Chen Zan, Lei Fei, Ye Fei, Zhang Hao, Yuan Hao, Li Songke, Feng Daxiong
Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, PR China.
Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, PR China.
World Neurosurg. 2023 Mar;171:e760-e767. doi: 10.1016/j.wneu.2022.12.098. Epub 2022 Dec 27.
To explore a new magnetic resonance imaging (MRI)-based bone quality assessment method for predicting pedicle screw loosening in the lumbar spine.
We reviewed 174 patients aged ≥50 years who were treated for lumbar degenerative diseases using posterior lumbar interbody fusion. All patients were followed-up for ≥12 months. Based on the presence of radiolucent areas on follow-up MRI images, the patients were divided into loosening and nonloosening groups. The vertebral bone quality (VBQ) score was calculated using T1-weighted MRI images. Demographic data, health history, and radiological parameters were also recorded and compared between the 2 groups. Logistic regression analysis was used to predict the independent risk factors affecting screw loosening.
Screw loosening occurred in 29.88% (52/174) of patients. A total of 83 screws (9.18%, 83/904) were loosened. There were differences in the age, fixation length, fixation at S1, preoperative and postoperative PI-LL, PT, preoperative LL, lowest bone mineral density (BMD), and VBQ scores (P < 0.05) between the nonloosening and loosening groups. In the logistic regression, the VBQ score (OR = 1.02 per point; 95% CI: 1.01-1.03; P < 0.001) was identified as an independent factor influencing screw loosening.
As an independent risk factor for screw loosening after lumbar spine fusion, the VBQ score provides a new noninvasive protocol for assessing bone quality during surgical planning.
探索一种基于磁共振成像（MRI）的新的骨质量评估方法，用于预测腰椎椎弓根螺钉松动。
我们回顾性分析了174例年龄≥50岁、因腰椎退行性疾病接受后路腰椎椎间融合术治疗的患者。所有患者均随访≥12个月。根据随访MRI图像上是否存在透亮区，将患者分为松动组和未松动组。使用T1加权MRI图像计算椎体骨质量（VBQ）评分。还记录并比较了两组患者的人口统计学数据、健康史和放射学参数。采用逻辑回归分析预测影响螺钉松动的独立危险因素。
29.88%（52/174）的患者发生螺钉松动。共83枚螺钉（9.18%，83/904）松动。未松动组和松动组在年龄、固定长度、S1节段固定情况、术前和术后矢状面垂直轴（PI-LL）、骨盆倾斜角（PT）、术前腰椎前凸（LL）、最低骨密度（BMD）和VBQ评分方面存在差异（P<0.05）。在逻辑回归分析中，VBQ评分（每分的比值比[OR]=1.02；95%可信区间[CI]：1.01-1.03；P<0.001）被确定为影响螺钉松动的独立因素。
作为腰椎融合术后螺钉松动的独立危险因素，VBQ评分为手术规划过程中评估骨质量提供了一种新的非侵入性方案。
