J Korean Neurosurg Soc.  2015 Oct;58(4):357-362. 10.3340/jkns.2015.58.4.357.

The Effects of Spinopelvic Parameters and Paraspinal Muscle Degeneration on S1 Screw Loosening

• Kim JB
• Park SW
• Lee YS
• Nam TK
• Park YS
• Kim YB

• KMID: 2114373
• DOI: http://doi.org/10.3340/jkns.2015.58.4.357

Abstract

OBJECTIVE
To investigate risk factors for S1 screw loosening after lumbosacral fusion, including spinopelvic parameters and paraspinal muscles.
METHODS
We studied with 156 patients with degenerative lumbar disease who underwent lumbosacral interbody fusion and pedicle screw fixation including the level of L5-S1 between 2005 and 2012. The patients were divided into loosening and non-loosening groups. Screw loosening was defined as a halo sign larger than 1 mm around a screw. We checked cross sectional area of paraspinal muscles, mean signal intensity of the muscles on T2 weight MRI as a degree of fatty degeneration, spinopelvic parameters, bone mineral density, number of fusion level, and the characteristic of S1 screw.
RESULTS
Twenty seven patients showed S1 screw loosening, which is 24.4% of total. The mean duration for S1 screw loosening was 7.3+/-4.1 months after surgery. Statistically significant risk factors were increased age, poor BMD, 3 or more fusion levels (p<0.05). Among spinopelvic parameters, a high pelvic incidence (p<0.01), a greater difference between pelvic incidence and lumbar lordotic angle preoperatively (p<0.01) and postoperatively (p<0.05). Smaller cross-sectional area and high T2 signal intensity in both multifidus and erector spinae muscles were also significant muscular risk factors (p<0.05). Small converging angle (p<0.001) and short intraosseous length (p<0.05) of S1 screw were significant screw related risk factors (p<0.05).
CONCLUSION
In addition to well known risk factors, spinopelvic parameters and the degeneration of paraspinal muscles also showed significant effects on the S1 screw loosening.

Keyword

Lumbosacral region; Pedicle screws; Instrumentation; Muscle; Spinal fusion; Risk factors

MeSH Terms

Bone Density
Humans
Incidence
Lumbosacral Region
Magnetic Resonance Imaging
Muscles
Paraspinal Muscles*
Risk Factors
Spinal Fusion

Figure

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  Fig. 1 Halo sign around S1 screws (arrows) on simple radiograph (A) and CT (B).

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  Fig. 2 Paraspinal muscles at L5-S1 level, multifidus muscle (MF), erector spinae muscle (ES), and psoas muscle (PS).

• 

  Fig. 3 A : Sagittal angle of S1 screw between screw and upper end plate of S1 vertebra on simple lateral radiograph. B : Axial angle of S1 screw between screw and vertical line (a) and intraosseous length of S1 screw as the length of intraosseous portion of the screw on postoperative CT (b).

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