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Published on: August 8, 2019
NLR and PLR as Adjunctive Markers of MRI-Derived Vertebral Bone Quality in a Preoperative Lumbar Cohort
Liang Ma1, Yuxiu Liu2, Yazhuo Qin1
1Department of Orthopedic, Baoding No. 1 Central Hospital, Baoding, Hebei, People's Republic of China.
Background:
MRI-derived vertebral bone quality (VBQ) rises with marrow fat and denotes poorer bone integrity. We examined whether simple inflammatory ratios-neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR)-relate to VBQ in degenerative lumbar disease.
Methods:
We retrospectively studied 200 patients aged ≥50 years who underwent surgery between January 2022 and January 2024. VBQ was calculated on mid-sagittal T1-weighted MRI using vertebral and cerebrospinal-fluid regions of interest. Associations were tested with Spearman correlations and multivariable linear regression adjusting for age, sex, smoking, diabetes, and body mass index (BMI).
Results:
Among 200 patients (mean age = 64.8 ± 8.7 years), those with higher VBQ values (indicating poorer bone quality) were older and had higher NLR and PLR (all p<0.001). VBQ showed significant positive correlations with age (ρ = 0.650), NLR (ρ = 0.534), and PLR (ρ = 0.452) (all p<0.001). In multivariable regression, age, NLR, and PLR remained independently associated with higher VBQ, whereas BMI, sex, smoking, and diabetes were not significant (adjusted R2=0.520; all VIF≤2.26). Standardized effect sizes indicated moderate independent contributions (β_std = 0.151 for NLR; β_std = 0.303 for PLR), corresponding to roughly 0.020-unit and 0.075-unit increases in VBQ per 1-unit NLR and 50-unit PLR increments, respectively.
Conclusion:
Preoperative NLR and PLR were independently associated with higher MRI-derived VBQ and may aid imaging-based risk stratification; prospective validation with calibrated thresholds is needed.
Insights
Simple inflammatory ratios, neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR), correlate with poorer bone quality in degenerative lumbar disease. Higher NLR and PLR indicate increased vertebral bone quality (VBQ) values, suggesting potential for imaging-based risk stratification.
Area of Science:
- Orthopedics
- Radiology
- Inflammation Research
Background:
- Vertebral bone quality (VBQ), assessed via MRI, is linked to bone integrity and marrow fat content.
- Degenerative lumbar disease presents a relevant clinical context for evaluating bone quality.
- Inflammatory markers, specifically neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), are simple blood test indicators.
Purpose of the Study:
- To investigate the association between preoperative inflammatory ratios (NLR and PLR) and MRI-derived VBQ in patients with degenerative lumbar disease.
- To determine if NLR and PLR can serve as predictors of bone quality in this patient cohort.
- To explore the potential of these inflammatory markers for imaging-based risk stratification.
Main Methods:
- Retrospective study of 200 patients (age ≥50) who underwent surgery for degenerative lumbar disease.
- VBQ calculated from mid-sagittal T1-weighted MRI using vertebral and cerebrospinal-fluid regions of interest.
- Statistical analysis included Spearman correlations and multivariable linear regression, adjusting for age, sex, smoking, diabetes, and BMI.
Main Results:
- Higher VBQ values, indicative of poorer bone quality, were significantly associated with older age, higher NLR, and higher PLR (all p<0.001).
- VBQ demonstrated significant positive correlations with age (ρ=0.650), NLR (ρ=0.534), and PLR (ρ=0.452).
- Multivariable regression confirmed age, NLR, and PLR as independent predictors of higher VBQ, with moderate effect sizes for NLR and PLR.
Conclusions:
- Preoperative NLR and PLR are independently associated with higher MRI-derived VBQ in degenerative lumbar disease.
- These inflammatory ratios may contribute to imaging-based risk stratification for bone quality.
- Prospective validation studies with calibrated thresholds are recommended to confirm these findings.
