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Magnetic Resonance Imaging-Based Vertebral Bone Quality Score for Prediction of Cage Subsidence and Screw Loosening in Patients Undergoing Degenerative Lumbar Surgery: A Meta-analysis
Neurospine. 2024;21(3):913-924.   Published online September 30, 2024
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Magnetic Resonance Imaging-Based Vertebral Bone Quality Score for Prediction of Cage Subsidence and Screw Loosening in Patients Undergoing Degenerative Lumbar Surgery: A Meta-analysis
Neurospine. 2024;21(3):913-924.   Published online September 30, 2024
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Objective
Poor bone quality is a risk factor for postoperative complications after degenerative lumbar fusion surgery. The magnetic resonance imaging-based vertebral bone quality (VBQ) score is a good tool for assessing bone quality, and this is the first meta-analysis performed to summarize the predictive value of the VBQ score for cage subsidence and screw loosening in patients undergoing degenerative lumbar surgery.
Methods
Studies were comprehensively searched in electronic databases. The quality of the studies was assessed. The pooled sensitivity, specificity and summary receiver operating characteristic curve were calculated. Publication bias was assessed and meta-regression was conducted.
Results
We ultimately included 9 studies with a total of 1,404 patients with a mean age of 60.4 years and a percentage of females of 57.0%. According to the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool to assess methodological quality, the quality of the included studies was relatively low and risks of bias might exist. Results showed that a high VBQ was significantly associated with cage subsidence and screw loosening, and risk factor analysis revealed that the merged odds ratio was 5.37 for cage subsidence and 3.87 for screw loosening. With a VBQ cutoff value of 3.34±0.45, the pooled sensitivity and specificity for the diagnosis of postoperative complications were 0.75 and 0.75, respectively, and the area under the curve was 0.82 (95% confidence interval, 0.78–0.85).
Conclusion
A high VBQ was associated with a high risk of cage subsidence and screw loosening in patients who underwent degenerative lumbar surgery. The VBQ score could be considered for identifying high-risk patients for further evaluation.

Citations

Citations to this article as recorded by  Crossref logo
  • Evaluation of MRI-Based Region-specific Vertebral Bone Quality Score for Bone Mineral Density in Lumbar Fusion Surgery
    Xuan Zhao, Wei Wang, Xiaolong Chen, Shibao Lu
    Global Spine Journal.2026; 16(5): 2070.     CrossRef
  • MRI-based pedicle bone quality score predicts cage subsidence following oblique lumbar interbody fusion
    Xiao Hu, Xingxiao Pu, Xiandi Wang, Chuan Luo, Liyu Ran, Xingrui Peng, Tianhang Xie, Jiancheng Zeng
    European Spine Journal.2026; 35(6): 3454.     CrossRef
  • A novel method of C-VBQ score and CT-HU as risk predictors for cage subsidence after short level ACDF
    Qiang Zhang, Zequn Zhang, Rongzhi Ma, Yuan Xue
    Scientific Reports.2026;[Epub]     CrossRef
  • Development and validation of an MRI-based musculoskeletal model for predicting pedicle screw loosening after lumbar fusion surgery: a multicenter study
    Xuan Zhao, Ranlv Zhu, Wei Wang, Xiaolong Chen, Chunde Li, Shibao Lu
    International Journal of Surgery.2026; 112(2): 2518.     CrossRef
  • Accuracy of Magnetic Resonance Imaging-Based Vertebral and Endplate Bone Quality in Predicting Cage Subsidence in Anterior Cervical Spine Surgery: A Systematic Review and Meta-Analysis
    Alexander Erick Purnomo, Aldi Nanda Kurniawan, Yang Yang Endro Arjuna, Jephtah Furano Lumban Tobing, Hendra Tjong
    Journal of Neurological Surgery Part A: Central European Neurosurgery.2026; 87(04): 273.     CrossRef
  • Knee-specific bone quality assessment for cementless total knee arthroplasty candidate selection: a narrative review
    Dong Hwan Lee, Dai-Soon Kwak, Sheen-Woo Lee, Sung-Min Kim, Yong Deok Kim, In Jun Koh
    Knee Surgery & Related Research.2026;[Epub]     CrossRef
  • Emerging MRI-Based Imaging Markers in Musculoskeletal Imaging: Advancing Diagnosis and Prognosis
    Yejin Park, Chang Ho Kang, Kyung-Sik Ahn, Kyu-Chong Lee
    Journal of the Korean Society of Radiology.2026;[Epub]     CrossRef
  • Exploring the MRI-based vertebral bone quality score as a novel predictor of spongy cement distribution in osteoporotic vertebral compression fractures following percutaneous vertebral augmentation
    Heng Wu, Wenjun Shen, Bin Hu, Shike Luo, Zhuolin Wang, Junwei Xiang, Yuquan Chen, Hua Yang, Chuanen Wang
    Frontiers in Endocrinology.2026;[Epub]     CrossRef
  • Predictive value of vertebral specificity of bone mineral density for cage subsidence among patients undergoing anterior cervical diskectomy and fusion: a retrospective study
    Xiaozhe Zhou, Ranxu Yang, Xiong Zhang, Yunsheng Wang, Wenshuai Li, Linfeng Wang
    European Spine Journal.2025; 34(6): 2207.     CrossRef
  • Endplate Hounsfield units outperform lumbar HU and VBQ in predicting cage subsidence after posterior lumbar interbody fusion: a retrospective cohort study
    Sheyang Xu, Xingling Liu, Xianglong Meng
    European Spine Journal.2025; 34(9): 4140.     CrossRef
  • Clinical Insights on Transforaminal Lumbar Interbody Fusion (TLIF) Implantations Following Spinal Fusion Surgery: Enhancing and Monitoring Bone Health in Patients
    Francesco Puglia, Marcello Ferraro, Valentina Longhi, Enrico Gallazzi, Giovanni Andrea La Maida
    Orthopedic Research and Reviews.2025; Volume 17: 281.     CrossRef
  • Accuracy of CT hounsfield units for predicting cage subsidence and pedicle screw loosening after lumbar interbody fusion: a systematic review and meta-analysis
    Alexander Erick Purnomo, Jephtah Furano Lumban Tobing, Aldi Nanda Kurniawan, Regan Elbert, Rivaldo Steven Heriyanto, Yang Yang Endro Arjuna
    Neurosurgical Review.2025;[Epub]     CrossRef
  • Predictive value of the VBQ score for internal fixation failure after PLIF and determinants of its cutoff value
    Jia-Yan Wu, Wen-Hao Hu, Zhi-Hao Ma, Ya-Wei Yao, Wen-Chao Wang, Ding-Fei Qian, Yi-Peng Cai, Fan-Qi Hu, Xue-Song Zhang
    Spine Research.2025; 1(3): 180.     CrossRef
  • 6,033 View
  • 160 Download
  • 12 Web of Science
  • 13 Crossref

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Prediction of Screw Loosening After Dynamic Pedicle Screw Fixation With Lumbar Polyetheretherketone Rods Using Magnetic Resonance Imaging-Based Vertebral Bone Quality Score
Neurospine. 2024;21(2):712-720.   Published online June 30, 2024
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Prediction of Screw Loosening After Dynamic Pedicle Screw Fixation With Lumbar Polyetheretherketone Rods Using Magnetic Resonance Imaging-Based Vertebral Bone Quality Score
Neurospine. 2024;21(2):712-720.   Published online June 30, 2024
Close
Objective
To investigate the correlation between magnetic resonance imaging-based vertebral bone quality (VBQ) score and screw loosening after dynamic pedicle screw fixation with polyetheretherketone (PEEK) rods, and evaluate its predictive value.
Methods
A retrospective analysis was conducted on the patients who underwent dynamic pedicle screw fixation with PEEK rods from March 2017 to June 2022. Data on age, sex, body mass index, hypertension, diabetes, hyperlipidemia history, long-term smoking, alcohol consumption, VBQ score, L1–4 average Hounsfield unit (HU) value, surgical fixation length, and the lowest instrumented vertebra were collected. Logistic regression analysis was employed to assess the relationship between VBQ score and pedicle screw loosening (PSL).
Results
A total of 24 patients experienced PSL after surgery (20.5%). PSL group and non-PSL group showed statistical differences in age, number of fixed segments, fixation to the sacrum, L1–4 average HU value, and VBQ score (p < 0.05). The VBQ score in the PSL group was higher than that in the non-PSL group (3.56 ± 0.45 vs. 2.77 ± 0.31, p < 0.001). In logistic regression analysis, VBQ score (odds ratio, 3.425; 95% confidence interval, 1.552–8.279) were identified as independent risk factors for screw loosening. The area under the receiver operating characteristic curve for VBQ score predicting PSL was 0.819 (p < 0.05), with the optimal threshold of 3.15 (sensitivity, 83.1%; specificity, 80.5%).
Conclusion
The VBQ score can independently predict postoperative screw loosening in patients undergoing lumbar dynamic pedicle screw fixation with PEEK rods, and its predictive value is comparable to HU value.

Citations

Citations to this article as recorded by  Crossref logo
  • Comparative effectiveness of Hounsfield unit, MRI-based bone quality, dual-energy X-ray absorptiometry T-score, and quantitative computed tomography-measured bone mineral density in predicting cage subsidence and screw loosening post-spinal surgery
    Jin Shang, Chuanbin Wang, Naiyu Li, Yaoyuan Wu, Yulan Chen, Zhongyuan Zhang, Jiangning Dong, Chao Wei, Luping Zhou, Wei Hong, Bingqian Chu
    International Journal of Surgery.2026; 112(2): 5014.     CrossRef
  • Evaluation of Screw Loosening in Patients Undergoing Semi-rigid Stabilization with Polyetheretherketone (PEEK) Rods
    Nimetullah Alper Durmus, Ali Sahin, Sukru Oral, Halil Ulutabanca, Ahmet Kucuk, Rahmi Kemal Koc
    Indian Journal of Orthopaedics.2026; 60(6): 1537.     CrossRef
  • Predictive Value of the Preoperative Screw Trajectory-to-Vertebral Body Hounsfield Unit Ratio and the Combined Model Incorporating MRI-Based Pedicle Bone Quality Score for Pedicle Screw Loosening After Pedicle Screw Fixation
    Jinhua Yang, Xincan Wu, Qiancheng Sun, Yunxin Su, Yuanzhen Zhang, Guoyong Yin, Jian Chen
    Global Spine Journal.2026; 16(7): 3354.     CrossRef
  • Mid-Term Outcomes of Screw Loosening in Lumbar Dynamic Stabilization with Polyetheretherketone Rods versus Titanium Rods: A Minimum 4-Year Follow-Up
    Guozheng Jiang, Jiawei Song, Luchun Xu, Jianbin Guan, Zeyu Li, Ningning Feng, Ziye Qiu, Yukun Ma, Yi Qu, Yang Xiong, Yongdong Yang, Xing Yu
    World Neurosurgery.2025; 196: 123630.     CrossRef
  • Biomechanical effects of screw loosening after lumbar PEEK rod and titanium rod fixation: a finite element analysis
    Guozheng Jiang, Shuyang Wang, Luchun Xu, Zeyu Li, Ningning Feng, Ziye Qiu, Yongdong Yang, Xing Yu
    Frontiers in Bioengineering and Biotechnology.2025;[Epub]     CrossRef
  • A PEEK-Based Pedicle Screw System for One-Level Lumbar Spinal Canal Stenosis: An Appraisal at a Five-Year Follow Up
    Andrei George Anghel, Jonas Garthmann, Baraa Alkahawagi
    Journal of Clinical Medicine.2025; 14(12): 4252.     CrossRef
  • Emerging MRI-based spine scoring techniques targeting bone quality to assess osteoporosis, vertebral fracture risk, other spinal degenerative diseases, and post-surgical outcomes
    Rahman Ud Din, Haisheng Yang
    La radiologia medica.2025; 130(9): 1442.     CrossRef
  • Biomechanical Impact of Cement Augmentation on Pedicle Screw Fixation and Adjacent Segment Disease in Multilevel Lumbar Fusion: A Finite Element Analysis
    Min-Young Jo, Sung-Jae Lee, Je-Hoon An, Young-Hoon Kim, Jun-Seok Lee, Hyung-Youl Park
    Neurospine.2025; 22(3): 763.     CrossRef
  • Risk factors for screw loosening following lumbar interbody fusion surgery in degenerative lumbar disease: a systematic review and meta-analysis
    Bryan Gervais de Liyis, Made Dwinanda Prabawa Mahardana, Tjokorda Istri Putri Mahadewi, Tjokorda Gde Bagus Mahadewa
    Asian Spine Journal.2025; 19(6): 1013.     CrossRef
  • Enhancing long-term fixation in thoracolumbar injuries: From screw design to bone quality optimization
    Musa Ergin, Süha A Aktaş
    World Journal of Orthopedics.2025;[Epub]     CrossRef
  • 8,907 View
  • 180 Download
  • 11 Web of Science
  • 10 Crossref

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Comparison of Cortical Bone Trajectory to Pedicle-Based Dynamic Stabilization: An Analysis of 291 Patients
Neurospine. 2023;20(1):308-316.   Published online March 31, 2023
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Comparison of Cortical Bone Trajectory to Pedicle-Based Dynamic Stabilization: An Analysis of 291 Patients
Neurospine. 2023;20(1):308-316.   Published online March 31, 2023
Close
Objective
Pedicle-based dynamic stabilization (DS) has gained popularity outside of America. Although pedicle screw (PS) loosening has always been a concern, it is reportedly innocuous. Cortical bone trajectory (CBT) screw is an emerging option with less invasiveness and similar effectiveness to PS in short-segment lumbar fusion. This study aimed to verify the use of CBT for DS by comparing the outcomes between pedicle- and CBT-based DS.
Methods
Consecutive patients with lumbar spondylosis or low-grade spondylolisthesis who underwent 1- or 2-level DS between L3–5 with a minimum follow-up of 24 months were reviewed. Screw loosening was determined by computed tomography and the incidences were compared.
Results
A total of 291 patients who underwent Dynesys DS (235 pedicle- and 56 CBT-based, respectively) were compared. The demographics and preoperative conditions were similar. All the clinical outcomes improved at 24-month postoperation, while the CBT-based group had less operation time and blood loss than the pedicle-based group. The rates of screw loosening were lower in the CBT-based (5.4% per screw and 12.5% per patient) than the pedicle-based group (9% per screw and 26.4% per patient). Furthermore, there were no differences in the clinical outcomes and complication profiles.
Conclusion
The CBT-based DS for 1- or 2-level lumbar degeneration demonstrated equivalent clinical improvement as the pedicle-based DS. The adaption of CBT-based screws for DS could be a less invasive approach (shorter operation time and less blood loss), with lower chances of screw loosening than the conventional PS-based DS.

Citations

Citations to this article as recorded by  Crossref logo
  • Comparative CT-Based Bone Density of Traditional Pedicle Screw Trajectory, Cortical Bone Trajectory, and Modified Cortical Bone Trajectory — Radiographic Analysis of 3500 Simulated Pedicle-Screw Trajectories in 1750 Lumbar Vertebrae
    Sathish Muthu, Kavya Priyadharshini Natarajan, Vibhu Krishnan Viswanathan, Dhibin Vikash Kolarpatti Ponnusamy, Sathish Kumar Rajappan Chandra, Khan Sharun
    Global Spine Journal.2026; 16(7): 3190.     CrossRef
  • The Effect of Osteopenia and Osteoporosis on Screw Loosening in MIS-TLIF and Dynamic Stabilization
    Hsuan-Kan Chang, Chih-Chang Chang, Yu-Wen Cheng, Ching-Lan Wu, Tsung-Hsi Tu, Jau-Ching Wu, Wen-Cheng Huang
    Global Spine Journal.2025; 15(4): 2209.     CrossRef
  • Comparative Analysis Between Cortical Bone Trajectory (CBT) Screw Fixation and Traditional Pedicle Screw Fixation in Lumbar Spine Surgery: A Systematic Review and Meta-Analysis
    Vivek Sanker, Amr Badary, Aliza Asad, Barabara Buccilli, Ahed H Kattaa, David J Park, Steven D. Chang, Atman Desai, Harminder Singh
    Cureus.2025;[Epub]     CrossRef
  • Robot-assisted cortical bone trajectory versus traditional pedicle screws in the treatment of lumbar spinal stenosis with osteoporosis: A retrospective cohort study
    Ruizhao Zhao, Yuyu Fan, Junjie Qiao, Lixiang Ding, Wei Qu, Xiutong Fang
    Asian Journal of Surgery.2025; 48(10): 6062.     CrossRef
  • Screening patients requiring secondary lumbar surgery for degenerative lumbar spine diseases: a nationwide sample cohort study
    Hangeul Park, Juhee Lee, Yunhee Choi, Jun-Hoe Kim, Sum Kim, Young-Rak Kim, Chang-Hyun Lee, Sung Bae Park, Kyoung-Tae Kim, John M. Rhee, Chi Heon Kim
    Scientific Reports.2024;[Epub]     CrossRef
  • Comparative Biomechanical Stability of the Fixation of Different Miniplates in Restorative Laminoplasty after Laminectomy: A Finite Element Study
    Guoyin Liu, Weiqian Huang, Nannan Leng, Peng He, Xin Li, Muliang Lin, Zhonghua Lian, Yong Wang, Jianmin Chen, Weihua Cai
    Bioengineering.2024; 11(5): 519.     CrossRef
  • Clinical study on freehand of bicortical sacral screw fixation with the assistance of torque measurement device
    Guozheng Jiang, Luchun Xu, Yukun Ma, Jianbin Guan, Ningning Feng, Ziye Qiu, Shibo Zhou, Wenhao Li, Yongdong Yang, Yi Qu, He Zhao, Zeyu Li, Xing Yu
    BMC Musculoskeletal Disorders.2024;[Epub]     CrossRef
  • Expert consensus on the clinical application of cortical bone trajectory for lumbar pedicle screws: results from a modified Delphi study
    Yiqi Zhang, Jingwei Liu, Honghao Yang, Qiang Wang, Yong Hai, Yuzeng Liu
    Asian Spine Journal.2024; 18(5): 690.     CrossRef
  • Diabetes‐related Screw Loosening: The Distinction of Surgical Sites and the Relationship among Diabetes, Implant Stabilization and Clinical Outcomes
    Tianji Wang, Jing Wang, Xiaofan Hu, Kaili Hao, Geng Xiang, Zixiang Wu, Zhensheng Ma, Tianqing Li, Yu Chen, Xiong Zhao, Yang Zhang, Tiancheng Ma, Jingjuan Ren, Wei Lei, Yafei Feng
    Orthopaedic Surgery.2023; 15(12): 3136.     CrossRef
  • 9,213 View
  • 217 Download
  • 8 Web of Science
  • 9 Crossref

Case Report

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Screw loosening and Migration after Dynesys Implantation
Korean J Spine. 2012;9(3):300-303.   Published online September 30, 2012
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Screw loosening and Migration after Dynesys Implantation
Korean J Spine. 2012;9(3):300-303.   Published online September 30, 2012
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Due to the problems associated with rigid fixation, the concept of dynamic stabilization was introduced. Dynesys is one of the pedicle screw-based dynamic stabilization systems. In spite of the dynamic nature of Dynesys, there are concerns about the rigidity of the Dynesys system. We present a case of vertebral body split fracture after Dynesys implantation in a 74-year-old woman. She had undergone L2-L5 laminectomy and Dynesys implantation for spinal stenosis 15 months ago. She was discharged with improvement in lower back pain and claudication. Follow-up X-ray images were taken at 1, 3 and 6 months and there was no evidence of screw migration. During the follow-up period, she received selective root block due to persistent leg pain. Eight months after the operation, she visited our hospital due to severe lower back pain. Magnetic resonance imaging showed the features of lumbar spondylitis from L2 to L5. Plain X-ray and computed tomography images showed the presence of a superiorly migrated screw at L5. The screws migrated superiorly into the intervertebral disc space creating a bony defect resembling a sagittal migrated fracture. The Dynesys system was removed and lumbar spondylitis was treated with antibiotics. The aim of the present case was to demonstrate the problems caused due to rigidity of the Dynesys system, when postoperative infection occurs after Dynesys implantation.

Citations

Citations to this article as recorded by  Crossref logo
  • Dynamic spine stabilization through mechanically tuned constructs and embedded biomechanical feedback systems: a narrative review
    Rahul Kumar, Andrew Bouras, Rohan Phadke, Samer Salman, Harlene Kaur, Kyle Sporn, Alejandro Damian, Phani Paladugu, Swapna Vaja, Alireza Tavakkoli, Nathan J. Lee
    Discover Sensors.2026;[Epub]     CrossRef
  • Unique and late onset infections after Dynamic Dynesys Stabilization in the lumbosacral spine
    Po-Hsin Lin, Ting-Wei Chang, Zhuo-Hao Liu, Nan-Yu Chen, Jyi-Feng Chen
    Medicine.2026; 105(34): e50352.     CrossRef
  • Efficacy of Antibiotic-Loaded Cement Augmentation for Correcting Low Grade Pedicle Screw Loosening
    Chi Ho Kim, Chang Il Ju, Sung Myung Lee, Seok Won Kim
    Korean Journal of Neurotrauma.2021; 17(1): 41.     CrossRef
  • Lateral Lumbar Interbody Fusion and in Situ Screw Fixation for Rostral Adjacent Segment Stenosis of the Lumbar Spine
    Young Hoon Choi, Shin Won Kwon, Jung Hyeon Moon, Chi Heon Kim, Chun Kee Chung, Sung Bae Park, Won Heo
    Journal of Korean Neurosurgical Society.2017; 60(6): 755.     CrossRef
  • Complications associated with the Dynesys dynamic stabilization system: a comprehensive review of the literature
    Martin H. Pham, Vivek A. Mehta, Neil N. Patel, Andre M. Jakoi, Patrick C. Hsieh, John C. Liu, Jeffrey C. Wang, Frank L. Acosta
    Neurosurgical Focus.2016; 40(1): E2.     CrossRef
  • 11,321 View
  • 75 Download
  • 5 Crossref