ArticleBMC surgery2026
S
Article in BMC surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis study aimed to evaluate the predictive value of CT-based S1 Hounsfield Unit (HU) measurements for postoperative pedicle screw loosening (PSL) in patients with lumbar degenerative diseases who underwent posterior lumbar interbody fusion (PLIF).
methodsConsecutive patients who underwent PLIF at our institution between January 2016 and June 2024 were retrospectively analyzed. The L1 and S1 HU values were obtained using CT, whereas L1–L4 and S1 vertebral bone quality (VBQ) scores were obtained using MRI. Multivariate logistic regression analysis was performed to identify independent predictors of PSL. The area under the receiver operating characteristic curve (AUC) was used to assess the predictive performance of bone quality parameters. Optimal cutoff values were determined using the Youden index.
resultsA total of 285 patients were included. The PSL rate was 21.40% (61/285). The loosening group demonstrated a lower L1 and S1 HU values, and higher L1–L4 and S1 VBQ scores (P < 0.001) than the non-loosening group. Multivariable logistic regression analysis identified lowest instrumented vertebra (LIV) at S1 (P = 0.001) and L1 (P < 0.001) and S1 HU values (P < 0.001) and L1–L4 (P = 0.026) and S1 VBQ scores (P < 0.001) as independent predictors of PSL. The AUCs for L1 and S1 HU values and L1–L4 and S1 VBQ scores were 0.772, 0.770, 0.730, and 0.753, respectively.
conclusionsWhen conventional bone mineral density metrics are unavailable, the S1 HU value serves as an effective preoperative predictor. Notably, S1 HU demonstrated a higher discriminative capacity for PSL than the S1 VBQ score. Furthermore, integrating L1 and S1 HU values yielded markedly superior predictive efficiency compared with either parameter assessed independently.
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