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Pedicle screw fixation in single-level, double-level or multilevel posterior lumbar fusion for osteoporotic spine: A retrospective study with a minimum 2-year follow-up.

BACKGROUND: Pedicle screw loosening is a common postoperative complication for osteoporotic patients, and several studies have found the important role of fusion length in internal fixation failure, but the relationship between the number of fusion segments and the potential risks is still unclear. This study aimed to investigate the rate and risk factors of screw loosening in osteoporotic patients with different segment degenerative lumbar diseases.

METHODS: 217 patients were divided into 3 groups according to the different fusion levels: single-level (group A, 100 cases), double-level (group B, 73 cases), and multilevel fusion group (group C, 44 cases). Patient baseline demographic characteristics were compared. Furthermore, we also assessed the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) before operation and at the last follow-up.

RESULTS: Compared with pre-operative value, the scores of VAS and ODI of the last follow-up were significantly improved for these three groups. And in terms of the operative time, blood loss, hospital stay, screw loosening rate, fusion rate as well as VAS and ODI scores of the last follow-up, all of them obviously increased with the increasing of fusion segments (group C> group B> group A). It is worth noting that all the screw loosening was observed in cranial and caudal vertebra. Furthermore, the multivariate logistic regression analysis indicated that lumbosacral fixation, larger PI-LL, and larger post-operation PT are the independent predictors for screw loosening. However, gender, BMD, BMI, LL, SS, PI, the change of LL, and pre-operation PT are not relevant to the screw loosening (P>0.05).

CONCLUSIONS: Owing to the high rate of screw loosening in cranial and caudal vertebra, osteoporotic patients with double-level or multilevel pedicle screw fixation benefited less than those with single-level pedicle screw fixation. Larger PI-LL, larger PT, and lumbosacral fixation are other risk factors for the loosening of screw. An instrument with stronger holding strength at cranial and caudal pedicle screws is recommended for those high-risk patients.

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