Zhan Jinxiang, Wei Qipeng, Guo Weijun, Liu Zihao, Chen Shiji, Huang Qingyan, Cai Dongling
Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China.
Department of Orthopedics, Panyu Hospital of Chinese Medicine, Guangzhou, Guangdong, 511400, China.
J Orthop Surg Res. 2024 Dec 31;19(1):898. doi: 10.1186/s13018-024-05367-7.
This study aims to explore the predictive value of endplate morphology and pedicle screw bone quality score on screw loosening after single-level lumbar spinal fusion surgery.
A retrospective analysis was conducted on the clinical data of 207 patients who underwent single-level lumbar spinal fusion (34 in the screw loosening group and 173 in the non-screw loosening group). Univariate analysis and binary logistic regression model analysis were performed using SPSS 27.0. MedCalc 23 was used to plot the receiver operating characteristic (ROC) curve to evaluate diagnostic efficacy.
Through comparative analysis of clinical data, we found statistically significant differences between the two groups in terms of endplate morphology, lumbar CT values, and PBQ scores(P<0.05). The results of the binary logistic regression analysis indicated that endplate morphology (OR = 17.088, 95% CI: 3.886-75.142; p < 0.001) and PBQ score (OR = 3.347, 95% CI: 1.473-7.603; p = 0.004) are independent risk factors for screw loosening after single-level lumbar spinal fusion surgery. The ROC analysis showed that the area under the curve (AUC) for endplate morphology was 0.731 (95% confidence interval [CI]: 0.665-0.790), with the optimal threshold representing irregular endplate morphology (sensitivity: 94.1%, specificity: 52.0%). The AUC for the PBQ score was 0.791 (95% CI: 0.729-0.844), with an optimal threshold of 3.198 (sensitivity: 91.2%, specificity: 61.8%). Furthermore, the predictive model constructed using both endplate morphology and PBQ score had an AUC of 0.870 (95% confidence interval: 0.817-0.913), with a maximum Youden index of 0.668, yielding a diagnostic sensitivity of 88.2% and specificity of 78.6%.
Endplate morphology and pedicle screw bone quality score have significant reference value for diagnosing screw loosening after single-level lumbar spinal fusion surgery.
本研究旨在探讨终板形态和椎弓根螺钉骨质质量评分对单节段腰椎融合术后螺钉松动的预测价值。
对207例行单节段腰椎融合术的患者的临床资料进行回顾性分析（螺钉松动组34例，非螺钉松动组173例）。使用SPSS 27.0进行单因素分析和二元逻辑回归模型分析。采用MedCalc 23绘制受试者工作特征（ROC）曲线以评估诊断效能。
通过对临床资料的对比分析，我们发现两组在终板形态、腰椎CT值和PBQ评分方面存在统计学显著差异（P<0.05）。二元逻辑回归分析结果表明，终板形态（OR = 17.088，95%CI：3.886 - 75.142；p < 0.001）和PBQ评分（OR = 3.347，95%CI：1.473 - 7.603；p = 0.004）是单节段腰椎融合术后螺钉松动的独立危险因素。ROC分析显示，终板形态的曲线下面积（AUC）为0.731（95%置信区间[CI]：0.665 - 0.790），最佳阈值代表不规则终板形态（敏感性：94.1%，特异性：52.0%）。PBQ评分的AUC为0.791（95%CI：0.729 - 0.844），最佳阈值为3.198（敏感性：91.2%，特异性：61.8%）。此外，使用终板形态和PBQ评分构建的预测模型的AUC为0.870（95%置信区间：0.817 - 0.913），最大约登指数为0.668，诊断敏感性为88.2%，特异性为78.6%。
终板形态和椎弓根螺钉骨质质量评分对诊断单节段腰椎融合术后螺钉松动具有重要参考价值。
