Zheng Bin, Zhou Qiang, Liu Xuanwen, Ma Ke, Qiang Zhe
Spine Surgery, Peking University People's Hospital, Beijing, China.
Department of Orthopedic Surgery, 363 Hospital, Chengdu, Sichuan, China.
Front Surg. 2025 Jul 30;12:1607323. doi: 10.3389/fsurg.2025.1607323. eCollection 2025.
High-density pedicle screws provide satisfactory correction in adolescent idiopathic scoliosis (AIS) but add to the operative time, blood loss, and cost; low-density constructs may mitigate these burdens and achieve similar correction results. Studies use inconsistent density cutoffs (most often <1.6 screws/level) and report conflicting results; therefore, we performed a systematic review and meta-analysis to clarify the clinical, radiographic, and economic impact of low screw density in patients with AIS.
A systematic review and meta-analysis were conducted following PRISMA guidelines. The PubMed, Web of Science, and Embase databases were searched until December 2024 for comparative studies. The outcomes analyzed included surgical and safety parameters (blood loss, operative time, revision rates, and complications), radiographic outcomes (Cobb angle, correction rate, and thoracic kyphosis), and implant costs. Statistical analyses were performed using RevMan 5.4, with fixed- or random-effects models applied on the basis of heterogeneity (² threshold < 50%).
Twenty-one studies comprising 1,762 patients met the inclusion criteria. Low-density screws were superior in reducing blood loss [mean difference (MD) = -88.06, = 0.01] and operative time (MD = -22.27, = 0.02), with no significant difference in revision rates ( = 0.78) or complications ( = 0.64). No differences were observed between the groups in the final Cobb angle ( = 0.4), Cobb correction rate ( = 0.21), or thoracic kyphosis ( = 0.43). The per-level implant cost was lower (standard mean difference = -1.32, < 0.00001) in the low-density group.
Compared with high-density screws, low-density pedicle screws provide comparable radiographic and safety outcomes while reducing the operative time, blood loss, and cost. These findings support the use of low-density constructs in AIS surgery, although the variability in study designs and screw density definitions warrants further research. Future multicenter randomized controlled trials are needed to refine the optimal screw density strategies for treating AIS.
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251088403, PROSPERO CRD420251088403.
高密度椎弓根螺钉在青少年特发性脊柱侧凸（AIS）的矫正中效果令人满意，但会增加手术时间、出血量和成本；低密度固定方式可能会减轻这些负担并取得相似的矫正效果。各研究使用的密度截断值不一致（最常见的是<1.6枚螺钉/节段）且报告的结果相互矛盾；因此，我们进行了一项系统评价和荟萃分析，以阐明低密度螺钉对AIS患者的临床、影像学和经济影响。
按照PRISMA指南进行系统评价和荟萃分析。检索了PubMed、Web of Science和Embase数据库，直至2024年12月，查找比较研究。分析的结果包括手术和安全参数（出血量、手术时间、翻修率和并发症）、影像学结果（Cobb角、矫正率和胸椎后凸）以及植入物成本。使用RevMan 5.4进行统计分析，根据异质性（I²阈值<50%）应用固定效应或随机效应模型。
21项研究共纳入1762例患者，符合纳入标准。低密度螺钉在减少出血量[平均差（MD）=-88.06，P=0.01]和手术时间（MD=-22.27，P=0.02）方面更具优势，翻修率（P=0.78）或并发症（P=0.64）无显著差异。两组在最终Cobb角（P=0.4）、Cobb角矫正率（P=0.21）或胸椎后凸（P=0.43）方面未观察到差异。低密度组每节段的植入物成本更低（标准化平均差=-1.32，P<0.00001）。
与高密度螺钉相比，低密度椎弓根螺钉在影像学和安全性方面能取得相似的结果，同时减少了手术时间、出血量和成本。这些发现支持在AIS手术中使用低密度固定方式，尽管研究设计和螺钉密度定义的变异性值得进一步研究。未来需要多中心随机对照试验来完善治疗AIS的最佳螺钉密度策略。
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251088403，PROSPERO CRD420251088403。
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