Jiang Guozheng, Song Jiawei, Xu Luchun, Guan Jianbin, Li Zeyu, Feng Ningning, Qiu Ziye, Ma Yukun, Qu Yi, Xiong Yang, Yang Yongdong, Yu Xing
Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China.
Department of Honghui-hospital, Xi'an Jiaotong University, Xi'an, China.
World Neurosurg. 2025 Apr;196:123630. doi: 10.1016/j.wneu.2024.123630. Epub 2025 Mar 6.
To retrospectively analyze screw loosening rates following dynamic fixation with polyetheretherketone (PEEK) rods and rigid fixation with titanium rods and assess mid-term outcomes of loosened screws.
This retrospective analysis included 203 patients who underwent lumbar pedicle screw fixation between March 2017 and June 2020 (57 with PEEK rods, 146 with titanium rods). Patients were followed for at least 48 months to evaluate screw loosening postoperatively and investigate outcomes of loosened screws. Multivariate logistic regression identified factors influencing screw restabilization.
Both PEEK rod and titanium rod groups exhibited peak screw loosening rates approximately 1 year after surgery, decreasing with longer follow-up. At 48 months, screw loosening rates were 5.3% and 15.8% for PEEK and titanium rods, respectively (P < 0.05). Among patients experiencing early loosening (within 12 months), the proportion of stabilized screws was significantly higher with PEEK rods (84% vs. 34%, P < 0.001). Regression analysis revealed dynamic fixation (odds ratio 4.579; 95% confidence interval 1.611-12.519), lowest fixed vertebra S1 (odds ratio 3.151; 95% confidence interval 1.352-9.233), and L1-L4 average computed tomography value (odds ratio 1.132; 95% confidence interval 1.015-1.263) as independent risk factors for screw restabilization. The area under the receiver operating characteristic curve for L1-L4 average computed tomography value predicting restabilization was 0.713 (P < 0.05), with an optimal threshold of 106 Hounsfield units (sensitivity 0.771, specificity 0.803).
Following PEEK rod dynamic fixation surgery, a certain proportion of screw loosening may occur in the short term. With prolonged follow-up, screws gradually restabilize at the bone interface, with most loosened screws returning to a stable state.
回顾性分析聚醚醚酮（PEEK）棒动态固定和钛棒刚性固定后螺钉松动率，并评估松动螺钉的中期结果。
这项回顾性分析纳入了2017年3月至2020年6月期间接受腰椎椎弓根螺钉固定的203例患者（57例使用PEEK棒，146例使用钛棒）。对患者进行至少48个月的随访，以评估术后螺钉松动情况并调查松动螺钉的结果。多因素逻辑回归分析确定影响螺钉再稳定的因素。
PEEK棒组和钛棒组的螺钉松动率均在术后约1年达到峰值，随着随访时间延长而下降。在48个月时，PEEK棒和钛棒的螺钉松动率分别为5.3%和15.8%（P<0.05）。在早期（12个月内）出现松动的患者中，PEEK棒组螺钉再稳定的比例显著更高（84%对34%，P<0.001）。回归分析显示，动态固定（比值比4.579；95%置信区间1.611-12.519）、最低固定椎体S1（比值比3.151；95%置信区间1.352-9.233）和L1-L4平均计算机断层扫描值（比值比1.132；95%置信区间1.015-1.263）是螺钉再稳定的独立危险因素。L1-L4平均计算机断层扫描值预测再稳定的受试者工作特征曲线下面积为0.713（P<0.05），最佳阈值为106亨氏单位（灵敏度0.77） 1，特异性0.803）。
PEEK棒动态固定手术后，短期内可能会出现一定比例的螺钉松动。随着随访时间延长，螺钉在骨界面逐渐再稳定，大多数松动螺钉恢复到稳定状态。
