Huang Yen-Chun, Liu Po-Chun, Lin Hsi-Hsien, Wang Shih-Tien, Su Yu-Ping, Chou Po-Hsin, Yao Yu-Cheng
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Spine J. 2025 Jul;25(7):1474-1482. doi: 10.1016/j.spinee.2025.01.033. Epub 2025 Jan 31.
Pedicle screw loosening (PSL) after spinal fusion surgery is one of the most frequently reported complications and leads to poor clinical outcomes.
This study aimed to develop and validate a risk prediction model for PSL within 2 years in patients undergoing lumbar instrumented fusion surgery based on their risk profiles.
STUDY DESIGN/SETTING: Retrospective, observational study.
Patients who underwent lumbar instrumented fusion surgery at a single academic institution between May 2015 and February 2019.
Risk assessment of PSL and development of a rating score based on patient characteristics.
The demographic profiles and radiographic parameters using computed tomography were obtained. These factors were analyzed to determine possible risk factors related to postoperative PSL after 2 years. A scoring system was developed using these independent risk factors and validated using prospectively collected data from another center between May 2019 and December 2021.
The occurrence of PSL within 2 years postoperation was 12.7% (40/315). PSL was significantly predicted by smoking, low Hounsfield units (HU) of the pedicle tract at the index level (P), and a low psoas-lumbar vertebral index (PLVI). The risk of PSL according to the categories of the risk score was 1.1% for those with a score of 0-1, 15.1% for a score of 2-3, and 61.5% for a score of 4-6. In validation, this model demonstrated both good discrimination and calibration results. The area under the curve was 0.887 (95% CI 0.830-0.938) for the derivation cohort and 0.835 (95% CI 0.738-0.918) for the external validation cohort.
This PSL risk score, including smoking, Index P HU, and PLVI, is a novel approach to predict PSL 2 years postsurgery. This approach highlights the role of factors associated with osteoporosis and sarcopenia in the development of PSL and could aid in preoperative decision-making and surgical planning.
脊柱融合手术后椎弓根螺钉松动（PSL）是最常报道的并发症之一，会导致不良的临床结果。
本研究旨在基于患者风险特征，开发并验证腰椎器械融合手术患者术后2年内发生PSL的风险预测模型。
研究设计/地点：回顾性观察研究。
2015年5月至2019年2月期间在一家学术机构接受腰椎器械融合手术的患者。
PSL的风险评估以及基于患者特征制定评分。
获取患者人口统计学资料及计算机断层扫描的影像学参数。分析这些因素以确定术后2年与PSL相关的可能危险因素。利用这些独立危险因素开发评分系统，并使用2019年5月至2021年12月期间从另一个中心前瞻性收集的数据进行验证。
术后2年内PSL的发生率为12.7%（40/315）。吸烟、手术节段椎弓根通道的低Hounsfield单位（HU）值（P）以及低腰大肌-腰椎指数（PLVI）可显著预测PSL。根据风险评分类别，PSL风险在得分为0 - 1分的患者中为1.1%，2 - 3分的患者中为15.1%，4 - 6分的患者中为61.5%。在验证中，该模型显示出良好的区分度和校准结果。推导队列的曲线下面积为0.887（95%CI 0.830 - 0.938），外部验证队列的曲线下面积为0.835（95%CI 0.738 - 0.918）。
这个包括吸烟、P节段HU值和PLVI的PSL风险评分，是预测术后2年PSL的一种新方法。该方法突出了与骨质疏松症和肌肉减少症相关因素在PSL发生中的作用，有助于术前决策和手术规划。
