A Nomogram for Predicting Screw Loosening After Single-level Posterior Lumbar Interbody Fusion Utilizing Cortical Bone Trajectory Screw: A Minimum 2-year Follow-up Study

Overview

Journal Front Surg

Specialty General Surgery

Date 2022 Oct 31

PMID 36311946

Authors

Yiqi Zhang

Yue Li

Yong Hai

Li Guan

Xinuo Zhang

Aixing Pan

Hongyi Lu

Bingchao Wu

Yuzeng Liu

Affiliations

Soon will be listed here.

Abstract

Purpose: This study aims to investigate the risk factors for screw loosening after single-level posterior lumbar interbody fusion (PLIF) utilizing cortical bone trajectory (CBT) screw and establish a nomogram for predicting screw loosening.

Methods: A total of 79 patients (316 screws) who underwent single-level PLIF with CBT screw were included in the study. Preoperative, postoperative, and final follow-up demographic data, surgical data, and radiographic parameters were documented and analyzed to identify risk factors, and a predictive nomogram was established for screw loosening. The nomogram was assessed by concordance index (C-index), calibration plot, decision curve analysis (DCA), and internal validation.

Results: The incidence of screw loosening was 26.6% in 79 patients and 11.4% in 316 screws. Multifactorial regression analysis confirmed that fixed to S1 (FS1, OR = 3.82, 95% CI 1.12-12.71, = 0.029), the coronal angle of the screw (CA, OR = 1.07, 95% CI 1.01-1.14, = 0.039), and cortical bone contacted layers (CBCLs, OR = 0.17, 95% CI 0.10-0.29, < 0.001) were risk factors and incorporated in the nomogram for predicting screw loosening after single-level PLIF with a CBT screw. The C-index of the nomogram was 0.877 (95% CI 0.818-0.936), which demonstrated good predictive accuracy. The calibration plot indicated an acceptable calibration of the nomogram that also had a positive benefit in guiding treatment decisions.

Conclusion: FS1, CA, and CBCLs are identified to be significant risk factors for screw loosening after single-level PLIF with the CBT technique. The nomogram we have established can be used to predict screw loosening and contribute to surgical decisions.

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