Is vertebral bone quality an independent predictor of total blood loss in transforaminal lumbar interbody fusion?

doi:10.5312/wjo.v17.i5.116758

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. May 18, 2026; 17(5): 116758
Published online May 18, 2026. doi: 10.5312/wjo.v17.i5.116758

Table 1 Demographic information of all patients, mean ± SD

	Total	1 level	2 levels	≥ 3 levels	P value
n	247	172	60	15
Male/female	93/154	70/102	17/43	6/9	0.231
Age (year)	59.59 ± 9.09	59.58 ± 9.45	60.03 ± 8.75	57.93 ± 5.82	0.727
Hospital stays (day)	14.23 ± 3.81	14.07 ± 3.07	14.23 ± 4.45	16.13 ± 4.53	0.133
BMI (kg/m²)	25.85 ± 3.31	25.57 ± 3.14	26.61 ± 3.76	27.57 ± 2.86	0.049
Fixation segments	1.37 ± 0.62	1	2	3.13 ± 0.35
Hb (preoperative, g/L)	135.64 ± 14.93	136.39 ± 15.81	133.85 ± 11.91	134.13 ± 15.57	0.486
HCT (preoperative, %)	40.18 ± 3.85	40.34 ± 4.08	39.72 ± 3.08	40.10 ± 3.96	0.556
ESR (mm/hour)	14.27 ± 11.87	14.03 ± 10.69	15.02 ± 15.24	14.00 ± 9.79	0.855
PT (second)	11.34 ± 0.84	11.45 ± 0.89	11.12 ± 0.65	11.09 ± 0.69	0.014
APTT (second)	27.51 ± 4.30	26.99 ± 4.19	28.80 ± 4.17	28.29 ± 5.04	0.014
INR	0.98 ± 0.08	0.98 ± 0.08	0.97 ± 0.07	0.95 ± 0.53	0.352
TT (second)	16.84 ± 2.30	17.12 ± 2.29	16.19 ± 2.16	16.34 ± 2.42	0.017
FIB (g/L)	2.81 ± 0.70	2.78 ± 0.67	2.85 ± 0.77	3.01 ± 0.68	0.422
D-dimer (mg/L)	0.49 ± 0.83	0.53 ± 0.94	0.37 ± 0.33	0.58 ± 0.79	0.405
PLT (10⁹/L)	235.16 ± 59.11	232.73 ± 57.07	243.65 ± 67.26	229.00 ± 45.98	0.431
TBL (mL)	796.95 ± 569.94	761.26 ± 640.40	827.04 ± 323.71	1085.84 ± 384.73	0.095
VBQ (L1-4 median)	3.50 ± 0.70	3.58 ± 0.72	3.39 ± 0.67	3.15 ± 0.44	0.025
VBQ (L1-4 average)	3.49 ± 0.67	3.55 ± 0.69	3.40 ± 0.66	3.14 ± 0.41	0.039
VBQ (S1)	3.19 ± 0.72	3.21 ± 0.73	3.21 ± 0.71	2.87 ± 0.49	0.197
VBQ (fixation levels)	3.42 ± 0.71	3.46 ± 0.73	3.37 ± 0.69	3.08 ± 0.41	0.120

BMI: Body mass index; Hb: Hemoglobin; HCT: Hematocrit; ESR: Erythrocyte sedimentation rate; PT: Prothrombin time; APTT: Activated partial thromboplastin time; INR: International normalized ratio; TT: Thrombin time; FIB: Fibrinogen; PLT: Platelet count; TBL: Total blood loss; VBQ: Vertebral bone quality.

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Table 2 Correlations between total blood loss and all variables

	r	P value	95%CI
	r	P value	Lower limit	Upper limit
Gender	-0.061	0.340	-0.251	0.040
Age	-0.157	0.014	-0.256	-0.029
Hospital stays	0.171	0.007	0.097	0.272
BMI	0.066	0.302	-0.036	0.253
Fixation segments	0.235	< 0.001	0.113	0.355
Preoperative Hb	0.120	0.060	0.016	0.353
Preoperative HCT	0.118	0.064	0.017	0.340
ESR	-0.043	0.498	-0.175	0.051
PT	0.003	0.959	-0.177	0.107
INR	-0.073	0.251	-0.260	0.027
APTT	-0.132	0.038	-0.276	-0.057
TT	0.122	0.057	0.023	0.231
FIB	-0.094	0.143	-0.224	0.001
D-dimer	0.044	0.489	-0.067	0.228
PLT	0.025	0.700	-0.095	0.098
VBQ (L1-4 median)	-0.133	0.037	-0.216	-0.030
VBQ (L1-4 average)	-0.133	0.037	-0.227	-0.014
VBQ (S1)	-0.181	0.004	-0.279	-0.099
VBQ (fixation levels)	-0.158	0.013	-0.248	-0.050

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Table 3 Multiple linear regression analysis of total blood loss

	*Beta*	*Standardized beta*	t	P value	95%CI
	*Beta*	*Standardized beta*	t	P value	Lower limit	Upper limit
VBQ (S1)	-146.249	-0.181	-2.905	0.004	-245.433	-47.065
Hospital stays	24.938	0.166	2.662	0.008	6.484	43.392

F = 7.907, P < 0.001, R² = 0.061, VBQ: Vertebral bone quality; CI: Confidence interval.

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Table 4 Information on demographic characteristics of patients who had preoperative dual-energy X-ray absorptiometry scan, mean ± SD

	Subgroup	1 level	2 levels	≥ 3 levels	P value
n	71	42	24	5
Male/female	23/48	15/27	8/16	1/4	0.927
Age (year)	60.52 ± 8.46	61.40 ± 8.40	59.67 ± 8.62	57.20 ± 4.66	0.485
Hospital stays (day)	12.76 ± 3.32	12.50 ± 3.45	12.96 ± 2.77	14.00 ± 4.85	0.601
BMI (kg/m²)	26.06 ± 3.51	25.76 ± 3.06	26.43 ± 4.30	26.75 ± 3.39	0.687
Fixation segments	1.48 ± 0.63	1	2	3
Hb (preoperative, g/L)	132.30 ± 13.22	132.56 ± 15.67	132.13 ± 9.41	130.80 ± 5.45	0.959
HCT (preoperative, %)	39.56 ± 3.55	39.70 ± 4.26	39.45 ± 2.34	38.88 ± 1.48	0.874
ESR (mm/hour)	15.01 ± 10.38	16.24 ± 11.96	13.21 ± 7.67	13.40 ± 6.50	0.495
PT (second)	11.03 ± 0.65	11.05 ± 0.71	11.04 ± 0.59	10.86 ± 0.43	0.827
APTT (second)	31.68 ± 2.63	31.76 ± 2.78	31.30 ± 2.42	32.76 ± 2.33	0.506
INR	0.99 ± 0.06	1.00 ± 0.07	1.00 ± 0.07	0.97 ± 0.04	0.618
TT (second)	14.67 ± 1.00	14.57 ± 0.99	14.89 ± 0.88	14.48 ± 1.64	0.429
FIB (g/L)	3.11 ± 0.67	3.23 ± 0.72	2.88 ± 0.53	3.26 ± 0.69	0.113
D-dimer (mg/L)	0.32 ± 0.28	0.33 ± 0.31	0.31 ± 0.26	0.29 ± 0.17	0.938
PLT (10⁹/L)	225.43 ± 47.01	224.69 ± 43.79	229.29 ± 55.04	213.00 ± 36.27	0.775
T value	-1.19 ± 1.22	-1.34 ± 1.20	-0.99 ± 1.35	-0.86 ± 0.69	0.446
Minimal T value	-2.25 ± 1.30	-2.36 ± 1.29	-2.06 ± 1.43	-2.27 ± 0.68	0.676
TBL (mL)	667.78 ± 293.78	589.09 ± 276.05	780.95 ± 295.84	785.51 ± 25.55	0.023
VBQ (L1-4median)	3.50 ± 0.50	3.57 ± 0.43	3.40 ± 0.58	3.33 ± 0.52	0.278
VBQ (L1-4 average)	3.51 ± 0.50	3.59 ± 0.46	3.41 ± 0.57	3.28 ± 0.48	0.212
VBQ (S1)	3.37 ± 0.63	3.43 ± 0.63	3.28 ± 0.67	3.25 ± 0.52	0.585
VBQ (fixation levels)	3.52 ± 0.56	3.59 ± 0.52	3.44 ± 0.63	3.34 ± 0.54	0.431

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Table 5 Correlations between T score and vertebral bone quality score and blood loss

	T-total		T-lowest		TBL
	*Rho*	P value	*Rho*	P value	*Rho*	P value
VBQ (L1-4median)	-0.394	0.001	-0.331	0.005	-0.095	0.429
VBQ (L1-4 average)	-0.408	0.000	-0.334	0.004	-0.065	0.590
VBQ (S1)	-0.380	0.001	-0.342	0.004	-0.165	0.170
VBQ (fixation levels)	-0.419	0.000	-0.347	0.003	-0.090	0.455
TBL	0.190	0.113	0.165	0.168	-	-

VBQ: Vertebral bone quality; TBL: Total blood loss.

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Citation: 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
URL: https://www.wjgnet.com/2218-5836/full/v17/i5/116758.htm
DOI: https://dx.doi.org/10.5312/wjo.v17.i5.116758

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]

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