ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2025
Endplate Hounsfield units outperform lumbar HU and VBQ in predicting cage subsidence after posterior lumbar interbody fusion: a retrospective cohort study.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Association between lumbar vertebral body bone quality and cranial/caudal endplate bone quality with intervertebral disc degeneration: a retrospective study of 2018 patients.Journal of orthopaedic surgery and research · 2026Article
- Sacral Insufficiency Fracture Following L4-S1 Circumferential Fusion in Corticosteroid-associated Bone Fragility: A Case Report and Biomechanical Considerations.Journal of orthopaedic case reports · 2026Article
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Abstract
purposeTo 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.
methodsWe 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.
resultsAmong 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).
conclusionEndplate 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.
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