Evaluation of MRI-Based Region-specific Vertebral Bone Quality Score for Bone Mineral Density in Lumbar Fusion Surgery

Study DesignRetrospective study.ObjectivesTo compare region-specific VBQ scores and to evaluate their effectiveness in assessing bone quality in patients with lumbar degenerative diseases.MethodsThis study retrospectively included patients who underwent lumbar fusion surgery for lumbar degenerative diseases between April 2021 and January 2025. Region-specific VBQ scores (VBQ-anterior, VBQ-classic and VBQ-posterior), assessed using preoperative MRI. Hounsfield Unit (HU) values were also recorded. Receiver operating characteristic (ROC) curves were generated to assess the diagnostic accuracy. Pearson correlation analysis was performed to evaluate the associations between region-specific VBQ scores, HU values, and lumbar T-scores.ResultsA total of 329 eligible patients was included. VBQ-anterior demonstrated the highest scores, whereas VBQ-posterior exhibited significantly lower values. Furthermore, we evaluated the diagnostic accuracy of the three VBQ measurement approaches, as well as HU values, in identifying osteoporotic patients. The results revealed that HU values showed the highest area under the curve (AUC = 0.857), followed by VBQ-posterior (AUC = 0.825). In contrast, VBQ-anterior exhibited the lowest diagnostic accuracy (AUC = 0.735). Correlation analysis demonstrated that HU values had the strongest correlation with lumbar T-scores (r = 0.57, <i>P</i> < 0.001), followed by VBQ-posterior (r = 0.49, <i>P</i> < 0.001) and VBQ-classic (r = 0.37, <i>P</i> < 0.001). VBQ-anterior showed the weakest correlation with T-scores (r = 0.24, <i>P</i> < 0.001).ConclusionsVBQ scoring provides a simple and relatively accurate method for assessing bone quality in patients with lumbar degenerative diseases. However, region-specific variations exist and VBQ-posterior may demonstrate superior diagnostic accuracy.