Abstract：
Pedicle screw loosening after posterior lumbar fusion is associated with poor bone quality, which often determines screw pull-out strength, insertion torque, and vertebral body loading characteristics. Magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score were associated with poor bone quality. Current evidence suggests that pedicle bone quality (PBQ) has a greater impact on screw stability. However, the correlation between MRI-based PBQ score and screw loosening has not been reported.
OBJECTIVE: To introduce and evaluate an MRI-based PBQ score to determine its effectiveness in predicting pedicle screw loosening following lumbar fusion surgery.
METHODS: The retrospective study analyzed 244 patients who underwent posterior lumbar interbody fusion (PLIF) with pedicle screws between December 2017 and December 2021, with CT and MRI imaging before surgery. Data collected included patient demographics and preoperative radiological data. Radiographic screw loosening was measured at 12 months postoperatively. Clinical assessments included pain visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. The PBQ score was measured using MRI scans. We use univariate analysis for preliminary screening of the risk factors of screw loosening. Subsequent analysis involved multivariate logistic regression to identify independent predictive factors for screw loosening. We constructed the receiver operating characteristic (ROC) curve to ascertain the discriminative capacity of the PBQ score. The area under the curve (AUC) quantified its predictive accuracy. Additionally, we evaluated the association between PBQ score and screw loosening using Spearman\'s correlation analysis.
RESULTS: Overall, 244 patients who underwent PLIF with pedicle screw fixation participated in this study, including 35 in the loosening group and 209 in the non-loosening group. PBQ score in the loosening group was significantly higher than that in the non-loosening group. On multivariate logistic regression, the higher PBQ score (OR = 8.481, 95% CI: 3.158-22.774; p < 0.001) and the lower mean Hounsfield unit (HU) value of L1-4 (OR = 0.967, 95% CI 0.951-0.984; p < 0.001) were the variables that significantly predicted screw loosening. The AUC for the PBQ score and HU value were 0.751 (95% CI: 0.673-0.828) and 0.702 (95% CI: 0.612-0.791). The PBQ score optimal cutoff to differentiate patients with loosening and with non-loosening was calculated as 3.045 with a sensitivity of 85.7% and specificity of 76.9%, while the optimal cutoff of the HU value was 151.5 with a sensitivity of 64.6% and specificity of 89.5%.
CONCLUSIONS: The association between the PBQ score and the propensity for lumbar pedicle screw loosening was found to be substantial. As a predictive measure, the PBQ score outperformed the HU value in forecasting the likelihood of screw loosening post-posterior lumbar fusion.
OBJECTIVE: To introduce and evaluate an MRI-based PBQ score to determine its effectiveness in predicting pedicle screw loosening following lumbar fusion surgery.
METHODS: The retrospective study analyzed 244 patients who underwent posterior lumbar interbody fusion (PLIF) with pedicle screws between December 2017 and December 2021, with CT and MRI imaging before surgery. Data collected included patient demographics and preoperative radiological data. Radiographic screw loosening was measured at 12 months postoperatively. Clinical assessments included pain visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. The PBQ score was measured using MRI scans. We use univariate analysis for preliminary screening of the risk factors of screw loosening. Subsequent analysis involved multivariate logistic regression to identify independent predictive factors for screw loosening. We constructed the receiver operating characteristic (ROC) curve to ascertain the discriminative capacity of the PBQ score. The area under the curve (AUC) quantified its predictive accuracy. Additionally, we evaluated the association between PBQ score and screw loosening using Spearman\'s correlation analysis.
RESULTS: Overall, 244 patients who underwent PLIF with pedicle screw fixation participated in this study, including 35 in the loosening group and 209 in the non-loosening group. PBQ score in the loosening group was significantly higher than that in the non-loosening group. On multivariate logistic regression, the higher PBQ score (OR = 8.481, 95% CI: 3.158-22.774; p < 0.001) and the lower mean Hounsfield unit (HU) value of L1-4 (OR = 0.967, 95% CI 0.951-0.984; p < 0.001) were the variables that significantly predicted screw loosening. The AUC for the PBQ score and HU value were 0.751 (95% CI: 0.673-0.828) and 0.702 (95% CI: 0.612-0.791). The PBQ score optimal cutoff to differentiate patients with loosening and with non-loosening was calculated as 3.045 with a sensitivity of 85.7% and specificity of 76.9%, while the optimal cutoff of the HU value was 151.5 with a sensitivity of 64.6% and specificity of 89.5%.
CONCLUSIONS: The association between the PBQ score and the propensity for lumbar pedicle screw loosening was found to be substantial. As a predictive measure, the PBQ score outperformed the HU value in forecasting the likelihood of screw loosening post-posterior lumbar fusion.
摘要：
腰椎后路融合后椎弓根螺钉松动与骨质量差相关,这通常决定了螺钉的拔出强度，插入扭矩,和椎体载荷特性。基于磁共振成像（MRI）的椎骨质量（VBQ）评分与不良的骨质量相关。目前的证据表明，椎弓根骨质量（PBQ）对螺钉稳定性有更大的影响。然而,尚未报道基于MRI的PBQ评分与螺钉松动之间的相关性.
目的：介绍并评估基于MRI的PBQ评分，以确定其预测腰椎融合术后椎弓根螺钉松动的有效性。
方法：回顾性研究分析了在2017年12月至2021年12月期间接受椎弓根螺钉后路腰椎椎间融合术（PLIF）的244例患者，术前进行CT和MRI成像。收集的数据包括患者人口统计学和术前放射学数据。术后12个月测量X线螺钉松动。临床评估包括疼痛视觉模拟量表（VAS）和Oswestry残疾指数（ODI）评分。使用MRI扫描测量PBQ评分。我们使用单因素分析来初步筛选螺钉松动的危险因素。随后的分析涉及多变量逻辑回归，以确定螺钉松动的独立预测因素。我们构建了接收器工作特性（ROC）曲线，以确定PBQ得分的判别能力。曲线下面积(AUC)量化其预测准确性。此外,我们采用Spearman相关分析评价PBQ评分与螺钉松动的相关性.
结果：总体而言，244例接受PLIF椎弓根螺钉固定的患者参加了这项研究，其中松动组35例,非松动组209例。松动组PBQ评分明显高于非松动组。在多元逻辑回归中，较高的PBQ评分(OR=8.481,95%CI:3.158-22.774;p<0.001)和较低的L1-4平均Hounsfield单位(HU)值(OR=0.967,95%CI0.951-0.984;p<0.001)是显著预测螺钉松动的变量.PBQ评分和HU值的AUC分别为0.751(95%CI:0.673-0.828)和0.702(95%CI:0.612-0.791)。PBQ评分用于区分有松动和无松动患者的最佳截止值计算为3.045，灵敏度为85.7％，特异性为76.9％。而HU值的最佳截断值为151.5，敏感性为64.6%，特异性为89.5%。
结论：发现PBQ评分与腰椎椎弓根螺钉松动倾向之间存在实质性关联。作为一种预测措施，在预测腰椎后路融合后螺钉松动的可能性方面,PBQ评分优于HU值.
目的：介绍并评估基于MRI的PBQ评分，以确定其预测腰椎融合术后椎弓根螺钉松动的有效性。
方法：回顾性研究分析了在2017年12月至2021年12月期间接受椎弓根螺钉后路腰椎椎间融合术（PLIF）的244例患者，术前进行CT和MRI成像。收集的数据包括患者人口统计学和术前放射学数据。术后12个月测量X线螺钉松动。临床评估包括疼痛视觉模拟量表（VAS）和Oswestry残疾指数（ODI）评分。使用MRI扫描测量PBQ评分。我们使用单因素分析来初步筛选螺钉松动的危险因素。随后的分析涉及多变量逻辑回归，以确定螺钉松动的独立预测因素。我们构建了接收器工作特性（ROC）曲线，以确定PBQ得分的判别能力。曲线下面积(AUC)量化其预测准确性。此外,我们采用Spearman相关分析评价PBQ评分与螺钉松动的相关性.
结果：总体而言，244例接受PLIF椎弓根螺钉固定的患者参加了这项研究，其中松动组35例,非松动组209例。松动组PBQ评分明显高于非松动组。在多元逻辑回归中，较高的PBQ评分(OR=8.481,95%CI:3.158-22.774;p<0.001)和较低的L1-4平均Hounsfield单位(HU)值(OR=0.967,95%CI0.951-0.984;p<0.001)是显著预测螺钉松动的变量.PBQ评分和HU值的AUC分别为0.751(95%CI:0.673-0.828)和0.702(95%CI:0.612-0.791)。PBQ评分用于区分有松动和无松动患者的最佳截止值计算为3.045，灵敏度为85.7％，特异性为76.9％。而HU值的最佳截断值为151.5，敏感性为64.6%，特异性为89.5%。
结论：发现PBQ评分与腰椎椎弓根螺钉松动倾向之间存在实质性关联。作为一种预测措施，在预测腰椎后路融合后螺钉松动的可能性方面,PBQ评分优于HU值.
