{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T22:58:36Z","timestamp":1781218716781,"version":"3.54.1"},"reference-count":41,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg A Cent Eur Neurosurg"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Conventional radiographs and bone mineral density are commonly used to predict cage subsidence, though their accuracy can be limited by several factors. Magnetic resonance imaging (MRI)-based measurement of vertebral bone quality (VBQ) and endplate bone quality (EBQ) offer a more detailed assessment of bone quality and subsidence risk. This study aims to evaluate the accuracy of MRI-based VBQ and EBQ in predicting cage subsidence in anterior cervical spine surgery patients.<\/jats:p>\n                  <jats:p>A comprehensive search was conducted across databases including PubMed, Europe PMC, ScienceDirect, and Google Scholar using keywords such as \u201cMagnetic Resonance Imaging,\u201d \u201cMRI,\u201d \u201cVertebral Bone Quality,\u201d \u201cEndplate Bone Quality,\u201d \u201cCage Subsidence,\u201d \u201cAnterior Cervical Spine Surgery,\u201d \u201cACDF,\u201d \u201cACCF,\u201d combined with Boolean operators \u201cAND\u201d and \u201cOR\u201d up to November 2024. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), with the primary outcome focusing on VBQ and EBQ values, and secondary outcomes examining the area under the curve (AUC), sensitivity, and specificity of VBQ and EBQ.<\/jats:p>\n                  <jats:p>Nine retrospective cohort studies involving 911 patients were included. Pooled analysis showed that high VBQ and EBQ scores were significantly associated with increased subsidence risk (odds ratio [OR]: 2.63, 95% confidence interval [CI]: 1.51\u20134.60, p\u2009=\u20090.0007). Pooled sensitivity and specificity for VBQ were 78.9% (95% CI: 72.5\u201385.3%) and 85.7% (95% CI: 82.2\u201393.1%), respectively, with an AUC of 0.865. EBQ demonstrated pooled sensitivity of 81.8% and specificity of 88.7%, with an AUC of 0.890. The cutoff values for VBQ and EBQ ranged from 2.68 to 3.445 and 1.973 to 4.7, respectively.<\/jats:p>\n                  <jats:p>MRI-based VBQ and EBQ scores demonstrate strong diagnostic accuracy for predicting cage subsidence in anterior cervical spine surgery. These scores could aid in preoperative risk assessment, though further research should aim to standardize MRI protocols and validate cutoff values across diverse populations.<\/jats:p>","DOI":"10.1055\/a-2793-1168","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:11:31Z","timestamp":1769040691000},"page":"273-286","source":"Crossref","is-referenced-by-count":0,"title":["Accuracy of Magnetic Resonance Imaging-Based Vertebral and Endplate Bone Quality in Predicting Cage Subsidence in Anterior Cervical Spine Surgery: A Systematic Review and Meta-Analysis"],"prefix":"10.1055","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9284-7732","authenticated-orcid":false,"given":"Alexander Erick","family":"Purnomo","sequence":"additional","affiliation":[{"name":"Departement of Medicine, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, Banten, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldi Nanda","family":"Kurniawan","sequence":"additional","affiliation":[{"name":"Departement of Medicine, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, Banten, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang Yang Endro","family":"Arjuna","sequence":"additional","affiliation":[{"name":"Departement of Medicine, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, Banten, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jephtah Furano Lumban","family":"Tobing","sequence":"additional","affiliation":[{"name":"Departement of Orthopaedics and Traumatology, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, Banten, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendra","family":"Tjong","sequence":"additional","affiliation":[{"name":"Departement of Orthopaedics and Traumatology, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, Banten, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"issue":"04","key":"ref1","first-page":"e7643","article-title":"Anterior cervical discectomy and fusion complications and thirty-day mortality and morbidity","volume":"12","author":"S Al Eissa","year":"2020","journal-title":"Cureus"},{"issue":"09","key":"ref2","doi-asserted-by":"crossref","first-page":"3167","DOI":"10.1007\/s00586-023-07854-7","article-title":"MRI-based vertebral bone quality score for predicting cage subsidence by assessing bone mineral density following transforaminal lumbar interbody fusion: a retrospective analysis","volume":"32","author":"Y Ai","year":"2023","journal-title":"Eur Spine J"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.14444\/8363","article-title":"Subsidence of spinal fusion cages: a systematic review","volume":"16","author":"A Parisien","year":"2022","journal-title":"Int J Spine Surg"},{"issue":"12","key":"ref4","doi-asserted-by":"crossref","first-page":"8637","DOI":"10.1007\/s00330-023-09929-x","article-title":"Comparison of predictive performance for cage subsidence between CT-based Hounsfield units and MRI-based vertebral bone quality score following oblique lumbar interbody fusion","volume":"33","author":"X Pu","year":"2023","journal-title":"Eur Radiol"},{"issue":"07","key":"ref5","doi-asserted-by":"crossref","first-page":"1703","DOI":"10.1177\/21925682211046897","article-title":"Titanium cervical cage subsidence: postoperative computed tomography analysis defining incidence and associated risk factors","volume":"13","author":"Z W Pinter","year":"2023","journal-title":"Global Spine J"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"e264579","DOI":"10.1590\/s1808-185120222103264579","article-title":"Hounsfield units use in spinal surgery planning: systematic review and meta-analysis","volume":"21","author":"P L Baz\u00e1n","year":"2022","journal-title":"Coluna\/Columna"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1186\/s13018-022-03239-6","article-title":"Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion","volume":"17","author":"Z Wang","year":"2022","journal-title":"J Orthop Surg Res"},{"issue":"12","key":"ref8","doi-asserted-by":"crossref","first-page":"3034","DOI":"10.1007\/s00586-018-5792-9","article-title":"Hounsfield units as predictor for cage subsidence and loss of reduction: following posterior-anterior stabilization in thoracolumbar spine fractures","volume":"27","author":"B W Ullrich","year":"2018","journal-title":"Eur Spine J"},{"issue":"10","key":"ref9","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.3390\/diagnostics13101751","article-title":"Diagnostic accuracy of dual-energy CT material decomposition technique for assessing bone status compared with quantitative computed tomography","volume":"13","author":"X Wang","year":"2023","journal-title":"Diagnostics (Basel)"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"499","DOI":"10.3171\/2019.9.SPINE19954","article-title":"A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis","volume":"32","author":"J Ehresman","year":"2019","journal-title":"J Neurosurg Spine"},{"issue":"10","key":"ref11","doi-asserted-by":"crossref","first-page":"7561","DOI":"10.21037\/qims-24-532","article-title":"Diagnostic value of a magnetic resonance imaging (MRI)-based vertebral bone quality score for bone mineral density assessment: an updated systematic review and meta-analysis","volume":"14","author":"D Yang","year":"2024","journal-title":"Quant Imaging Med Surg"},{"issue":"08","key":"ref13","doi-asserted-by":"crossref","first-page":"529","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies","volume":"155","author":"P F Whiting","year":"2011","journal-title":"Ann Intern Med"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/jebm.12018","article-title":"Understanding GRADE: an introduction","volume":"6","author":"G Goldet","year":"2013","journal-title":"J Evid Based Med"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1186\/s12891-024-07791-6","article-title":"A novel cervical vertebral bone quality score can independently predict cage subsidence after anterior cervical corpectomy and fusion","volume":"25","author":"J Li","year":"2024","journal-title":"BMC Musculoskelet Disord"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1111\/os.13931","article-title":"The association between high preoperative MRI-based vertebral bone quality (VBQ) score and titanium mesh cage subsidence after anterior cervical corpectomy and fusion","volume":"16","author":"Q Li","year":"2023","journal-title":"Orthop Surg"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1007\/s00586-024-08250-5","article-title":"A novel MRI-based cervical-endplate bone quality score independently predicts cage subsidence after anterior cervical discectomy and fusion","volume":"33","author":"J Li","year":"2024","journal-title":"Eur Spine J"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1177\/21925682241280258","article-title":"Cervical vertebra bone quality score predicts zero-profile anchored spacer interbody fusion cage subsidence after anterior cervical diskectomy and fusion: a retrospective study","volume":"15","author":"N Feng","year":"2025","journal-title":"Global Spine J"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1007\/s00586-024-08511-3","article-title":"MRI-based endplate bone quality score independently predicts cage subsidence after anterior cervical corpectomy fusion","volume":"34","author":"S Zheng","year":"2025","journal-title":"Eur Spine J"},{"issue":"04","key":"ref20","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1097\/BSD.0000000000001623","article-title":"MRI vertebral bone quality correlates with interbody cage subsidence after anterior cervical discectomy and fusion","volume":"37","author":"J T Bernatz","year":"2024","journal-title":"Clin Spine Surg"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1186\/s13018-024-04716-w","article-title":"Preoperative MRI-based endplate quality: a novel tool for predicting cage subsidence after anterior cervical spine surgery","volume":"19","author":"Y Tuo","year":"2024","journal-title":"J Orthop Surg Res"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"e377","DOI":"10.1016\/j.wneu.2023.11.111","article-title":"Cervical vertebral bone quality score independently predicts zero-profile cage subsidence after single-level anterior cervical discectomy and fusion","volume":"182","author":"Z Wang","year":"2024","journal-title":"World Neurosurg"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1227\/neu.0000000000002269","article-title":"A novel cervical vertebral bone quality score independently predicts cage subsidence after anterior cervical diskectomy and fusion","volume":"92","author":"M AR Soliman","year":"2023","journal-title":"Neurosurgery"},{"issue":"10","key":"ref24","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1016\/j.spinee.2021.02.021","article-title":"Endplate volumetric bone mineral density is a predictor for cage subsidence following lateral lumbar interbody fusion: a risk factor analysis","volume":"21","author":"C Jones","year":"2021","journal-title":"Spine J"},{"issue":"03","key":"ref25","doi-asserted-by":"crossref","first-page":"913","DOI":"10.14245\/ns.2448496.248","article-title":"Magnetic resonance imaging-based vertebral bone quality score for prediction of cage subsidence and screw loosening in patients undergoing degenerative lumbar surgery: a meta-analysis","volume":"21","author":"F Hu","year":"2024","journal-title":"Neurospine"},{"issue":"11","key":"ref26","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1007\/s00198-024-07190-6","article-title":"The diagnostic value of MRI-based vertebral bone quality score for osteoporosis or osteopenia in patients undergoing lumbar surgery: a meta-analysis","volume":"35","author":"F Hu","year":"2024","journal-title":"Osteoporos Int"},{"issue":"01","key":"ref27","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/s13244-023-01603-6","article-title":"MRI-based synthetic CT for assessment of the bony elements of the sacroiliac joints in children","volume":"15","author":"E Schiettecatte","year":"2024","journal-title":"Insights Imaging"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1177\/02841851231169173","article-title":"Clinical feasibility of MRI-based synthetic CT imaging in the diagnosis of lumbar disc herniation: a comparative study","volume":"65","author":"G Cao","year":"2024","journal-title":"Acta Radiol"},{"issue":"06","key":"ref29","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1136\/ard-2023-225444","article-title":"MRI-based synthetic CT: a new method for structural damage assessment in the spine in patients with axial spondyloarthritis\u2014a comparison with low-dose CT and radiography","volume":"83","author":"S T Willesen","year":"2024","journal-title":"Ann Rheum Dis"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"20548","DOI":"10.1038\/s41598-025-05399-x","article-title":"Evaluation of MRI-based synthetic CT for lumbar degenerative disease: a comparison with CT","volume":"15","author":"Z Jiang","year":"2025","journal-title":"Sci Rep"},{"issue":"04","key":"ref31","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1177\/21925682221138261","article-title":"Preoperative assessment of bone density using MRI-based vertebral bone quality score modified for patients undergoing cervical spine surgery","volume":"14","author":"W Huang","year":"2024","journal-title":"Global Spine J"},{"issue":"01","key":"ref32","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.spinee.2020.05.540","article-title":"Vertebral bone quality score predicts fragility fractures independently of bone mineral density","volume":"21","author":"J Ehresman","year":"2021","journal-title":"Spine J"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"e760","DOI":"10.1016\/j.wneu.2022.12.098","article-title":"Prediction of pedicle screw loosening using an MRI-based vertebral bone quality score in patients with lumbar degenerative disease","volume":"171","author":"Z Chen","year":"2023","journal-title":"World Neurosurg"},{"issue":"08","key":"ref34","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1016\/j.spinee.2022.03.006","article-title":"Preoperative MRI-based vertebral bone quality (VBQ) score assessment in patients undergoing lumbar spinal fusion","volume":"22","author":"S N Salzmann","year":"2022","journal-title":"Spine J"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1177\/2192568221992098","article-title":"The influence of endplate morphology on cage subsidence in patients with stand-alone oblique lateral lumbar interbody fusion (OLIF)","volume":"13","author":"Z Hu","year":"2023","journal-title":"Global Spine J"},{"issue":"01","key":"ref36","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.spinee.2006.02.029","article-title":"Correlation of end plate shape on MRI and disc degeneration in surgically treated patients with degenerative disc disease and herniated nucleus pulposus","volume":"7","author":"I P Pappou","year":"2007","journal-title":"Spine J"},{"issue":"11","key":"ref37","doi-asserted-by":"crossref","first-page":"1875","DOI":"10.1016\/j.spinee.2022.07.085","article-title":"The predictive value of a novel site-specific MRI-based bone quality assessment, endplate bone quality (EBQ), for severe cage subsidence among patients undergoing standalone lateral lumbar interbody fusion","volume":"22","author":"C Jones","year":"2022","journal-title":"Spine J"},{"issue":"05","key":"ref38","doi-asserted-by":"crossref","first-page":"654","DOI":"10.3171\/2022.3.SPINE211489","article-title":"Novel MRI-based vertebral bone quality score as a predictor of cage subsidence following transforaminal lumbar interbody fusion","volume":"37","author":"Y H Hu","year":"2022","journal-title":"J Neurosurg Spine"},{"issue":"01","key":"ref39","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1186\/s13018-023-03729-1","article-title":"Vertebral bone quality score to predict cage subsidence following oblique lumbar interbody fusion","volume":"18","author":"Y Huang","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.1016\/j.wneu.2021.10.084","article-title":"Comparison of outcomes between cage materials used for patients undergoing anterior cervical discectomy and fusion with standalone cages: a systematic review and meta-analysis","volume":"158","author":"C Onyedimma","year":"2022","journal-title":"World Neurosurg"},{"issue":"01","key":"ref41","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1186\/1471-2474-13-172","article-title":"Anterior cervical discectomy and fusion: comparison of titanium and polyetheretherketone cages","volume":"13","author":"M Cabraja","year":"2012","journal-title":"BMC Musculoskelet Disord"},{"issue":"05","key":"ref42","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1007\/s00586-009-0897-9","article-title":"Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up","volume":"18","author":"J S Uribe","year":"2009","journal-title":"Eur Spine J"}],"container-title":["Journal of Neurological Surgery Part A: Central European Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2793-1168.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T22:38:00Z","timestamp":1781217480000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2793-1168"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,21]]},"references-count":41,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2026,6,11]]},"published-print":{"date-parts":[[2026,7]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2793-1168","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2193-6315","2193-6323"],"issn-type":[{"value":"2193-6315","type":"print"},{"value":"2193-6323","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1,21]]},"published":{"date-parts":[[2026,1,21]]}}}