ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
MRI-based pedicle bone quality score: a superior predictor over vertebral bone quality score for pedicle screw loosening following transforaminal lumbar interbody fusion.
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, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Fragility fracture risk prediction using quantitative magnetic resonance and Vertebral Bone Quality scoring beyond density.World journal of methodology · 2026Review
- Impact of Paraspinal Muscle Characteristics on the Risk of Symptomatic Epidural Hematoma Following Transforaminal Lumbar Interbody Fusion.Global spine journal · 2026Article
- Distinct regional bone quality patterns in L5-S1 isthmic and degenerative spondylolisthesis: implications for pedicle screw loosening risk.Journal of orthopaedic surgery and research · 2026Article
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6 authors.
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Abstract
purposePedicle screw loosening (PSL) is a significant complication in transforaminal lumbar interbody fusion (TLIF), often associated with poor bone quality. This study evaluates the predictive value of MRI-based pedicle bone quality (PBQ) and vertebral body quality (VBQ) scores for PSL, hypothesizing that PBQ is a stronger predictor than VBQ.
methodsThis retrospective cohort study analyzed 394 patients who underwent TLIF between January 2018 and January 2021. Preoperative PBQ and VBQ scores were derived from sagittal T1-weighted MRI images. The primary outcome measure was PSL, which was evaluated in accordance with established radiographic criteria. Secondary outcomes included fusion rates and patient-reported outcomes. Statistical analyses included receiver operating characteristic curves to determine predictive accuracy and multivariate logistic regression to identify other risk factors for PSL.
resultsPBQ demonstrated superior predictive performance for PSL relative to VBQ, with higher sensitivity (75.93% vs. 50.00%) and specificity (92.31% vs. 87.06%). In addition, PBQ yielded higher positive predictive value (78.85% vs. 59.34%) and negative predictive value (91.03% vs. 82.18%). The discriminative ability of PBQ was further supported by a larger area under the ROC curve (0.894, 95% CI: 0.856-0.932) compared with VBQ (0.722, 95% CI: 0.664-0.781). Independent risk factors associated with PSL included advanced age, lower hip bone mineral density T-scores, longer fusion constructs, and reduced fusion rates. Furthermore, patients who developed PSL reported significantly higher postoperative back pain scores.
conclusionMRI-derived PBQ and VBQ scores independently predict PSL, with PBQ demonstrating superior performance. Incorporating PBQ into preoperative planning may improve surgical decision-making and potentially enhance outcomes in patients with reduced bone strength. Additionally, lower hip BMD T-scores, reduced fusion rates, longer fusion constructs, and advanced age were identified as significant risk factors for PSL.
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