Risk factors of screw loosening after surgical treatment for single-level lumbar degenerative disease with osteoporosis utilizing cortical bone trajectory screw fixation

doi:10.3877/cma.j.issn.2096-0263.2024.03.005

Abstract

Abstract:

Objective

To investigate the risk factors of screw loosening after surgical treatment for single-level lumbar degenerative disease with osteoporosis utilizing cortical bone trajectory (CBT) screw fixation.

Methods

A retrospective study was conducted with 88 cases who diagnosed as lumbar degenerative disease with osteoporosis and underwent single-level posterior lumbar interbody fusion utilizing CBT screw fixation from November 2017 to January 2020 in Beijing Chao-Yang Hospital.Clinical data were recorded and a total of 70 patients (280 screws) were enrolled. The mean age was (62.87±10.07) years and the mean follow-up time was (25.53±1.82) months. According to the imaging findings, screws were divided into screw loosening group (36 screws) and Non-screw loosening group (244 screws). The correlation of screw fixed to S1, mean CT Hu value of the screw location, screw sagittal angle, screw lateral angle and the number of cortical bone layers was analyzed by univariate factor analysis. Multivariate Logistic regression analysis was used to determine the risk factors of postoperative screw loosening.

Results

Univariate analysis showed that screw fixed to S₁ (P<0.001), screw lateral angle (P<0.001) and the number cortical bone layers (P<0.001) were correlated with screw loosening after CBT screw fixation for single-level lumbar degeneration complicated with osteoporosis. The mean CT Hu value of the screw location and sagittal angle of the screw were not correlated with screw loosening. Multivariate Logistic analysis showed that screw fixed to S1 (OR=3.640, 95%CI:1.08, 12.25, P=0.037), screw lateralangle (OR=1.071, 95%CI: 1.00, 1.14, P=0.037) and cortical bone layers (OR=0.189, 95%CI: 0.11, 0.33, P<0.001) were associated with postoperative CBT screw loosening.

Conclusion

The placement of CBT screw to S1, lateralangle of the screw and the number of cortical bone layers contacted by the screw are risk factors for screw loosening after surgical treatment for single-level lumbar degeneration disease with osteoporosis utilizing CBT screw fixation.

Key words: lumbar interbody fusion, cortical bone trajectory, risk factors, lumbar

Yiqi Zhang, Yong Hai, Li Guan, Aixing Pan, Yangpu Zhang, Hongtao Ding, Yue Li, Yuzeng Liu. Risk factors of screw loosening after surgical treatment for single-level lumbar degenerative disease with osteoporosis utilizing cortical bone trajectory screw fixation[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(03): 153-158.

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Figures/Tables 5

References 25

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基本特点	数据
一般资料
性别（男/女）	23/47
年龄（岁）	62.87±10.07
骨密度T值（SD）	-3.04±0.49
BMI（kg/m²）	26.83±4.49
随访时间（月）	25.53±1.82
手术资料
平均手术时间（分）	179.81±41.28
出血量（毫升）	211.43±75.03
手术节段位置[例（%）]
L2/3	2（2.9）
L3/4	3（4.3）
L4/5	54（77.1）
L5/S1	11（15.7）

基本特点	数据
一般资料
性别（男/女）	23/47
年龄（岁）	62.87±10.07
骨密度T值（SD）	-3.04±0.49
BMI（kg/m²）	26.83±4.49
随访时间（月）	25.53±1.82
手术资料
平均手术时间（分）	179.81±41.28
出血量（毫升）	211.43±75.03
手术节段位置[例（%）]
L2/3	2（2.9）
L3/4	3（4.3）
L4/5	54（77.1）
L5/S1	11（15.7）

时间	腰痛VAS评分	腿痛VAS评分	ODI评分
术前	4.43±1.98	2.50±1.13	49.26±6.71
术后6月	1.77±1.18	1.10±1.01	22.31±4.74
末次随访	1.66±1.11	0.87±0.74	20.93±4.63
t值	12.17	9.99	32.84
P值	0.001	0.001	0.001

时间	腰痛VAS评分	腿痛VAS评分	ODI评分
术前	4.43±1.98	2.50±1.13	49.26±6.71
术后6月	1.77±1.18	1.10±1.01	22.31±4.74
末次随访	1.66±1.11	0.87±0.74	20.93±4.63
t值	12.17	9.99	32.84
P值	0.001	0.001	0.001

变量	螺钉总数（280枚）	松动组（36枚）	未松动租（244枚）	t/χ²/Z值	P值
是否固定至S1（M,Q_R，%）	20（7.1）	9（25）	11（4.5）	19.861	<0.001
CT Hu值	165.18±84.08	179.04±83.63	167.41±87.76	0.278	0.458
矢状位角（°）	75.97±7.10	75.72±8.05	75.93±7.15	-0.160	0.873
外展角（°）	10.77±5.72	13.94±6.53	10.36±5.49	3.620	<0.001
接触皮质层数（层）	4（3～4）	2（2～3）	4（3～4）	-6.667	<0.001

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