| Title | Incidence, Risk, and Outcome of Pedicle Screw Loosening in Degenerative Lumbar Scoliosis Patients Undergoing Long-Segment Fusion |
| Authors | Yuan, Lei Zhang, Xinling Zeng, Yan Chen, Zhongqiang Li, Weishi |
| Affiliation | Peking Univ Third Hosp, Dept Orthoped, 49 North Garden St, Beijing 100191, Peoples R China Peking Univ Third Hosp, Beijing Key Lab Spinal Dis Res, Beijing, Peoples R China Peking Univ Third Hosp, Engn Res Ctr Bone & Joint Precis Med, Minist Educ, Beijing, Peoples R China |
| Keywords | CLINICALLY IMPORTANT DIFFERENCE SPINAL-FUSION SURGERY VERTEBRAE FIXATION STENOSIS |
| Issue Date | May-2021 |
| Publisher | GLOBAL SPINE JOURNAL |
| Abstract | Study Design: Retrospective study. Objective: To investigate the incidence, risk factors, and outcomes of pedicle screw loosening in degenerative lumbar scoliosis (DLS) undergoing long-segment spinal fusion surgery. Methods: One hundred and thirty DLS patients who underwent long-segment fusion surgery with at least a 12-month follow-up were studied. The incidence and risk factors of screw loosening were investigated. VAS, SRS-22, and ODI scores were obtained preoperatively and at follow-up. Results: One hundred and sixty-eight of 1784 (9.4%) screws showed evidence of loosening in 71 (54.6%) patients. Three patients required revision surgery. Screw loosening rates according to vertebral insertion level were lowest instrumented vertebra (LIV): 45.4%; uppermost instrumented vertebra (UIV):17.7%; one vertebra above the LIV: 0.5%; 2 vertebrae above the LIV: 0.4%. Multiple logistic regression analysis of possible risk factors indicated that preoperative lateral subluxation >= 8 mm (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 1.16-6.20), osteopenia (OR: 5.52, 95% CI: 1.64-18.56), osteoporosis (OR: 8.19, 95% CI: 2.40-27.97), fusion to sacrum (OR: 2.55, 95% CI: 1.12-5.83), postoperative TLK greater than 10 degrees (OR: 2.63, 95% CI: 1.14-6.04) and SVA imbalance (OR: 3.44, 95% CI: 1.17-10.14) were statistically significant. No difference was noted in preoperative, follow-up, and change of VAS, ODI, and SRS-22 scores. Conclusions: Screw loosening in DLS underwent long-segment surgery is common and tends to occur in the LIV or UIV. Lateral subluxation >= 8 mm, osteopenia, osteoporosis, fusion to the sacrum, postoperative TLK greater than 10 degrees, and SVA imbalance were the independent influencing factors. Screw loosening can be asymptomatic, while longer-term follow-up is required. |
| URI | http://hdl.handle.net/20.500.11897/623170 |
| ISSN | 2192-5682 |
| DOI | 10.1177/21925682211017477 |
| Indexed | SCI(E) |
| Appears in Collections: | 第三医院 |
