CORRELATION BETWEEN QUALITY OF LIFE AND OSTEOLYSIS AROUND LUMBAR PEDICLE SCREWS

ABSTRACT Objective: To evaluate whether the presence of osteolysis around the pedicle screws affects the quality of life of patients who underwent posterolateral arthrodesis of the lumbosacral spine. Methods: A retrospective study of patients undergoing lumbar posterolateral or lumbosacral arthrodesis due to spinal degenerative disease. CT scans of the operated segments were performed at intervals of 45, 90, 180, and 360 postoperatively. In these tests, the presence of a peri-implant radiolucent halo was investigated, which was considered present when greater than 1mm in the coronal section. Concurrently with the completion of CT scans, the participants completed the questionnaire Oswestry Disability Index (ODI) to assess the degree of disability of the patients. Results: A total of 38 patients were evaluated, and 14 (36.84%) of them showed some degree of osteolysis around at least one pedicle screw at the end of follow-up. Of the 242 analyzed screws, 27 (11.15%) had osteolysis in the CT coronal section, with the majority of these occurrences located at the most distal level segment of the arthrodesis. There was no correlation between the presence of the osteolysis to the quality of life of patients. The quality of life has significantly improved when comparing the preoperative results with the postoperative results at different times of application of ODI. This improvement in ODI maintains linearity over time. Conclusion: There is no correlation between the presence of peri-implant osteolysis to the quality of life of patients undergoing lumbar or posterolateral lumbosacral arthrodesis in the follow-up period up to 360 days. The quality of life in postoperative has significantly improvement when compared to the preoperative period.

摘要 目的：评估腰骶椎后外侧融合术后椎弓根螺钉周围骨溶解是否对患者生活质量产生影响。方法：针对因脊柱退行性疾病接受腰椎后外侧或腰骶椎融合术的患者开展回顾性研究。于术后45、90、180及360天对手术节段行CT扫描，观察植入物周围是否存在透光晕影，当冠状位层面上该晕影直径大于1mm时，即可判定存在骨溶解。在完成CT扫描的同时，受试者需填写Oswestry功能障碍指数（Oswestry Disability Index, ODI）问卷以评估患者功能障碍程度。结果：本研究共纳入38例患者，随访结束时，其中14例（36.84%）至少1枚椎弓根螺钉周围出现不同程度的骨溶解。本次共分析242枚螺钉，其中27枚（11.15%）在CT冠状位层面显示存在骨溶解，此类骨溶解多位于融合术最远端节段。椎弓根螺钉周围骨溶解的存在与患者生活质量无相关性。对比术前与术后各时间点的ODI评分，患者生活质量均得到显著改善，且该改善程度随时间呈线性变化。结论：在术后长达360天的随访期内，接受腰椎或腰骶椎后外侧融合术的患者，其植入物周围骨溶解的发生情况与生活质量无相关性。与术前相比，患者术后生活质量得到显著提升。