Would Roussouly classification affect the diagnostic efficiency of vertebral bone quality score for assessing osteopenia or osteoporosis in lumbar degenerative disease?

Purpose: The aim of this study is to estimate the diagnostic efficiency of VBQ score for assessing osteopenia and osteoporosis in different Roussouly types in lumbar degenerative disease.

Methods: We reviewed the preoperative data of 501 patients with lumbar degenerative diseases who underwent lumbar spine surgery between July 2019 and December 2022 with available T1-weighted magnetic resonance imaging and dual-energy X-ray absorptiometry. Receiver operating characteristic (ROC) curves were plotted to analyze the diagnostic performance of VBQ score in different Roussouly classifications. For each Roussouly type, one-way ANOVA was applied to compare VBQ score across different lumbar segments. Statistical significance was set at P < 0.05.

Results: No statistical difference was found between the VBQ score of L1, L2, L3 and L4. Lumbar lordosis and sacral slope were not independently associated with VBQ score. According to the ROC curve, Roussouly type 1 to 4 showed AUC of 0.738, 0.799, 0.764 and 0.817, respectively, in diagnosing osteopenia. Roussouly type 1 to 4 showed AUC of 0.690, 0.703, 0.851 and 0.643, respectively, in diagnosing osteoporosis.

Conclusions: Different Roussouly types would not affect the diagnosis efficiency of VBQ score in diagnosing osteopenia. However, VBQ score showed better performance in diagnosing osteoporosis for Roussouly type 3. When VBQ score was applied as opportunistic screening method for osteoporosis, choosing appropriate patients was important to improve the diagnostic accuracy.