Comparison of the predictive value of different segmental bone quality assessments for cage subsidence following anterior cervical discectomy and fusion.

Abstract

Objective: To compare the predictive value of different segmental bone quality assessments for cage subsidence following single-level and multi-level anterior cervical discectomy and fusion (ACDF) and determine the best one.

Methods: From 2019 to 2023, we reviewed patients who underwent single- or multi-level ACDF. The segmental endplate bone quality (SEBQ) score, segmental vertebral bone quality (SVBQ) score, and segmental Hounsfield units (SHU) value were measured using preoperative magnetic resonance imaging (MRI) and computed tomography (CT) scans. Cage subsidence was defined as a loss of segment height (SH) greater than 3 mm. Risk factors for cage subsidence were identified through logistic regression analysis. The predictive value of the different segmental bone quality assessments for cage subsidence was evaluated using receiver operating characteristic (ROC) curves.

Results: This study included 128 patients, of whom 61 underwent single-level procedures and 67 underwent multi-level procedures. Logistic regression analysis showed that the SEBQ score, SVBQ score, and SHU value were significantly associated with subsidence (p < 0.05). In the single-level group, the area under the curve (AUC) values for SEBQ score, SVBQ score, and SHU values in predicting subsidence were 0.823, 0.748, and 0.793, respectively. In the multi-level group, the AUC values for SEBQ score, SVBQ score, and SHU values predicting subsidence were 0.843, 0.805, and 0.738, respectively.

Conclusions: All segmental bone quality assessments can predict cage subsidence after ACDF. Regardless of whether the procedure is single- or multi-level, the SEBQ score demonstrated superior predictive value compared to the SHU value and SVBQ score.