Work

NLR and PLR as Adjunctive Markers of MRI-Derived Vertebral Bone Quality in a Preoperative Lumbar Cohort

Year: 2025

Type: article

Abstract: Background: MRI-derived vertebral bone quality (VBQ) rises with marrow fat and denotes poorer bone integrity. We examined whether simple inflammatory ratios—neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR)—relate to VBQ in degenerative lumbar disease. Methods: We retrospectively studied 200 patients aged ≥ 50 years who underwent surgery between January 2022 and January 2024. VBQ was calculated on mid-sagittal T1-weighted MRI using vertebral and cerebrospinal-fluid regions of interest. Associations were tested with Spearman correlations and multivariable linear regression adjusting for age, sex, smoking, diabetes, and body mass index (BMI). Results: Among 200 patients (mean age = 64.8 ± 8.7 years), those with higher VBQ values (indicating poorer bone quality) were older and had higher NLR and PLR (all p< 0.001). VBQ showed significant positive correlations with age ( ρ = 0.650), NLR ( ρ = 0.534), and PLR ( ρ = 0.452) (all p< 0.001). In multivariable regression, age, NLR, and PLR remained independently associated with higher VBQ, whereas BMI, sex, smoking, and diabetes were not significant (adjusted R 2 =0.520; all VIF≤ 2.26). Standardized effect sizes indicated moderate independent contributions (β_std = 0.151 for NLR; β_std = 0.303 for PLR), corresponding to roughly 0.020-unit and 0.075-unit increases in VBQ per 1-unit NLR and 50-unit PLR increments, respectively. Conclusion: Preoperative NLR and PLR were independently associated with higher MRI-derived VBQ and may aid imaging-based risk stratification; prospective validation with calibrated thresholds is needed. Keywords: vertebral bone quality, neutrophil-to-lymphocyte, platelet-to-lymphocyte, osteoporosis

Source: Therapeutics and Clinical Risk Management

DOI: 10.2147/tcrm.s552982