Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China.
Department of Imaging, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Eur Radiol. 2023 Mar;33(3):1526-1536. doi: 10.1007/s00330-022-09157-9. Epub 2022 Oct 14.
Screw loosening is a widely reported issue after spinal screw fixation and triggers several complications after lumbar interbody fusion. Osteoporosis is an essential risk factor for screw loosening. Hounsfield units (HU) value is a credible indicator during bone mineral density (BMD) evaluation. As compared with the general evaluation of BMD, we hypothesized that specific measurements of HU at the precise location of the future screw insertion may be a better predictor of screw loosening.
Clinical data of 56 patients treated by oblique lumbar interbody fusion (OLIF) of the L4-L5 segments with an anterior lateral single rod (ALSR) screw fixation were reviewed in this study. Vertebral bodies with ≥ 1 mm width radiolucent zones around the screw were defined as screw loosening. HU in the insertional screw positions, the central transverse plane, and the average values of three and four planes were measured. Regression analyses identified independent risk factors for screw loosening separately. The area under the receiver operating characteristic curve (AUC) was computed to evaluate predictive performance.
The local HU values were significantly lower in the loosening group, regardless of the selected measuring methods. The AUC of screw loosening prediction was higher in the insertional screw positions' HU than other frequently used methods.
The HU value measured in the insertional screw position is a better predictor of ALSR screw loosening than other methods. The risk of screw loosening should be reduced by optimizing the trajectory of the screw based on the measurement of HU in preoperative CT.
• Osteoporosis is an essential risk factor for screw loosening, and Hounsfield units (HU) are a credible predictor during bone mineral density (BMD) evaluation. • The HU value measured in the insertional screw position is a better predictor of screw loosening than other frequently used HU measurement methods. • The risk of screw loosening might potentially be reduced by optimizing the trajectory of the screw based on the measurement of HU in preoperative CT.
脊柱螺钉固定后螺钉松动是一个广泛报道的问题，并在腰椎椎间融合后引发了多种并发症。骨质疏松症是螺钉松动的一个重要危险因素。骨密度（BMD）评估时，Hounsfield 单位（HU）值是一个可信的指标。与 BMD 的一般评估相比，我们假设在未来螺钉插入的确切位置测量 HU 值可能是螺钉松动的更好预测指标。
本研究回顾了 56 例接受斜侧腰椎间融合术（OLIF）L4-L5 节段前路单棒（ALSR）螺钉固定治疗的患者的临床资料。将螺钉周围有≥1mm 宽度透亮带的椎体定义为螺钉松动。测量插入螺钉位置、中央横断面以及三个和四个平面的平均 HU 值。回归分析分别确定了螺钉松动的独立危险因素。计算了接收者操作特征曲线（AUC）下的面积以评估预测性能。
无论选择哪种测量方法，松动组的局部 HU 值均显著较低。与其他常用方法相比，插入螺钉位置的 HU 值预测螺钉松动的 AUC 更高。
与其他方法相比，插入螺钉位置的 HU 值是 ALSR 螺钉松动的更好预测指标。根据术前 CT 测量的 HU 值优化螺钉轨迹，可以降低螺钉松动的风险。
骨质疏松症是螺钉松动的一个重要危险因素，Hounsfield 单位（HU）值是骨密度（BMD）评估中的一个可信预测指标。
与其他常用 HU 测量方法相比，插入螺钉位置的 HU 值是螺钉松动的更好预测指标。
基于术前 CT 测量的 HU 值优化螺钉轨迹，可能会降低螺钉松动的风险。
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