8. 椎弓根骨质量评分对经椎间孔腰椎椎体间融合术后椎弓根螺钉松动的预测价值优于椎体骨质量评分：基于mri的研究

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100702

An-Jhih Luo MD, Yu-Cheng Yeh MD, Yung Hsueh Hu MD

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引用次数: 0

摘要

背景背景椎弓根螺钉松动（PSL）是经椎间孔腰椎椎体间融合术（TLIF）的常见并发症，导致不良的临床结果，如假关节、邻近节段病理和脊柱不稳定，通常需要翻修手术。骨质量显著影响螺钉稳定性，传统上通过计算机断层扫描（CT）或双能x线吸收仪（DEXA）评估。然而，基于磁共振成像（MRI）的椎弓根骨质量（PBQ）和椎体骨质量（VBQ）评分为术前骨质量评估提供了非电离替代方案。目的比较PBQ和VBQ评分对TLIF术后PSL的预测强度，并确定导致螺钉松动的关键危险因素。研究设计/设置一项回顾性队列研究，评估mri衍生的PBQ和VBQ评分作为TLIF患者PSL的预测因子。共有394例患者（年龄≥18岁）接受了腰椎退行性疾病的TLIF治疗，术前有完整的影像学检查，术后随访至少12个月。主要结果包括PSL的发生率以及PBQ和VBQ评分的预测准确性。次要测量包括融合率、DEXA的t评分和患者报告的结果，如视觉模拟量表（VAS）和Oswestry残疾指数（ODI）。方法从矢状面t1加权MRI图像中计算spbq和VBQ评分，并根据脑脊液强度归一化。受试者工作特征（ROC）曲线和曲线下面积（AUC）值比较其预测效果。多因素logistic回归确定了PSL的独立危险因素。结果spbq对PSL的预测准确度优于VBQ （AUC: 0.894 vs 0.722）。PBQ具有较高的敏感性（75.93%）、特异性（92.31%）、阳性预测值（78.85%）和阴性预测值（91.03%）。PSL的重要预测因素包括更高的PBQ评分、更长的融合结构、更低的t评分、更低的融合率和年龄。PSL与背部疼痛增加有关，但对ODI或腿部VAS评分没有显著影响。结论spbq评分比VBQ评分更能预测PSL，为术前评估提供了有价值的非电离替代指标。将PBQ评分整合到手术计划中可以优化螺钉固定策略，特别是在骨质量受损的患者中。螺钉松动的其他重要危险因素包括年龄较大、髋关节DEXA t评分较低、较长的融合装置和较低的融合率。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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8. Pedicle bone quality score offers superior predictive value over vertebral bone quality score for pedicle screw loosening following instrumented transforaminal lumbar interbody fusion: an MRI-based study

BACKGROUND CONTEXT

Pedicle screw loosening (PSL) is a common complication in transforaminal lumbar interbody fusion (TLIF), leading to poor clinical outcomes such as pseudarthrosis, adjacent segment pathology, and spinal instability, often necessitating revision surgeries. Bone quality significantly impacts screw stability, traditionally assessed through computed tomography (CT) or dual-energy X-ray absorptiometry (DEXA). However, magnetic resonance imaging (MRI)-based pedicle bone quality (PBQ) and vertebral bone quality (VBQ) scores offer non-ionizing alternatives for preoperative bone quality evaluation.

PURPOSE

To compare the predictive strength of PBQ and VBQ scores for assessing PSL following TLIF and to identify key risk factors contributing to screw loosening.

STUDY DESIGN/SETTING

A retrospective cohort study evaluating MRI-derived PBQ and VBQ scores as predictors of PSL in patients undergoing TLIF.

PATIENT SAMPLE

A total of 394 patients (aged ≥ 18) were treated with TLIF for degenerative lumbar spinal conditions, with complete preoperative imaging and at least 12 months of postoperative follow-up.

OUTCOME MEASURES

Primary outcomes included the incidence of PSL and the predictive accuracy of PBQ and VBQ scores. Secondary measures included fusion rates, T-scores from DEXA, and patient-reported outcomes such as the visual analog scale (VAS) and Oswestry Disability Index (ODI).

METHODS

PBQ and VBQ scores were calculated from sagittal T1-weighted MRI images and normalized against cerebrospinal fluid intensity. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values compared their predictive efficacy. Multivariate logistic regression identified independent risk factors for PSL.

RESULTS

PBQ exhibited superior predictive accuracy for PSL compared to VBQ (AUC: 0.894 vs 0.722). PBQ demonstrated higher sensitivity (75.93%), specificity (92.31%), positive predictive value (78.85%), and negative predictive value (91.03%). Significant predictors of PSL included higher PBQ scores, longer fusion constructs, lower T-scores, reduced fusion rates, and older age. PSL was associated with increased back pain but did not significantly impact ODI or leg VAS scores.

CONCLUSIONS

PBQ scores are stronger predictors of PSL than VBQ, providing a valuable non-ionizing alternative for preoperative assessment. Integration of PBQ scores into surgical planning may optimize screw fixation strategies, particularly in patients with compromised bone quality. Additional significant risk factors for screw loosening included older age, lower hip DEXA T-scores, longer fusion constructs, and lower fusion rates.