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Background <p>This study aimed to evaluate the predictive value of CT-based S<sub>1</sub> Hounsfield Unit (HU) measurements for postoperative pedicle screw loosening (PSL) in patients with lumbar degenerative diseases who underwent posterior lumbar interbody fusion (PLIF).</p> Methods <p>Consecutive patients who underwent PLIF at our institution between January 2016 and June 2024 were retrospectively analyzed. The L<sub>1</sub> and S<sub>1</sub> HU values were obtained using CT, whereas L<sub>1</sub>–L<sub>4</sub> and S<sub>1</sub> 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.</p> Results <p>A total of 285 patients were included. The PSL rate was 21.40% (61/285). The loosening group demonstrated a lower L<sub>1</sub> and S<sub>1</sub> HU values, and higher L<sub>1</sub>–L<sub>4</sub> and S<sub>1</sub> VBQ scores (<i>P</i> &lt; 0.001) than the non-loosening group. Multivariable logistic regression analysis identified lowest instrumented vertebra (LIV) at S<sub>1</sub> (<i>P</i> = 0.001) and L<sub>1</sub> (<i>P</i> &lt; 0.001) and S<sub>1</sub> HU values (<i>P</i> &lt; 0.001) and L<sub>1</sub>–L<sub>4</sub> (<i>P</i> = 0.026) and S<sub>1</sub> VBQ scores (<i>P</i> &lt; 0.001) as independent predictors of PSL. The AUCs for L<sub>1</sub> and S<sub>1</sub> HU values and L<sub>1</sub>–L<sub>4</sub> and S<sub>1</sub> VBQ scores were 0.772, 0.770, 0.730, and 0.753, respectively.</p> Conclusions <p>When conventional bone mineral density metrics are unavailable, the S<sub>1</sub> HU value serves as an effective preoperative predictor. Notably, S<sub>1</sub> HU demonstrated a higher discriminative capacity for PSL than the S<sub>1</sub> VBQ score. Furthermore, integrating L<sub>1</sub> and S<sub>1</sub> HU values yielded markedly superior predictive efficiency compared with either parameter assessed independently.</p>

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S1 vertebral Hounsfield Unit value independently predicts pedicle screw loosening after posterior lumbar interbody fusion in patients with lumbar degenerative diseases

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  • 发表日期：

    2026年2月9日

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  • Han Ke,
  • Minghui Liang,
  • Yu Xi,
  • Ruiyuan Chen,
  • Congying Zou,
  • Tianyi Wang,
  • Aobo Wang,
  • Ziqian Ma,
  • Ning Fan,
  • Shuo Yuan,
  • Lei Zang

摘要

Background

This 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).

Methods

Consecutive 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.

Results

A 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.

Conclusions

When 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.