respectively) and a positive correlation with the DFF of erector spinae muscle (ES), multifidus muscle (MF), and psoas muscle (PS) (r =0.478, p<0.001; r =0.441, p<0.001; r =0.356, p<0.001, respectively). VBQ score, average DFF, and VBQ score combined with average DFF of paraspinal muscles were able to effectively predict occurrence of both ASD (AUC=0.754, 0.735, and 0.789 respectively) and S-ASD (AUC=0.864, 0.845, and 0.895 respectively).
Conclusion: Higher VBQ score and DFF were significantly associated with occurrence of ASD. Both osteopenia and sarcopenia may predispose occurrence of ASD after TLIF. Treatment mearsures on osteopenia and sarcopenia may be helpful to prevent ASD.