Abstract
Although osteoporosis has negative impacts on lumbar fusion, its effects on screw loosening in dynamic stabilization remain elusive. We aimed to correlate bone mineral density (BMD) with screw loosening in Dynesys dynamic stabilization (DDS). Consecutive patients who underwent 2- or 3-level DDS for spondylosis, recurrent disc herniations, or low-grade spondylolisthesis at L3-5 were retrospectively reviewed. BMD was assessed by the Hounsfield Unit (HU) in vertebral bodies (VB) and pedicles with and without cortical bone (CB) on pre-operative computed tomography (CT). Screw loosening was assessed by radiographs and confirmed by CT. HU values were compared between the loosened and intact screws. 176 patients and 918 screws were analyzed with 78 loosened screws found in 36 patients (mean follow-up: 43.4 months). The HU values of VB were similar in loosened and intact screws (p = 0.14). The HU values of pedicles were insignificantly less in loosened than intact screws (including CB: 286.70 ± 118.97 vs. 297.31 ± 110.99, p = 0.45; excluding CB: 238.48 ± 114.90 vs. 240.51 ± 108.91, p = 0.88). All patients had clinical improvements. In conclusion, the HU values, as a surrogate for BMD, were unrelated to screw loosening in DDS. Therefore, patients with compromised BMD might be potential candidates for dynamic stabilization rather than fusion.
Highlights
Osteoporosis has negative impacts on lumbar fusion, its effects on screw loosening in dynamic stabilization remain elusive
There are scant reports on the correlation of bone mineral density (BMD) and success of Dynesys dynamic stabilization (DDS). Since it remains elusive in the literature how BMD would affect the success of DDS in lumbar spine surgery, the current study aimed to evaluate BMD by Hounsfield Unit (HU) values and correlate with the incidences of screw loosening in a series of patients who underwent surgery
We found that the vertebral bodies (VB) HU was not significantly different between the loosened screws and the intact screws
Summary
Osteoporosis has negative impacts on lumbar fusion, its effects on screw loosening in dynamic stabilization remain elusive. We aimed to correlate bone mineral density (BMD) with screw loosening in Dynesys dynamic stabilization (DDS). There are scant reports on the correlation of BMD and success of DDS Since it remains elusive in the literature how BMD would affect the success of DDS in lumbar spine surgery, the current study aimed to evaluate BMD by HU values and correlate with the incidences of screw loosening in a series of patients who underwent surgery. To date, this is the first study to address the correlation between HU and screw loosening in DDS
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