Effects of smoking on pedicle screw–based dynamic stabilization: radiological and clinical evaluations of screw loosening in 306 patients (original) (raw)
Related papers
Spine, 2014
Objective. To study the impact of smoking status on postoperative complications and pseudarthrosis in adult patients undergoing posterolateral fusion (PLF) of the lumbar spine. Summary of Background Data. Results of studies analyzing the impact of smoking on complication and pseudarthrosis rates after spine surgery are confl icting. Methods. A retrospective medical record review was performed to identify all adult patients who underwent single-and 2-level instrumented PLF without interbody devices for degenerative spine disease in a 21-year period at a single institution. Patients were divided into smokers and nonsmokers. The main outcome variables were development of at least one postoperative complication and development of pseudarthrosis. Results. A total of 281 patients underwent single-or 2-level PLF in the 21-year period. Of these, 231 (82.21%) patients were nonsmokers and 50 (17.9%) were smokers. For patients undergoing single-level PLF, complication rates in nonsmokers (3.57%) versus smokers (7.69%) were not signifi cantly different ( P = 0.353); pseudarthrosis in nonsmokers occurred in 9.82% of cases compared with 7.69% in the smokers group ( P = 0.738). Nonsmokers undergoing 2-level PLF had complication rates of 6.72%, compared with 4.17% in smokers ( P = 0.638), but pseudarthrosis rates were signifi cantly higher in the smokers group than in the nonsmokers group (29.17% vs . 10.92%; P = 0.019). Patients were followed up for an average of 53.5 months. Conclusion. The fi ndings in this study suggest that smoking has a signifi cant impact on pseudarthrosis rates after 2-level PLF of the lumbar spine, but not necessarily on single-level PLF.
Effects of smoking on cervical disc arthroplasty
Journal of Neurosurgery: Spine, 2019
OBJECTIVECigarette smoking can adversely affect bone fusion in patients who undergo anterior cervical discectomy and fusion. However, there is a paucity of data on smoking among patients who have undergone cervical disc arthroplasty (CDA). The present study aimed to compare the clinical and radiological outcomes of smokers to those of nonsmokers following CDA.METHODSThe authors retrospectively reviewed the records of consecutive patients who had undergone 1- or 2-level CDA for cervical disc herniation or spondylosis and had a minimum 2-year follow-up. All patients were grouped into a smoking group, which consisted of those who had consumed cigarettes within 6 months prior to the CDA surgery, or a nonsmoking group, which consisted of those who had not consumed cigarettes at all or within 6 months of the CDA. Clinical outcomes were evaluated according to the visual analog scale for neck and arm pain, Neck Disability Index, Japanese Orthopaedic Association Scale, and Nurick Scale at ea...
2010
Background Smoking is associated with reduced fusion rates after anterior cervical decompression and arthrodesis procedures. Posterior cervical arthrodesis procedures are believed to have a higher fusion rate than anterior procedures. Questions/purposes We asked whether smoking (1) would reduce the fusion rate in posterior cervical procedures; and (2) be associated with increased pain, decreased activity level, and a decreased rate of return of work as compared with nonsmokers. Methods We retrospectively reviewed 158 patients who had a posterior cervical fusion with lateral mass instru-mentation and iliac crest bone grafting between 2003 and 2008. Fusion rates and Odom Criteria grades were com-pared among smokers and nonsmokers. The minimum followup was 3 months (average, 14.5 months; range, 3–72 months). Results Smokers and nonsmokers had similar fusion rates (100%). Although 80 % of patients had Odom Criteria Grade I or II, smokers were five times more likely to have Grade III or ...
Screw Loosening in Posterior Spine Fusion: Prevalence and Risk Factors
Global Spine Journal
Study Design: Retrospective cohort study. Objective: Screw loosening in spinal fusion is poorly defined. Accordingly, its prevalence rates range from 1% to 60%, and its risk factors remain undefined. The goal of this study was to assess the prevalence of screw loosening, according to precise definitions, and to identify factors associated with it. Methods: We retrospectively reviewed records for 166 patients who underwent a posterior spinal fusion in our institution between 2011 and 2016. We recorded demographic data, osteoporosis, pelvic balance, surgery-related information, and postoperative radiographic data at a minimum follow-up of 6 months. Univariable and multivariable logistic regression models were used. Significance was defined by P < .05. Results: When loosening was defined by partial pull-out, its prevalence was 9.6% (95% CI 5.6-15); thoracic localization, the use of CrCo (chromium-cobalt) rods, osteoporosis, PI/LL (pelvic incidence/lumbar lordosis) mismatch (preopera...
International Journal of Spine Surgery, 2020
Background: Smoking is a known predictor of negative outcomes in spinal surgery. However, its effect on the functional outcomes and revision rates after ADR is not well-documented. This study is a retrospective analysis of prospectively collected data at a major tertiary center. The objective was to elucidate the impact of smoking on functional outcomes in cervical artificial disc replacement (ADR). Methods: Patients who underwent cervical ADR for myelopathy or radiculopathy from 2004 to 2015 with a minimum of 2 years of follow-up were included in the study. Patient function was assessed using Short Form-36 (SF-36), American Association of Orthopaedic Surgery (AAOS) cervical spine, and Japanese Orthopaedic Association (JOA) scoring systems preoperatively and at 2 years postoperatively. Incidence of further surgery on affected and adjacent segments was analyzed as well. Results: A total of 137 patients were included in the study, consisting of 117 nonsmokers and 20 smokers. There were 60 patients who presented with myelopathy and 77 with radiculopathy. The mean age of smokers was 42.6 years, compared with 46.4 years in the nonsmoker group (P , .01). Statistical improvement was noted in postoperative range of motion, as well as AAOS, SF-36, and JOA scores in both groups, with no difference between groups at 2 years of follow-up. A total of 84.2% of nonsmokers and 87.5% of smokers reported as surgery having met their expectations. A total of 5 of 117 nonsmokers (5.1%) and 4 of 20 smokers (20%) needed revision surgery (P ¼ .018). Three of the 4 smokers who required surgery for adjacent or multisegment disease, whereas only 2 of the nonsmokers needed an operation for adjacent segment disease. Conclusions: Our analysis indicates that there is no difference in functional outcome or patient satisfaction between smokers and nonsmokers. Smokers have a higher chance of revision surgery after an artificial disc replacement compared with nonsmokers at 2 years. Level of Evidence: 3.
The Spine Journal, 2019
The mean clivus-canal angle improved from 113.0 degrees preoperatively to 148.4 degrees postoperatively. Shrinkage of the syrinx was observed in 6 patients in one week after surgery. Nine patients had 18month follow-up and achieved bone fusion. Twenty-two patients have a 12-month follow-up, and 19 (86.3%) achieved bony fusion. Unilateral vertebral artery occlusion was diagnosed in 2 cases without clinical symptoms. CONCLUSIONS: It appears effective and safe to treat irreducible AAD associated with BI by releasing the anterior soft tissue from a posterior approach. Cage implantation within the facet and fixation using cantilever can achieve complete reduction in most cases. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Clinical Orthopaedics & Related Research, 2010
Background Smoking is associated with reduced fusion rates after anterior cervical decompression and arthrodesis procedures. Posterior cervical arthrodesis procedures are believed to have a higher fusion rate than anterior procedures. Questions/purposes We asked whether smoking (1) would reduce the fusion rate in posterior cervical procedures; and (2) be associated with increased pain, decreased activity level, and a decreased rate of return of work as compared with nonsmokers. Methods We retrospectively reviewed 158 patients who had a posterior cervical fusion with lateral mass instrumentation and iliac crest bone grafting between 2003 and 2008. Fusion rates and Odom Criteria grades were compared among smokers and nonsmokers. The minimum followup was 3 months (average, 14.5 months; range, 3-72 months). Results Smokers and nonsmokers had similar fusion rates (100%). Although 80% of patients had Odom Criteria Grade I or II, smokers were five times more likely to have Grade III or IV with considerable limitation of physical activity. Age, gender, and diagnosis did not influence fusion rates or the Odom Criteria grade. Conclusions In contrast to the effect of smoking on anterior cervical fusion, we found smoking did not decrease posterior cervical fusion with lateral mass instrumentation and iliac crest bone grafting. Posterior cervical fusion with lateral mass instrumentation should be considered over anterior procedures in smokers if the abnormality can appropriately be addressed from a posterior approach. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
The adverse events in lumbar dynamic stabilization: a prospective case series
International Archives of Medicine, 2015
Background: We aimed to evaluate the complication rate in lumbar dynamic stabilization surgery of back pain in situations where conventional rigid implants could have been employed, with a follow-up of at least five years. Methods and Findings: Prospective study. There were included, all patients who underwent semi-rigid fixation of lumbar spine with the dynamic system during the period 2004 to 2010 in our department. Adverse events and reoperations were registered for analysis. In the study period, 144 patients were treated with the dynamic system and all of them were studied. Three screws were badly positioned. There were two (1.39%) infections, with need of surgical cleaning in one case. Out of 770 screws, the late complications included a radiolucency signal in 22 screws (2.86%) and four broken screws (0.52%). Nineteen patients (20.13%) needed reoperation due to pain or screw associated problems. Three (2.08%) of those cases received additional treatment due to segmental kyphosis, five (3.47%) due to flat back, five (3.47%) due to adjacent level stenosis, four (2.7%) due to lumbar pain complaints, and two (1.39%) due to a broken screw. Conclusions: The lumbar dynamic stabilization system is a fusion option for the treatment of degenerative spinal diseases. However it is not free of adverse events, the rates of implant failures, complications, and reoperations found in this study are similar to those described in the published literature about rigid systems.
Trials
Background: Spinal fusion with pedicle screw fixation represents the gold standard for lumbar degenerative disc disease with instability. Although it is an established technique, it is nevertheless an invasive intervention with high complication rates. Therefore, minimally invasive approaches have been developed, the medialized bilateral screw pedicel fixation (mPACT) being one of them. The study objective is to evaluate prospectively the efficacy and safety of the mPACT technique compared with the traditional trajectory for degenerative lumbar spondylolisthesis. Methods/design: This is a single-center, randomized, controlled, parallel group, superiority trial. A total of 154 adult patients are allocated in a ratio of 1:1. Sample size and power calculation were performed to detect the minimal clinically important difference of 10%, with an expected standard deviation of 20% in the primary outcome parameter, the Oswestry Disability Index, with power of 80%, based on an assumed maximal dropout rate of 20%. Secondary outcome parameters include the EuroQoL 5-Dimension questionnaire, the Beck Depression Inventory, the painDETECT questionnaire and the "timed up and go" test. Furthermore, radiological and health economic outcomes will be evaluated. Follow up is performed until 5 years after surgery. Major inclusion criteria are lumbar degenerative spondylolisthesis with Meyerding grade I or II, which qualifies for decompression and fusion by medialised posterior screw placement with cortical trajectory (mPACT) or by a traditional trajectory for lumbar pedicle screw placement. Discussion: This trial will contribute to the understanding of the short-term and long-term clinical and radiological postoperative course in patients with lumbar degenerative disc disease, in which the mPACT technique is used.