Screw Loosening in Posterior Spine Fusion: Prevalence and Risk Factors (original) (raw)
Related papers
Posterior Spinal Fusion Using Pedicle Screws
Orthopedics, 2013
Few clinical studies have reported polyetheretherketone (PEEK) rod pedicle screw spinal instrumentation systems (CD-Horizon Legacy PEEK rods; Medtronic, Minneapolis, Minnesota). This article describes a clinical series of 52 patients who underwent posterior spinal fusion using the PEEK Rod System between 2007 and 2010. Of the 52 patients, 25 had degenerative disk disease, 10 had lateral recess stenosis, 6 had degenerative spondylolisthesis, 6 had lumbar spine vertebral fracture, 4 had combined lateral recess stenosis and degenerative spondylolisthesis, and 1 had an L5 giant cell tumor. Ten patients had 1-segment fusion, 29 had 2-segment fusion, and 13 had 3-segment fusion. Mean follow-up was 3 years (range, 1.5-4 years); no patient was lost to follow-up. Clinical evaluation was performed using the Oswestry Disability Index and a low back and leg visual analog pain scale. Imaging evaluation of fusion was performed with standard and dynamic radiographs. Complications were recorded. Mean Oswestry Disability Index scores improved from 76% preoperatively (range, 52%-90%) to 48% at 6 weeks postoperatively, and to 34%, 28%, and 30% at 3, 6, and 12 months postoperatively, respectively. Mean low back and leg pain improved from 8 and 9 points preoperatively, respectively, to 6 and 5 points immediately postoperatively, respectively, and to 2 points each thereafter. Imaging union of the arthrodesis was observed in 50 (96%) patients by 1-year follow-up. Two patients sustained screw breakage: 1 had painful loss of sagittal alignment of the lumbar spine and underwent revision spinal surgery with pedicle screws and titanium rods and the other had superficial wound infection and was treated with wound dressing changes and antibiotics for 6 weeks. No adjacent segment degeneration was observed in any patient until the time of this writing.
The Spine Journal, 2020
BACKGROUND CONTEXT: Addition of interbody fusion via a transforaminal approach (TLIF) has become a popular surgical option for treatment of degenerative lumbar conditions. Although technically more complicated than posterolateral fusion surgery (PLF), it has been suggested that TLIF provides superior immediate stability and protects against early pedicle screw loosening. This theory has never been formally examined in a clinical study. PURPOSE: To determine the impact of TLIF on early pedicle screw loosening and radiographic fusion rates compared with PLF using pedicle screws alone in the treatment of single level lumbar degenerative conditions. STUDY DESIGN: Retrospective computed tomography (CT) based review. PATIENT SAMPLE: One hundred ninety-three patients underwent TLIF+PLF with local autograft bone or PLF alone with local autograft bone. OUTCOME MEASURES: Radiographic fusion rates and screw loosening were measured at 6 and 12 months using strict CT criteria. Patient self-reported outcome measures included Visual Analog Scale for low back pain and leg pain and Oswestry Disability Index. METHODS: Postoperative thin-cut CTs were examined for pedicle screw loosening and radiographic fusion status. Early screw loosening rates were determined using 6-month postoperative CT, whereas radiographic fusion rates were determined using 12-month postoperative CT. Oneway analysis of variance was used to determine significant differences in mean outcome scores and other continuous measures between groups at baseline and follow-up. Chi-square test of independence or Fisher's exact test was used to compare proportions between groups on categorical measures. RESULTS: Eighty-three patients underwent TLIF+PLF (Group A) and 115 patients underwent PLF alone (Group B). At 6-month follow-up, loosening was observed in 49 of 792 total screws FDA device/drug status: Pedicle screws, intervertebral cage.
Patient Safety in Surgery, 2010
Background Pedicle screw loosening is a major safety concern in instrumented spinal surgery due to loosening with potential pseudarthrosis and possible loss of correction requiring revision surgery. Several cadaver studies have compared insertion torque of pedicle screws with resistance to pullout or cyclic loading. In most of these studies, a correlation has been found between these variables. Clinical studies have been made, comparing insertion torque to bone mineral density or radiological signs of screw loosening. There are no clinical studies comparing insertion torque to extraction torque or other biomechanical parameters in vivo. This study was designed to investigate whether the insertion torque of pedicle screws can be used to predict the purchase of the screws. Methods The insertion torque of stainless steel pedicle screws was recorded in eight patients undergoing lumbar fusion surgery with four-screw constructs. Torque gauge manometers were used for the recordings. The im...
Neurosurgical focus, 2017
OBJECTIVE High-quality studies that compare outcomes of open and minimally invasively placed pedicle screws for adult spinal deformity are needed. Therefore, the authors compared differences in complications from a circumferential minimally invasive spine (MIS) surgery and those from a hybrid surgery. METHODS A retrospective review of a multicenter database of patients with spinal deformity who were treated with an MIS surgery was performed. Database inclusion criteria included an age of ≥ 18 years and at least 1 of the following: a coronal Cobb angle of > 20°, a sagittal vertical axis of > 5 cm, a pelvic incidence-lumbar lordosis angle of > 10°, and/or a pelvic tilt of > 20°. Patients were propensity matched according to the levels instrumented. RESULTS In this database, a complete data set was available for 165 patients, and after those who underwent 3-column osteotomy were excluded, 137 patients were available for analysis; 76 patients remained after propensity matchi...
European Spine Journal, 2019
Purpose To compare the clinical efficacy and safety between cortical bone trajectory (CBT) and pedicle screw (PS) in posterior lumbar fusion surgery. Methods Five electronic databases were used to identify relevant studies comparing the clinical efficacy and safety between CBT and PS. The main outcomes were postoperative fusion rates and complication (especially in superior facet joint violations, symptomatic ASD, wound infection, dural tear, screw malposition and hematoma). The secondary results included operation time, intraoperative blood loss, length of hospital stay, incision length, ODI, VAS, JOA score, JOA recovery rate, patients' satisfaction and health-related quality of life. Results The outcomes showed that there was no significant difference in terms of fusion rate (p = 0.55), back and leg VAS score (p > 0.05), JOA score (p = 0.08) and incidence of reoperation (p = 0.07). However, CBT was superior to PS with Oswestry Disability Index (ODI) (p = 0.02), JOA recovery rate (p < 0.00001) and patients' satisfaction (p = 0.001). In addition, CBT was superior to PS with significantly lower incidence of superior facet joint violation and symptomatic ASD. However, there was no significant difference regarding wound infection (p > 0.05) and screw malposition (p > 0.05). CBT group required significant shorter operation time, less blood loss, shorter incision length and shorter length of hospital stay in comparison with PS group (p < 0.05). Conclusions Both CBT and PS achieve similar, fusion rate and revision surgery rate. Furthermore, CBT is superior to PS with lower incidence of complications, shorter operation time, less blood loss, shorter incision length and shorter length of hospital stay.
European Spine Journal, 2014
Purpose Currently, the diagnosis of pedicle screw (PS) loosening is based on a subjectively assessed halo sign, that is, a radiolucent line around the implant wider than 1 mm in plain radiographs. We aimed at development and validation of a quantitative method to diagnose PS loosening on radiographs. Methods Between 11/2004 and 1/2010 36 consecutive patients treated with thoraco-lumbar spine fusion with PS instrumentation without PS loosening were compared with 37 other patients who developed a clinically manifesting PS loosening. Three different angles were measured and compared regarding their capability to discriminate the loosened PS over the postoperative course. The interobserver invariance was tested and a receiver operating characteristics curve analysis was performed. Results The angle measured between the PS axis and the cranial endplate was significantly different between the early and all later postoperative images. The Spearman correlation coefficient for the measurements of two observers at each postoperative time point ranged between 0.89 at 2 weeks to 0.94 at 2 months and 1 year postoperative. The angle change of 1.9°between immediate postoperative and 6-month postoperative was 75 % sensitive and 89 % specific for the identification of loosened screws (AUC = 0.82). Discussion The angle between the PS axis and the cranial endplate showed good ability to change in PS loosening. A change of this angle of at least 2°had a relatively high sensitivity and specificity to diagnose screw loosening.
Screw loosening after posterior dynamic stabilization--review of the literature
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca, 2010
The malposition of pedicle screws in the lumbar spine is associated with a potential risk of iatrogenic injury of neurological structures but also with a decrease of biomechanical stability. The correct position of the pedicle screws of a dynamic stabilization device, as a long-term implant, seems to be of great importance. A high incidence of screw loosening could influence both the rate of revision surgeries and the clinical results.We compared screw loosening in our own patients with published data after navigated and non-navigated implantation of Dynesys. Posterior instrumentation with the Dynesys system was performed in 19 patients after improvement of facet joint infiltrations. Seven (37%) patients underwent conventional surgery (group I), five (26%) were operated on using a CT-based navigation (group II) and seven (37%) using a fluoroscopic-based navigation (group III). Pre-operatively, the "Oswestry Low Back Pain Disability Questionnaire (OQ)" and the "Short F...
Spine, 2008
Study Design. This study retrospectively compares the clinical and radiologic outcomes of unilateral transforaminal lumbar interbody fusion (TLIF) with those of transvertebral screw fixation of the lumbosacral spine in highgrade spondylolisthesis. Objective. To examine the outcome and perioperative complications of unilateral TLIF and compare those results with Transvertebral Screw Fixation in the treatment of high-grade spondylolisthesis. Summary of Background Data. High-grade spondylolisthesis has been associated with a high complication and failure rate regardless of the method of treatment. We compare 2 techniques to improve success rates. Methods. Forty patients were divided into 2 groups: group A, unilateral TLIF, and group B, transacral screws. The mean age was 33 years (range, 19-48 years), and the mean follow-up was 35 months (range, 24-48 months). The mean grade of spondylolisthesis measured by Meyerding grading was 3.6 (range, 3-5). A Scoliosis Research Society outcome score was obtained on all patients. Fusion was determined by both radiograph and computed tomography scan. Results. Group A: 100% fusion. The slip angle improved from 38.6°(range, 24Ϫ78°) before surgery to 23.8°(range, 12-38°) after surgery. Group B: 95% of patients evidenced solid fusion by the 6-month follow-up. The slip angle, improved from 38.2°(range, 22-78°) before surgery to 23°(range, 9-36°) after surgery. There was no significant improvement in the percentage slip or the sacral inclination in any of the groups. Complications: A: 7 unintended durotomies and 3 wound infections. B: 1 unintended durotomy, 1 pseudarthrosis, 2 wound infections, and 1 implant failure. There were no neurologic complications in any of the groups. The Scoliosis Research Society outcome instrument demonstrated good postoperative pain control, function, self-image, and satisfaction in both groups. Conclusion. No significant differences in radiologic and clinical outcome were found, in either group. Both procedures appear to be safe and effective surgically and radiographically.
Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review
European Spine Journal, 2023
Background Restoration of three-dimensional (3D) alignment is critical in correcting patients with adolescent idiopathic scoliosis using posterior spinal fusion (PSF). However, current studies mostly rely on 2D radiographs, resulting in inaccurate assessment of surgical correction and underlying predictive factors. While 3D reconstruction of biplanar radiographs is a reliable and accurate tool for quantifying spinal deformity, no study has reviewed the current literature on its use in evaluating surgical prognosis. Purpose To summarize the current evidence on patient and surgical factors affecting sagittal alignment and curve correction after PSF based on 3D parameters derived from reconstruction of biplanar radiographs. Methods A comprehensive search was conducted by three independent investigators on Medline, PubMed, Web of Science, and Cochrane Library to obtain all published information on predictors of postoperative alignment and correction after PSF. Search items included "adolescent idiopathic scoliosis," "stereoradiography," "three-dimensional," "surgical," and "correction." The inclusion and exclusion criteria were carefully defined to include clinical studies. Risk of bias was assessed with the Quality in Prognostic Studies tool, and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development, and Evaluations approach. 989 publications were identified, with 444 unique articles subjected to full-text screening. Ultimately, 41 articles were included. Results Strong predictors of better curve correction included preoperative normokyphosis (TK > 15°), a corresponding rod contour, intraoperative vertebral rotation and translation, and upper and lower instrumented vertebrae selected based on sagittal and axial inflection points. For example, for Lenke 1 patients with junctional vertebrae above L1, fusion to NV-1 (1 level above the neutral vertebra) achieved optimal curve correction while preserving motion segments. Pre-op coronal Cobb angle and axial rotation, distal junctional kyphosis, pelvic incidence, sacral slope, and type of instrument were identified as predictors with moderate evidence. For Lenke 1C patients, > 50% LIV rotation was found to increase spontaneous lumbar curve correction. Pre-op thoracolumbar apical translation and lumbar lordosis, Ponte osteotomies, and rod material were found to be predictors with low evidence. Conclusions Rod contouring and UIV/LIV selection should be based on preoperative 3D TK in order to achieve normal postoperative alignment. Specifically, Lenke 1 patients with high-lying rotations should be fused distally at NV-1, while hypokyphotic patients with large lumbar curves and truncal shift should be fused at NV to improve lumbar alignment. Lenke 1C curves should be corrected using > 50% LIV rotation counterclockwise to the lumbar rotation. Further investigation should compare surgical correction between pedicle-screw and hybrid constructs using matched cohorts. DJK and overbending rods are potential predictors of postoperative alignment.