Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations

Jutte, Paul C.; Castelein, René M.

doi:10.1007/s00586-002-0469-8

Cited by 267 publications

(176 citation statements)

References 18 publications

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“…The failure rates ranged from 0.4 to 22% [10][11][12][13][14][15][16][17]. Interestingly, some characteristics of the implant failures in this study differed from those involving lumbar or thoracolumbar fusions reported in the literature.…”

Section: The Characteristics As For Cervical Instrumentation Failurementioning

confidence: 59%

“…First is the lack of rod fractures. Jutte et al [16] reported a 0.9% incidence of rod failure in 105 lumbar or lumbosacral fusions, and in most other reports, rod fractures occurred after posterior lumbar fusion surgery. Intraoperative rod contouring and corrective procedures using reduction devices are generally thought to be risk factors for the failure of spinal constructs, particularly with pure titanium or titanium alloy implants because of their notch sensitivity [10,18,19].…”

Section: The Characteristics As For Cervical Instrumentation Failurementioning

confidence: 94%

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Mechanical implant failure in posterior cervical spine fusion

et al. 2011

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Purpose The aim of this study was to determine whether the recent refinement and downsizing of the implants for posterior cervical fusion increase the occurrence of implant failure. Methods One hundred forty-two consecutive cases of cervical fusion, using either cannulated Magerl screws or a multiaxial pedicle screw-rod system, were reviewed retrospectively after an average follow-up period of more than 3 years, and the rate and characteristics of the failure of these implants were evaluated. Results Implant failure occurred in six (4.2%) patients: five with rheumatoid arthritis and one with athetoid cerebral palsy. Occipital plate fracture occurred in two patients, Magerl screw breakage in one patient, cervical pedicle screw fracture in two patients, and disassembly of the pedicle screw and rod in two patients (one with an occipital plate fracture). There was no rod fracture. The implant failures were asymptomatic, except in one patient. Disassembly of the pedicle screw and rod was observed immediately after another surgical procedure under general anesthesia in two patients. Conclusions The failure rate of 4.2% was similar to the rates reported in the literature for posterior lumbar spinal fusion, confirming the reliability of the recent cervical screw-rod system.

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Section: The Characteristics As For Cervical Instrumentation Failurementioning

confidence: 59%

Section: The Characteristics As For Cervical Instrumentation Failurementioning

confidence: 94%

Mechanical implant failure in posterior cervical spine fusion

et al. 2011

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“…Although several studies have shown satisfactory outcomes from spinal fusion for such spinal disorders, risks of complications associated with the extensive surgery remain, particularly in old patients [18,28,30]. In this context, development of less-invasive spinal fusion options is desirable to treat spinal disorders.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of interspinous process lumbar fusion with recombinant human bone morphogenetic protein-2 delivered with a synthetic polymer and β-tricalcium phosphate in a rabbit model

et al. 2011

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Introduction As a powerful bone-inducing cytokine, rhBMP-2 has been used as a bone graft substitute in combination with animal-derived collagen to achieve interbody or posterolateral spinal fusion. Successful interspinous process fusion using rhBMP-2 in combination with synthetic carrier materials would offer a safe, minimally invasive spinal fusion option for the treatment of spinal disorders. The aims of the present study were to achieve interspinous process fusion by implanting rhBMP-2-retaining degradable material instead of bone grafting and to evaluate efficacy for vertebral stabilization. Materials and methods A polymer gel (200 mg), btricalcium phosphate powder (400 mg), and rhBMP-2 (0, 30, 60 or 120 lg) were mixed to generate a plastic implant, which was then placed during surgery to bridge the L5-6 interspinous processes of 58 rabbits. Control animals received implants either without rhBMP-2 or with autogenous bone chips from the iliac crest. L5-6 vertebrae were recovered 8 weeks postoperatively. Interspinous process fusion was evaluated by radiography, biomechanical bending test, intradiscal pressure (IDP) measurement, and histology. Results In bending tests, strength of fusion was significantly greater in BMP60 and BMP120 groups than in sham, BMP0, BMP30 or autogenous bone groups. IDP at L5-6 was significantly reduced in BMP60 and BMP120 groups compared to sham, BMP0, BMP30, and autograft groups. Histologically, coronal sections of the fusion mass showed a bone mass bridging both spinous processes. ConclusionSolid interspinous process fusion was achieved in rabbit models by 8 weeks after implanting the biodegradable bone-inducing material. These results suggest a potential new less-invasive option without bone grafting for the treatment of lumbar disorders.

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“…Screw misplacement may cause neurologic and vascular complications. Pedicle screw-related complications have been reported to range from 1 % up to 54 % [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Robotic-assisted pedicle screw placement: lessons learned from the first 102 patients

2012

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Introduction Surgeons' interest in image and/or robotic guidance for spinal implant placement is increasing. This technology is continually improving and may be particularly useful in patients with challenging anatomy. Only through careful clinical evaluation can its successful applications, limitations, and areas for improvement be defined. This study evaluates the outcomes of robotic-assisted screw placement in a consecutive series of 102 patients. Methods Data were recorded from technical notes and operative records created immediately following each surgery case, in which the robotic system was used to guide pedicle screw placement. All cases were performed at the same hospital by a single surgeon. The majority of patients had spinal deformity and/or previous spine surgery. Each planned screw placement was classified as: (1) successful/ accurately placed screw using robotic guidance; (2) screw malpositioned using robot; (3) use of robot aborted and screw placed manually; (4) planned screw not placed as screw deemed non essential for construct stability. Data from each case were reviewed by two independent researchers to indentify the diagnosis, number of attempted robotic guided screw placements and the outcome of the attempted placement as well as complications or reasons for non-placement. Results Robotic-guided screw placement was successfully used in 95 out of 102 patients. In those 95 patients, 949 screws (87.5 % of 1,085 planned screws) were successfully implanted. Eleven screws (1.0 %) placed using the robotic system were misplaced (all presumably due to ''skiving'' of the drill bit or trocar off the side of the facet). Robotic guidance was aborted and 110 screws (10.1 %) were manually placed, generally due to poor registration and/or technical trajectory issues. Fifteen screws (1.4 %) were not placed after intraoperative determination that the screw was not essential for construct stability. The robot was not used as planned in seven patients, one due to severe deformity, one due to very high body mass index, one due to extremely poor bone quality, one due to registration difficulty caused by previously placed loosened hardware, one due to difficulty with platform mounting and two due to device technical issues. Conclusion Of the 960 screws that were implanted using the robot, 949 (98.9 %) were successfully and accurately implanted and 11 (1.1 %) were malpositioned, despite the fact that the majority of patients had significant spinal deformities and/or previous spine surgeries. ''Tool skiving'' was thought to be the inciting issue with the misplaced screws. Intraoperative anteroposterior and oblique fluoroscopic imaging for registration is critical and was the limiting issue in four of the seven aborted cases.

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Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations

Cited by 267 publications

References 18 publications

Mechanical implant failure in posterior cervical spine fusion

Mechanical implant failure in posterior cervical spine fusion

Efficacy of interspinous process lumbar fusion with recombinant human bone morphogenetic protein-2 delivered with a synthetic polymer and β-tricalcium phosphate in a rabbit model

Robotic-assisted pedicle screw placement: lessons learned from the first 102 patients

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