Huang Yen-Chun, Lin Hsi-Hsien, Wang Shih-Tien, Chou Po-Hsin, Liu Chien-Lin, Yao Yu-Cheng
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2025 Feb 1;88(2):151-155. doi: 10.1097/JCMA.0000000000001187. Epub 2024 Nov 4.
Posterior decompression with Dynesys dynamic stabilization (DDS) is an effective treatment option for degenerative spondylolisthesis. However, postoperative pedicle screw loosening (PSL) often results in poor outcomes. Determining possible risk factors may aid in making informed decisions. This study aimed to evaluate the incidence and risk factors for PSL in patients who underwent elective DDS.
We conducted a retrospective analysis of 94 patients with L4-L5 grade I degenerative spondylolisthesis who underwent DSS at a single academic institution between May 2008 and February 2015. Screw loosening was defined as the presence of a halo or double-halo sign on plain radiography.
The rate of screw loosening was 4.8% among screws and 11.7% among patients. Multivariable analysis revealed that age >65 years, smoking, segmental range of motion (ROM) >13°, and L1 vertebral body Hounsfield unit <110 were risk factors for PSL after DDS. Five reoperations were performed; however, no instances of screw breakage were observed.
Our study identified risk factors for PSL after DDS, including older age, smoking, larger preoperative segmental ROM, and lower L1 vertebral body HU, which could assist in preoperative decision-making and surgical planning.
后路减压联合Dynesys动态稳定系统（DDS）是治疗退行性腰椎滑脱的一种有效方法。然而，术后椎弓根螺钉松动（PSL）常导致疗效不佳。确定可能的危险因素有助于做出明智的决策。本研究旨在评估接受择期DDS治疗患者PSL的发生率及危险因素。
我们对2008年5月至2015年2月期间在单一学术机构接受DSS治疗的94例L4-L5 Ⅰ度退行性腰椎滑脱患者进行了回顾性分析。螺钉松动定义为X线平片上出现晕圈或双晕圈征。
螺钉松动率为4.8%，患者松动率为11.7%。多变量分析显示，年龄>65岁、吸烟、节段活动度（ROM）>13°以及L1椎体Hounsfield单位<110是DDS术后PSL的危险因素。进行了5次再次手术；然而，未观察到螺钉断裂的情况。
我们的研究确定了DDS术后PSL的危险因素，包括年龄较大、吸烟、术前节段ROM较大以及L1椎体HU较低，这有助于术前决策和手术规划。
