Letter to editor regarding: "Vertebral bone quality score independently predicts cage subsidence following transforaminal lumbar interbody fusion" by Soliman et al.

In 2022, Soliman et al. [ [1] Soliman MAR Aguirre AO Kuo CC Ruggiero N Azmy S Khan A et al. Vertebral bone quality score independently predicts cage subsidence following transforaminal lumbar interbody fusion. Spine J. 2022; 22: 2017-2023https://doi.org/10.1016/j.spinee.2022.08.002 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar ] published an interesting retrospective study regarding the relationship between poor bone quality, measured by the vertebral bone quality (VBQ) score using magnetic resonance imaging (MRI), and the risk of cage subsidence in transforaminal lumbar interbody fusion (TLIF). The study is intriguing and well-structured, demonstrating how the VBQ score can independently predict postoperative cage subsidence in patients undergoing TLIF surgery with a simple and well-quantifiable tool. However, we realized that some variables in the study's conceptualization need to be considered in view of the limitations given by a retrospective collection with many missing data (importantly preoperative laboratory values such as parathyroid hormone and vitamin D 25(OH)D). We would like to know the views of the authors. Response to the letter to the editor regarding “Vertebral bone quality score independently predicts cage subsidence following transforaminal lumbar interbody fusion”The Spine JournalVol. 23Issue 8PreviewWe thank Armocida et al for their critical review and valuable comments on our study entitled, “Vertebral bone quality score independently predicts cage subsidence following transforaminal lumbar interbody fusion [1].” Concern was raised regarding variables missing from our multivariable analysis that can be confounding factors for cage subsidence; specifically, cage material (polyetheretherketone [PEEK] vs titanium), type (expandable versus static), location, and size; whether the surgery was minimally invasive or open; and preoperative laboratory values, such as parathyroid hormone and vitamin D levels. Full-Text PDF