Establishing and Validating Cervical and Lumbar Vertebral Bone Quality Thresholds for Predicting Mechanical Complications in Patients Undergoing Spinal Fusion: A Systematic Review and Meta-Analysis

Study DesignSystematic review and meta-analysis.ObjectiveTo establish and validate region-specific MRI-derived vertebral bone quality (VBQ) thresholds predictive of mechanical complications following cervical and lumbar spinal fusion.MethodsPubMed, EMBASE, MEDLINE, and the Cochrane Library were searched to September 2025 for observational studies reporting VBQ in patients with and without postoperative mechanical complications. Data were pooled using random-effects models with Hartung-Knapp adjustment. Diagnostic accuracy was evaluated using a bivariate random-effects meta-analysis to estimate pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC).ResultsTwenty-four studies comprising 3122 patients were included. Patients who developed complications had significantly higher VBQ scores (SMD = 1.13, 95% CI 0.91-1.35). Pooled diagnostic performance demonstrated strong discrimination (sensitivity = 0.79, specificity = 0.79, DOR = 14.6, AUC = 0.83). Accuracy was higher in cervical than lumbar cohorts (AUC = 0.89 vs 0.83). Region-specific thresholds of 2.75 for cervical and 3.22 for lumbar fusion optimally balanced sensitivity and specificity. Validation analyses confirmed progressively increasing complication risk above these cut-offs.ConclusionsMRI-derived VBQ scores provide reliable, radiation-free predictors of mechanical complications after spinal fusion. Region-specific thresholds (2.75 cervical, 3.22 lumbar) offer clinically applicable tools for preoperative risk stratification and bone health optimisation.