Two-Stage Lumbar Dynamic Stabilization Surgery: A Comprehensive Analysis of Screw Loosening Rates and Functional Outcomes Compared to Single-Stage Approach in Osteopenic and Osteoporotic Patients

被引:3
作者
Hekimoglu, Mehdi [1 ]
Akgun, Mehmet Yigit [2 ]
Ozer, Hidir [3 ]
Basak, Ahmet Tulgar [1 ]
Ucar, Ege Anil [2 ]
Oktenoglu, Tunc [1 ,2 ]
Ates, Ozkan [2 ]
Ozer, Ali Fahir [2 ,4 ]
机构
[1] Amer Hosp, Dept Neurosurg, TR-34365 Istanbul, Turkiye
[2] Koc Univ Hosp, Dept Neurosurg, TR-34010 Istanbul, Turkiye
[3] Ordu Univ, Dept Neurosurg, TR-52200 Ordu, Turkiye
[4] Koc Univ Hosp, Spine Ctr, TR-34010 Istanbul, Turkiye
关键词
clinical outcomes; dynamic spine stabilization; osteopenia; osteoporosis; screw loosening; two-stage surgery; SPINE; FUSION; SYSTEM;
D O I
10.3390/diagnostics14141505
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Dynamic lumbar stabilization aims to preserve spinal movement, offering stability and controlled motion. However, screw loosening, especially in patients with osteopenia and osteoporosis, remains challenging. Method: Between 2018 and 2022, a retrospective analysis was conducted on a total of 119 patients diagnosed with osteopenia and osteoporosis who underwent spinal dynamic instrumentation surgery. These patients were categorized into two groups: single-stage surgery (n = 67) and two-stage surgery (n = 52). Over the 48-month follow-up period, the occurrence and percentage of screw loosening were examined at each surgical level per patient, as well as by screw location (pedicular, corpus, tip). Clinical outcomes were evaluated using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. Results: Total screw loosening rates were significantly lower in the two-stage group (2.83%) compared to the single-stage group (14.63%, p < 0.001). Patient-based loosening occurred in 5 patients (9.6%) in the two-stage group and 16 patients (23.9%) in the single-stage group. Loosening rates were lower in the two-stage group at L2 (7.78%, p = 0.040), L3 (5.56%, p < 0.001), L4 (8.89%, p = 0.002), and L5 (10.00%, p = 0.006), but higher at S1 (21.11%, p = 0.964), T12 (15.56%, p = 0.031), and iliac levels (15.56%, p = 0.001). Pedicular section exhibited the highest loosening (37 cases). VAS and ODI scores improved significantly in both groups, with better outcomes in the two-stage group at the 48. months (p < 0.001). Conclusions: The two-stage surgical approach significantly reduces screw loosening in patients with osteopenia and osteoporosis undergoing dynamic stabilization surgery, offering enhanced stability and better clinical outcomes.
引用
收藏
页数:15
相关论文
共 43 条
[1]   Foraminoplasty with Partial Pediculectomy in Degenerative Spondylolisthesis Cases with Nerve Compression [J].
Akgun, Mehmet Yigit ;
Toklu, Sureyya ;
Gunerbuyuk, Caner ;
Ates, Ozkan ;
Aydin, Ahmet Levent ;
Baran, Oguz ;
Oktenoglu, Tunc ;
Sasani, Mehdi ;
Ozer, Ali Fahir .
WORLD NEUROSURGERY, 2023, 172 :E532-E539
[2]  
Aycan MF, 2020, International Advanced Researches and Engineering Journal, V4, P161, DOI [10.35860/iarej.722229, 10.35860/iarej.722229, DOI 10.35860/IAREJ.722229]
[3]   Multi-Rod Constructs Can Increase the Incidence of Iliac Screw Loosening after Surgery for Adult Spinal Deformity [J].
Banno, Tomohiro ;
Hasegawa, Tomohiko ;
Yamato, Yu ;
Togawa, Daisuke ;
Yoshida, Go ;
Kobayashi, Sho ;
Yasuda, Tatsuya ;
Arima, Hideyuki ;
Oe, Shin ;
Mihara, Yuki ;
Ushirozako, Hiroki ;
Matsuyama, Yukihiro .
ASIAN SPINE JOURNAL, 2019, 13 (03) :500-510
[4]   Pedicle Screws Loosening in Patients With Degenerative Diseases of the Lumbar Spine: Potential Risk Factors and Relative Contribution [J].
Bokov, Andrey ;
Bulkin, Anatoliy ;
Aleynik, Alexander ;
Kutlaeva, Marina ;
Mlyavykh, Sergey .
GLOBAL SPINE JOURNAL, 2019, 9 (01) :55-61
[5]   Correlation of bone density to screw loosening in dynamic stabilization: an analysis of 176 patients [J].
Chang, Hsuan-Kan ;
Ku, Jason ;
Ku, Johnson ;
Kuo, Yi-Hsuan ;
Chang, Chih-Chang ;
Wu, Ching-Lan ;
Lirng, Jiing-Feng ;
Wu, Jau-Ching ;
Huang, Wen-Cheng ;
Cheng, Henrich ;
Hsu, Shih-Ming .
SCIENTIFIC REPORTS, 2021, 11 (01)
[6]   Location of pedicle screw hold in relation to bone quality and loads [J].
Cornaz, Frederic ;
Farshad, Mazda ;
Widmer, Jonas .
FRONTIERS IN BIOENGINEERING AND BIOTECHNOLOGY, 2022, 10
[7]   Screw Osteointegration-Increasing Biomechanical Resistance to Pull-Out Effect [J].
Costachescu, Bogdan ;
Niculescu, Adelina-Gabriela ;
Grumezescu, Alexandru Mihai ;
Teleanu, Daniel Mihai .
MATERIALS, 2023, 16 (16)
[8]   Finite element investigation of the loading rate effect on the spinal load-sharing changes under impact conditions [J].
El-Rich, Marwan ;
Arnoux, Pierre-Jean ;
Wagnac, Eric ;
Brunet, Christian ;
Aubin, Carl-Eric .
JOURNAL OF BIOMECHANICS, 2009, 42 (09) :1252-1262
[9]   Pedicle screw loosening: a clinically relevant complication? [J].
Galbusera, Fabio ;
Volkheimer, David ;
Reitmaier, Sandra ;
Berger-Roscher, Nikolaus ;
Kienle, Annette ;
Wilke, Hans-Joachim .
EUROPEAN SPINE JOURNAL, 2015, 24 (05) :1005-1016
[10]   Biomechanical and clinical research of Isobar semi-rigid stabilization devices for lumbar degenerative diseases: a systematic review [J].
Guan, Jianbin ;
Liu, Tao ;
Yu, Xing ;
Li, Wenhao ;
Feng, Ningning ;
Jiang, Guozheng ;
Zhao, He ;
Yang, Yongdong .
BIOMEDICAL ENGINEERING ONLINE, 2023, 22 (01)