Preoperative cervical vertebral bone quality score as a predictor of adjacent segment degeneration after anterior cervical discectomy and fusion: a retrospective study

To evaluate the predictive efficacy of the preoperative Cervical Vertebral Bone Quality (C-VBQ) score for Adjacent Segment Degeneration (ASD) following Anterior Cervical Discectomy and Fusion (ACDF). This single-center retrospective study included patients with degenerative cervical spine disease who underwent ACDF (2019–2023). All patients had ≥24 months of clinical and radiological follow-up. Demographic, surgical, and radiological data were collected. Simple linear regression assessed correlations between baseline characteristics and C-VBQ score. C-VBQ score’s predictive performance was evaluated via ROC curve analysis; multivariate logistic regression identified independent risk factors for ASD. A total of 121 patients met the inclusion criteria (mean age: 53 ± 9 years; female proportion: 56.2%). Among these patients, 63 (52.1%) developed radiographic ASD, and 19 (15.7%) developed symptomatic ASD. A higher C-VBQ score was a significant predictor of radiographic ASD in univariate analysis (2.5 [2.2; 2.9] vs 1.2 [0.9; 1.7]; P <0.001) and multivariate analysis (odds ratio [OR]: 10.240, 95% confidence interval [CI]: 4.052–25.882; P <0.001). For symptomatic ASD, a significantly higher C-VBQ score was seen in univariate analysis (2.7 [2.6; 2.9] vs 2.0 [1.3; 2.7]; 95% CI: 1.354–6.067; P <0.001) and served as an independent risk factor in multivariate analysis (OR: 2.866, 95%CI: 1.354-6.607; P=0.006). Additionally, age correlated positively with cervical vertebral bone quality (C-VBQ) score (P=0.035). C-VBQ score effectively predicts ASD after ACDF, particularly radiographic ASD. Additionally, higher C-VBQ score is a significant independent risk factor for ASD.