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.

Autor: Hekimoglu M; Department of Neurosurgery, American Hospital, Istanbul 34365, Turkey., Akgun MY; Department of Neurosurgery, Koc University Hospital, Istanbul 34010, Turkey., Ozer H; Department of Neurosurgery, Ordu University, Ordu 52200, Turkey., Basak AT; Department of Neurosurgery, American Hospital, Istanbul 34365, Turkey., Ucar EA; Department of Neurosurgery, Koc University Hospital, Istanbul 34010, Turkey., Oktenoglu T; Department of Neurosurgery, American Hospital, Istanbul 34365, Turkey.; Department of Neurosurgery, Koc University Hospital, Istanbul 34010, Turkey., Ates O; Department of Neurosurgery, Koc University Hospital, Istanbul 34010, Turkey., Ozer AF; Department of Neurosurgery, Koc University Hospital, Istanbul 34010, Turkey.; Spine Center, Koc University Hospital, Istanbul 34010, Turkey.
Jazyk: angličtina
Zdroj: Diagnostics (Basel, Switzerland) [Diagnostics (Basel)] 2024 Jul 12; Vol. 14 (14). Date of Electronic Publication: 2024 Jul 12.
DOI: 10.3390/diagnostics14141505
Abstrakt: 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.
Databáze: MEDLINE
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