Hekimoglu Mehdi, Akgun Mehmet Yigit, Ozer Hidir, Basak Ahmet Tulgar, Ucar Ege Anil, Oktenoglu Tunc, Ates Ozkan, Ozer Ali Fahir
Department of Neurosurgery, American Hospital, Istanbul 34365, Turkey.
Department of Neurosurgery, Koc University Hospital, Istanbul 34010, Turkey.
Diagnostics (Basel). 2024 Jul 12;14(14):1505. doi: 10.3390/diagnostics14141505.
Dynamic lumbar stabilization aims to preserve spinal movement, offering stability and controlled motion. However, screw loosening, especially in patients with osteopenia and osteoporosis, remains challenging.
Between 2018 and 2022, a retrospective analysis was conducted on a total of 119 patients diagnosed with osteopenia and osteoporosis who underwent spinal dynamic instrumentation surgery. These patients were categorized into two groups: single-stage surgery ( = 67) and two-stage surgery ( = 52). Over the 48-month follow-up period, the occurrence and percentage of screw loosening were examined at each surgical level per patient, as well as by screw location (pedicular, corpus, tip). Clinical outcomes were evaluated using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores.
Total screw loosening rates were significantly lower in the two-stage group (2.83%) compared to the single-stage group (14.63%, < 0.001). Patient-based loosening occurred in 5 patients (9.6%) in the two-stage group and 16 patients (23.9%) in the single-stage group. Loosening rates were lower in the two-stage group at L2 (7.78%, = 0.040), L3 (5.56%, < 0.001), L4 (8.89%, = 0.002), and L5 (10.00%, = 0.006), but higher at S1 (21.11%, = 0.964), T12 (15.56%, = 0.031), and iliac levels (15.56%, = 0.001). Pedicular section exhibited the highest loosening (37 cases). VAS and ODI scores improved significantly in both groups, with better outcomes in the two-stage group at the 48. months ( < 0.001).
The two-stage surgical approach significantly reduces screw loosening in patients with osteopenia and osteoporosis undergoing dynamic stabilization surgery, offering enhanced stability and better clinical outcomes.
动态腰椎稳定术旨在保留脊柱运动功能，提供稳定性并控制运动。然而，螺钉松动问题，尤其是在骨质减少和骨质疏松患者中，仍然具有挑战性。
在2018年至2022年期间，对总共119例诊断为骨质减少和骨质疏松并接受脊柱动态内固定手术的患者进行了回顾性分析。这些患者被分为两组：一期手术（n = 67）和二期手术（n = 52）。在48个月的随访期内，检查了每位患者每个手术节段以及按螺钉位置（椎弓根、椎体、尖端）的螺钉松动发生率和百分比。使用视觉模拟量表（VAS）和奥斯维斯特残疾指数（ODI）评分评估临床结果。
二期手术组的总螺钉松动率（2.83%）显著低于一期手术组（14.63%，P < 0.001）。二期手术组有5例患者（9.6%）发生基于患者的松动，一期手术组有16例患者（23.9%）发生。二期手术组在L2（7.78%，P = 0.040）、L3（5.56%，P < 0.001）、L4（8.89%，P = 0.002）和L5（10.00%，P = 0.006）节段的松动率较低，但在S1（21.11%，P = 0.964）、T12（15.56%，P = 0.031）和髂骨水平（15.56%，P = 0.001）节段较高。椎弓根节段的松动率最高（37例）。两组的VAS和ODI评分均显著改善，在48个月时二期手术组的结果更好（P < 0.001）。
二期手术方法显著降低了接受动态稳定手术的骨质减少和骨质疏松患者的螺钉松动率，提供了增强的稳定性和更好的临床结果。
