Incidence, Risk, and Outcome of Pedicle Screw Loosening in Degenerative Lumbar Scoliosis Patients Undergoing Long-Segment Fusion

Global Spine Journal - Tập 13 Số 4 - Trang 1064-1071 - 2023
Yuan Lei1,2,3, Xinling Zhang1,2,3, Yan Zeng1,2,3, Zhongqiang Chen1,2,3, Weishi Li1,2,3
1Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
2Department of Orthopedics, Peking University Third Hospital, Beijing, China
3Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China

Tóm tắt

Study Design: Retrospective study. Objective: To investigate the incidence, risk factors, and outcomes of pedicle screw loosening in degenerative lumbar scoliosis (DLS) undergoing long-segment spinal fusion surgery. Methods: One hundred and thirty DLS patients who underwent long-segment fusion surgery with at least a 12-month follow-up were studied. The incidence and risk factors of screw loosening were investigated. VAS, SRS-22, and ODI scores were obtained preoperatively and at follow-up. Results: One hundred and sixty-eight of 1784 (9.4%) screws showed evidence of loosening in 71 (54.6%) patients. Three patients required revision surgery. Screw loosening rates according to vertebral insertion level were lowest instrumented vertebra (LIV): 45.4%; uppermost instrumented vertebra (UIV):17.7%; one vertebra above the LIV: 0.5%; 2 vertebrae above the LIV: 0.4%. Multiple logistic regression analysis of possible risk factors indicated that preoperative lateral subluxation ≥8 mm (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 1.16-6.20), osteopenia (OR: 5.52, 95% CI: 1.64-18.56), osteoporosis (OR: 8.19, 95% CI: 2.40-27.97), fusion to sacrum (OR: 2.55, 95% CI: 1.12-5.83), postoperative TLK greater than 10° (OR: 2.63, 95% CI: 1.14-6.04) and SVA imbalance (OR: 3.44, 95% CI: 1.17-10.14) were statistically significant. No difference was noted in preoperative, follow-up, and change of VAS, ODI, and SRS-22 scores. Conclusions: Screw loosening in DLS underwent long-segment surgery is common and tends to occur in the LIV or UIV. Lateral subluxation ≥8 mm, osteopenia, osteoporosis, fusion to the sacrum, postoperative TLK greater than 10°, and SVA imbalance were the independent influencing factors. Screw loosening can be asymptomatic, while longer-term follow-up is required.

Từ khóa


Tài liệu tham khảo

10.1097/BRS.0000000000001392

10.2106/JBJS.RVW.N.00061

10.1007/s00586-013-2678-8

10.1093/neuros/nyw094

10.1007/s00586-015-3768-6

10.1007/s00068-013-0310-6

10.3171/2011.7.FOCUS11125

10.3340/jkns.2015.58.4.357

10.1177/2192568218772302

10.3340/jkns.2017.0216

10.1007/s00586-017-5091-x

10.1155/2015/152435

10.1097/BRS.0000000000002047

10.1097/BRS.0000000000003284

10.1097/BRS.0b013e31816b1eff

10.1097/BRS.0b013e31828826dd

Zou D, 2020, J Neurosurg Spine, 1

10.1227/NEU.0000000000000182o

10.1097/BRS.0000000000003713

10.1007/s00586-016-4619-9

10.1016/j.jos.2018.04.006

10.1097/BRS.0000000000002310

10.1016/j.jspd.2017.05.006

10.1016/j.spinee.2018.07.005

10.1016/j.spinee.2014.08.055

10.1016/j.spinee.2007.11.006

10.1007/BF01676569

10.1302/0301-620X.92B8.24237

10.1097/BRS.0000000000002305

10.1097/BSD.0000000000000703

10.1007/s00586-014-3165-6

10.1097/BRS.0b013e3181fb73ea

10.1177/2192568217699192

10.1007/s00586-020-06366-y

10.1007/s00586-013-3030-z

10.1097/00007632-199712150-00003

Thông tin
Thông tin xuất bản

Global Spine Journal

Tập 13 Số 4

1064-1071

Thông tin tác giả