Risk factors for screw loosening in patients with adult degenerative scoliosis: the importance of paraspinal muscle degeneration

Abstract

Background Paraspinal muscle is an important component to maintain spinal stability. But the relationship between the degeneration of paraspinal muscle and postoperative screw loosening in patients with adult degenerative scoliosis has not been studied. The objective of this study was to investigate risk factors for screw loosening in patients with adult degenerative scoliosis, including paraspinal muscle degeneration. Methods We investigated 93 patients with adult degenerative scoliosis who underwent spinal interbody fusion and pedicle screw fixation surgery. The lateral curvature was located in the lumbar spine and the follow-up time was ≥ 2 years. The patients were divided into loosening and non-loosening groups. Screw loosening was defined as a 1-mm or wider circumferential radiolucent line around the pedicle screw. We checked the cross-sectional area of paraspinal muscles, spinopelvic parameters, bone mineral density, number of fusion segment, and other factors. The potential risk factors for screw loosening were investigated by using binary logistical regression analysis. Results Fifty-seven patients showed screw loosening, which is 63.4% of total. Compared with patients in the non-loosening group, the cross-sectional area of erector spinae and psoas major muscle at L5 level were significantly smaller in patients with screw loosening (P < 0.05). Among these factors, the number of fused segments and relative erector spinae total cross-sectional area were independent risk factors for screw loosening. Conclusions The degeneration of paraspinal muscle and the increase of fusion segment were independent factors for screw loosening in patients with adult degenerative scoliosis.

The Establishment of a Mouse Model for Degenerative Kyphoscoliosis Based on Senescence-Accelerated Mouse Prone 8

“…Alterations in muscle structure and function, especially fatty infiltration and fibrosis, are clearly associated with spinal disorders [36]. An increasing number of studies have shown that in patients with DKS, the cross-sectional area of the lumbar erector spinae and psoas major is significantly thinner, and pathological assessment shows muscle atrophy, necrosis, and hyaline fibrosis, while muscle fat infiltration and inflammatory cell infiltration are more pronounced [37][38][39]. Therefore, we also performed pathological examination of the paraspinal muscle tissue of DKS mice by HE staining and Masson staining.…”

The role of paraspinal muscle degeneration in coronal imbalance in patients with degenerative scoliosis

“…Several studies reported lower preoperative thoracolumbar muscle quality in patients with proximal junctional kyphosis (PJK) and even muscle degeneration as a risk factor for occurrence of PJK (39)(40)(41). Furthermore, several studies reported that poor muscle quality is correlated with distal screw loosening in patients with DS after corrective surgery (42)(43)(44).…”

Is There a Relationship between Idiopathic Scoliosis and Body Mass? A Scoping Review

“…This is probably because, in predisposed subjects, from the biomechanical point of view, the pushing force of the paravertebral muscles is lost, which is essential to counteract the establishment and evolution of the scoliotic curve [ 26 , 40 , 41 ].…”

“…Some studies [ 34 , 35 , 45 ] have hypothesized that the relationship between low body mass index and scoliosis may be a consequence of hormonal problems [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ].…”