ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicNavigating Osteoporosis: Innovative Strategies for Treatment and PreventionView all articles
Synergistic Predictive Value of MRI-Based Vertebral Bone Quality and CT Hounsfield Units for Postoperative Sagittal Balance Deterioration After Cervical Laminoplasty
Provisionally accepted
- Peking University People's Hospital, Beijing, China
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Background: Sagittal balance deterioration is major concern after cervical laminoplasty, which affects neurological recovery and quality of life. Preoperative bone quality may play a key role. CT-derived Hounsfield Unit (HU) values reflect bone mineral density, while MRI-derived vertebral bone quality (VBQ) values indicate bone marrow fat content. Their combined predictive value remains unclear. Methods: This study retrospectively analyzes 104 patients (mean age 58.4 ± 11.6 years) who undergo posterior single-door laminoplasty with preoperative cervical CT and MRI. Mean HU and VBQ values (C2–T1) are measured, and patients are classified by postoperative change in cervical sagittal vertical axis (△cSVA). Logistic regression and ROC analyses are used to evaluate predictive performance. Results: HU and VBQ differ significantly among improvement, stable, and deterioration groups (P < 0.001). Both HU (-0.007, P = 0.009) and VBQ (2.521, P = 0.018) independently predict postoperative imbalance. VBQ correlates negatively with HU (r = −0.306, P = 0.0016). ROC analysis shows AUCs of 0.690 for HU, 0.747 for VBQ, and 0.791 for the combined VBQ+HU model, with improved sensitivity (0.838) and specificity (0.597). Conclusion: Decreased HU and elevated VBQ independently predict postoperative sagittal balance deterioration, reflecting complementary aspects of vertebral bone quality. The combined MRI-and CT-based assessment improves prediction accuracy and assists in preoperative risk stratification and individualized surgical planning.
Keywords: bone mineral density, Cervical laminoplasty, Hounsfield unit (HU), Sagittal balance deterioration, Vertebral bone quality (VBQ)
Received: 11 Oct 2025; Accepted: 03 Dec 2025.
Copyright: © 2025 Zheng, Yu, Zhu, Liang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Haiying Liu
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