Pedicle Screws Loosening in Patients With Degenerative Diseases of the Lumbar Spine: Potential Risk Factors and Relative Contribution

Andrey Bokov, Anatoliy Bulkin, Alexander Aleynik, Marina Kutlaeva, Sergey Mlyavykh, Andrey Bokov, Anatoliy Bulkin, Alexander Aleynik, Marina Kutlaeva, Sergey Mlyavykh

Abstract

Study design: Retrospective cohort study.

Objective: To determine risk factors that may affect the rate of pedicle screws loosening in patients with degenerative diseases of the lumbar spine.

Methods: A total of 250 patients with a low-grade spondylolisthesis and lumbar instability associated with degenerative diseases were enrolled. Preoperatively patients underwent computed tomography (CT) and cancellous bone radiodensity of a vertebral body was measured in Hounsfield units (HU). Pedicle screw fixation was used to treat patients either with a posterior fusion only or in combination with transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and direct lateral interbody fusion (D-LIF). Minimal follow-up period accounted for 18 months. Cases with screw loosening were registered assessing association with risk factors using logistic regression.

Results: The rate of screw loosening was in positive correlation with the number fused levels and decreasing bone radiodensity. Fusion with a greater load-bearing surface cage was associated with the decrease in rate of pedicle screws loosening. Incomplete reduction in case of spondylolisthesis, bilateral facet joints removal, and laminectomy performed without anterior support favored pedicle screws loosening development. The estimated model classifies correctly 79% of cases with the specificity and sensitivity accounting for 87% and 66% respectively.

Conclusions: The decreasing bone radiodensity in Hounsfield units has a considerable correlation with the rate of pedicle screws loosening. On the other hand, the length of fixation and applied surgical technique including fusion type also have a significant impact on complication rate. Spinal instrumentations should be planned by taking into account all potential risk factors and not characteristics relevant to bone quality assessment alone.

Keywords: Hounsfield units; decompression; degenerative diseases; interbody fusion; lumbar spine; pedicle screws loosening.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Cages that were used to perform transforaminal lumbar interbody fusion (TLIF) and either anterior lumbar interbody fusion (ALIF) or direct lateral interbody fusion (D-LIF) in patients enrolled in this study.
Figure 2.
Figure 2.
Computed tomographic image of a lumbar spine in a coronal plane. Bilateral double halo sign is evident on L3 level (radiolucent zone surrounded by sclerotic bone).

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