骨矿物质密度(BMD)降低会损害骨小梁中的螺钉购买,并可能导致脊柱器械后螺钉松动。现有的计算机断层扫描(CT)扫描可用于机会性骨质疏松症筛查,以降低BMD。这项病例对照研究的目的是研究机会性评估的BMD与使用半刚性器械进行腰椎退行性不稳的脊柱手术后的结果之间的关系。
我们回顾了在我们医院接受半刚性器械初次手术的连续患者。随访影像学显示螺钉松动的患者以病例为准。未显示螺钉松动的患者,或者-如果没有随访影像学检查(n=8)-报告了初次手术后≥6个月的手术获益,可作为对照。匹配标准是性别,年龄,和外科构造。在围手术期CT扫描中,通过自动脊柱分割和异步校准,在L1至L4进行机会性BMD筛查。这种深度学习驱动方法的处理步骤可以使用免费提供的在线工具Anduin(https://anduin。骨屏。de).计算BMD的曲线下面积(AUC)作为螺钉松动的预测因子。
纳入46例老年患者(69.9±9.1岁)-23例和23例对照。大多数手术涉及三个脊柱运动节段(n=34)。20例骨量低,13例骨质疏松BMD。病例的平均BMD(86.5±29.5mg/cm3)明显低于对照组(118.2±32.9mg/cm3,p=0.001),即螺钉松动患者BMD降低。螺钉松动最好通过BMD<81.8mg/cm²来预测(灵敏度=91.3%,特异性=56.5%,AUC=0.769,p=0.002)。
在接受脊柱手术的老年患者组中,骨质疏松症或低骨量(BMD≤120mg/cm²)的患病率相对较高。螺钉松动与骨密度接近骨质疏松阈值(<80mg/cm3)相关。使用所提出的方法进行机会性BMD筛查是可行的,并且可以指导外科医生采取措施以防止螺钉松动并增加有利的结果。
Decreased bone mineral density (BMD) impairs screw purchase in trabecular bone and can cause screw loosening following spinal instrumentation. Existing computed tomography (CT) scans could be used for opportunistic osteoporosis screening for decreased BMD. Purpose of this
case-control study was to investigate the association of opportunistically assessed BMD with the outcome after spinal surgery with semi-rigid instrumentation for lumbar degenerative instability.
We reviewed consecutive patients that had primary surgery with semi-rigid instrumentation in our hospital. Patients that showed screw loosening in follow-up imaging qualified as cases. Patients that did not show screw loosening or-if no follow-up imaging was available (n = 8)-reported benefit from surgery ≥ 6 months after primary surgery qualified as controls. Matching criteria were sex, age, and surgical construct. Opportunistic BMD screening was performed at L1 to L4 in perioperative CT scans by automatic spine segmentation and using asynchronous calibration. Processing steps of this deep learning-driven approach can be reproduced using the freely available online-tool Anduin (https://anduin.bonescreen.de). Area under the curve (AUC) was calculated for BMD as a predictor of screw loosening.
Forty-six elderly patients (69.9 ± 9.1 years)-23 cases and 23 controls-were included. The majority of surgeries involved three spinal motion segments (n = 34). Twenty patients had low bone mass and 13 had osteoporotic BMD. Cases had significantly lower mean BMD (86.5 ± 29.5 mg/cm³) compared to controls (118.2 ± 32.9 mg/cm³, p = 0.001), i.e. patients with screw loosening showed reduced BMD. Screw loosening was best predicted by a BMD < 81.8 mg/cm³ (sensitivity = 91.3%, specificity = 56.5%, AUC = 0.769, p = 0.002).
Prevalence of osteoporosis or low bone mass (BMD ≤ 120 mg/cm³) was relatively high in this group of elderly patients undergoing spinal surgery. Screw loosening was associated with BMD close to the threshold for osteoporosis (< 80 mg/cm³). Opportunistic BMD screening is feasible using the presented approach and can guide the surgeon to take measures to prevent screw loosening and to increase favorable outcomes.