A screw position change at an early postoperative stage preceding the subsequent occurrence of screw loosening

Satoru Tanioka, Masashi Fujimoto, Hirofumi Nishikawa, Fujimaro Ishida, Masanori Tsuji, Katsuhiro Tanaka, Yusuke Kamei, Keita Kuraishi, Hidenori Suzuki, Masaki Mizuno

January 2021, Volume 30, Issue 1, pp 136 - 141 Original Article Read Full Article 10.1007/s00586-020-06510-8

First Online: 23 June 2020

A screw position change at an early postoperative stage preceding the subsequent occurrence of screw loosening

Purpose

The authors recently proposed the novel radiologic assessment method to measure chronological screw position changes precisely. The aim of this study was to predict the late occurrence of screw loosening, which was diagnosed by the radiographic lucent zone, by evaluating screw position changes at an early postoperative stage using the novel method.

Methods

Forty-three patients who underwent thoracolumbar screw fixation and follow-up computed tomography (CT) scans on the day, between 1 and 5 weeks, and at more than 6 months after surgery were retrospectively evaluated. Screw images were generated from CT data. Screw position changes were evaluated by superposing screw images on the day and between 1 and 5 weeks after surgery. Screw loosening was diagnosed by the radiographic lucent zone on CT images at 6 months or later post-surgery, and patients were classified into screw loosening and non-loosening groups. The early screw position changes were compared between the two groups.

Results

Significant differences in early screw position changes were found between the screw loosening and non-loosening groups in Mann–Whitney U test (p = 0.001). On the receiver operating characteristic (ROC) curve analysis, the area under the ROC curve was 0.791, and the best cutoff value of early screw position change for the prediction of screw loosening was 0.83 mm with a sensitivity of 64.0% and a specificity of 88.9%.

Conclusion

We calculated a cutoff value of the screw position changes at an early postoperative stage for the prediction of subsequent development of screw loosening with the radiographic lucent zone.

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