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Purpose <p>To compare the predictive performance of endplate Hounsfield units (HU), mean lumbar HU, and vertebral bone quality (VBQ) scores for cage subsidence (CS) at 12 months after single-level posterior lumbar interbody fusion (PLIF) and to identify the strongest independent predictors.</p> Methods <p>We retrospectively evaluated 138 patients who underwent PLIF for degenerative lumbar conditions between 2017 and 2022. Preoperative CT was used to measure the cranial and caudal endplate HU values at the operative level (averaged as “endplate HU”) and mean HU from L1-L5. VBQ scores were calculated from T1-weighted MRI. CS was defined as a ≥ 25% loss of intervertebral height at the 12-month follow-up. Statistical analyses included Spearman’s correlation, multiple linear regression, and receiver operating characteristic (ROC) curve analyses.</p> Results <p>Among the 138 patients, 31 (22.46%) demonstrated significant CS, with lower endplate HU (235.313 ± 31.772 vs. 324.668 ± 79.142; <i>p</i> &lt; 0.001) and mean HU (92.332 ± 38.329 vs. 144.339 ± 47.881; <i>p</i> &lt; 0.001). Endplate HU correlated more strongly with CS (<i>r</i> = − 0.832) than did mean HU (<i>r</i> = − 0.536). In multiple regression, both HU measures independently predicted CS, with endplate HU showing greater predictive strength (<i>β</i> = − 0.539). VBQ was not significantly associated with CS. ROC analysis revealed that endplate HU (AUC = 0.929) outperformed mean HU (AUC = 0.798).</p> Conclusion <p>Endplate HU offers superior predictive accuracy for CS compared t<i>o</i> mean lumbar HU and VBQ. Evaluating endplate HU preoperatively can refine risk stratification and surgical decision-making in PLIF.</p>

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Endplate Hounsfield units outperform lumbar HU and VBQ in predicting cage subsidence after posterior lumbar interbody fusion: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2025年7月14日

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  • Sheyang Xu,
  • Xingling Liu,
  • Xianglong Meng

摘要

Purpose

To compare the predictive performance of endplate Hounsfield units (HU), mean lumbar HU, and vertebral bone quality (VBQ) scores for cage subsidence (CS) at 12 months after single-level posterior lumbar interbody fusion (PLIF) and to identify the strongest independent predictors.

Methods

We retrospectively evaluated 138 patients who underwent PLIF for degenerative lumbar conditions between 2017 and 2022. Preoperative CT was used to measure the cranial and caudal endplate HU values at the operative level (averaged as “endplate HU”) and mean HU from L1-L5. VBQ scores were calculated from T1-weighted MRI. CS was defined as a ≥ 25% loss of intervertebral height at the 12-month follow-up. Statistical analyses included Spearman’s correlation, multiple linear regression, and receiver operating characteristic (ROC) curve analyses.

Results

Among the 138 patients, 31 (22.46%) demonstrated significant CS, with lower endplate HU (235.313 ± 31.772 vs. 324.668 ± 79.142; p < 0.001) and mean HU (92.332 ± 38.329 vs. 144.339 ± 47.881; p < 0.001). Endplate HU correlated more strongly with CS (r = − 0.832) than did mean HU (r = − 0.536). In multiple regression, both HU measures independently predicted CS, with endplate HU showing greater predictive strength (β = − 0.539). VBQ was not significantly associated with CS. ROC analysis revealed that endplate HU (AUC = 0.929) outperformed mean HU (AUC = 0.798).

Conclusion

Endplate HU offers superior predictive accuracy for CS compared to mean lumbar HU and VBQ. Evaluating endplate HU preoperatively can refine risk stratification and surgical decision-making in PLIF.