Wang JM, Zhu TT, Wang L, Xu XD, Huang WM. Is vertebral bone quality an independent predictor of total blood loss in transforaminal lumbar interbody fusion? World J Orthop 2026; 17(5): 116758 [DOI: 10.5312/wjo.v17.i5.116758]
Corresponding Author of This Article
Wei-Min Huang, MD, PhD, Professor, Department of Orthopedics, The 960th Hospital of PLA, No. 25 Shifan Road, Jinan 250031, Shandong Province, China. ever_23@163.com
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Retrospective Study
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Wang JM, Zhu TT, Wang L, Xu XD, Huang WM. Is vertebral bone quality an independent predictor of total blood loss in transforaminal lumbar interbody fusion? World J Orthop 2026; 17(5): 116758 [DOI: 10.5312/wjo.v17.i5.116758]
World J Orthop. May 18, 2026; 17(5): 116758 Published online May 18, 2026. doi: 10.5312/wjo.v17.i5.116758
Is vertebral bone quality an independent predictor of total blood loss in transforaminal lumbar interbody fusion?
Jing-Ming Wang, Tian-Tian Zhu, Lei Wang, Xiao-Duo Xu, Wei-Min Huang
Jing-Ming Wang, Lei Wang, Xiao-Duo Xu, Wei-Min Huang, Department of Orthopedics, The 960th Hospital of PLA, Jinan 250031, Shandong Province, China
Tian-Tian Zhu, Quality Management Section, The 960th Hospital of PLA, Jinan 250031, Shandong Province, China
Co-first authors: Jing-Ming Wang and Tian-Tian Zhu.
Author contributions: Wang JM and Huang WM designed the research study; Wang JM, Zhu TT, Wang L and Xu XD performed the research; Wang JM and Zhu TT contributed new reagents and analytic tools, analyzed the data and wrote the manuscript, and they contributed equally to this manuscript as co-first authors. All authors have read and approve the final manuscript.
Institutional review board statement: This study was approved by the local Human Ethics Committee of 960th Hospital of PLA (approval No. 2025KYLL189) and was conducted in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data analyzed during this study are included in the manuscript. Raw data has been uploaded with the article.
Corresponding author: Wei-Min Huang, MD, PhD, Professor, Department of Orthopedics, The 960th Hospital of PLA, No. 25 Shifan Road, Jinan 250031, Shandong Province, China. ever_23@163.com
Received: November 21, 2025 Revised: December 15, 2025 Accepted: January 28, 2026 Published online: May 18, 2026 Processing time: 179 Days and 0.5 Hours
Abstract
BACKGROUND
Few studies have analyzed the correlation between magnetic resonance imaging-based vertebral bone quality (VBQ) and blood loss in transforaminal lumbar interbody fusion (TLIF).
AIM
To determine the effect of bone mineral density, as assessed by preoperative VBQ on intraoperative total blood loss (TBL) following TLIF under real world conditions.
METHODS
We retrospectively analyzed patients who received TLIF for lumbar degenerative diseases at our hospital from January 2023 to April 2024. The preoperative VBQ score and T-score were recorded, and data regarding surgical procedures and blood loss were collected. TBL during postoperative the first three days was the primary indicator, and secondary indicators included length of hospitalization, hematocrit and hemoglobin, VBQ score, and T-score.
RESULTS
A total of 247 patients (93 males and 154 females) were enrolled in this study, with a mean age of 59.59 ± 9.09 years. VBQ were measured in all patients’ preoperative lumbar magnetic resonance imaging scans. The value for VBQ (L1-4 median), VBQ (L1-4 average), VBQ (S1) and VBQ (fixation segments) was 3.50 ± 0.70, 3.49 ± 0.67, 3.19 ± 0.72, 3.42 ± 0.71, respectively. Among them, 71 patients had preoperative dual-energy X-ray absorptiometry scan. The average lowest T-score was -2.25 ± 1.29. The T-score was significantly correlated with the VBQ score (r = -0.331 to -0.419). The mean TBL over the first three postoperative days was 796.95 ± 569.94 mL. Controlling for age, number of fixed segments, preoperative platelet count, and coagulation testing, VBQ (S1) was correlated with perioperative TBL in TLIF.
CONCLUSION
Preoperative VBQ (S1) score may be correlated with TBL in TLIF. In multi-segment TLIF cases, greater TBL was associated with considerable perioperative hemorrhage, potentially leading to longer hospital stays.
Core Tip: The current study found preoperative magnetic resonance imaging-based vertebral bone quality (VBQ) score, particularly VBQ (S1), is independently correlated with total blood loss in patients undergoing transforaminal lumbar interbody fusion (TLIF). In multi-segment TLIF cases, greater blood loss is associated with increased perioperative hemorrhage and may lead to prolonged hospital stays. These findings suggest that VBQ assessment could serve as a useful preoperative tool for predicting bleeding risk and optimizing perioperative management in TLIF patients.
