Related Experiment Video
Updated: Jan 11, 2026
Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
Published on: July 25, 2025
MRI-based pedicle bone quality score predicts cage subsidence following oblique lumbar interbody fusion
Xiao Hu1, Xingxiao Pu2, Xiandi Wang2
1Frontiers Science Center for Disease-related Molecular Network, Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Sichuan, China.
Purpose:
To investigate the association between MRI-based pedicle bone quality (PBQ) score and cage subsidence in patients undergoing single-level OLIF, and to evaluate the diagnostic performance of PBQ as a preoperative predictor.
Methods:
This retrospective study analyzed data from patients who underwent single-level L4-L5 OLIF-AF between October 2017 and May 2023. PBQ scores were measured on preoperative T1-weighted sagittal MRI. Logistic regression analysis was used to identify independent risk factors, and receiver operating characteristic (ROC) curve analysis was performed to determine the predictive ability of PBQ.
Results:
Of the 73 patients, 23 (31.5%) developed cage subsidence. The PBQ score was significantly higher in the subsidence group than in the non-subsidence group (p < 0.001). Multivariable logistic regression confirmed PBQ as an independent risk factor for cage subsidence (OR = 3.321, 95% CI: 1.836-6.008, p < 0.001). ROC curve analysis demonstrated good diagnostic performance of PBQ, with an AUC of 0.844 (95% CI: 0.745-0.944) and an optimal cutoff value of 3.575 (sensitivity: 82.6%, specificity: 78.0%).
Conclusions:
Elevated MRI-based PBQ scores are significantly associated with an increased risk of cage subsidence following single-level OLIF. The PBQ score may serve as a reliable preoperative imaging parameter for guiding surgical planning.
Insights
High pedicle bone quality (PBQ) scores on MRI predict cage subsidence after oblique lateral interbody fusion (OLIF). This imaging metric can guide surgical planning to reduce subsidence risk.
Area of Science:
- Spine surgery
- Orthopedic imaging
- Biomechanical analysis
Background:
- Cage subsidence is a complication after oblique lateral interbody fusion (OLIF).
- Predictive markers for cage subsidence are crucial for surgical planning.
Purpose of the Study:
- To assess the association between MRI-based pedicle bone quality (PBQ) scores and cage subsidence in single-level OLIF.
- To evaluate PBQ's diagnostic performance as a preoperative predictor of cage subsidence.
Main Methods:
- Retrospective analysis of 73 patients undergoing single-level L4-L5 OLIF-AF.
- Measurement of preoperative T1-weighted sagittal MRI PBQ scores.
- Logistic regression and ROC curve analysis to identify risk factors and predictive ability.
Main Results:
- 23.5% of patients experienced cage subsidence.
- Higher PBQ scores were significantly associated with subsidence (p < 0.001).
- PBQ was an independent risk factor (OR = 3.321), with good diagnostic performance (AUC = 0.844).
Conclusions:
- Elevated MRI-based PBQ scores correlate with increased cage subsidence risk after single-level OLIF.
- PBQ is a reliable preoperative imaging parameter for surgical planning to mitigate subsidence.
