Complications of Transpedicular Lumbosacral Fixation for Non-Traumatic Disorders

Abstract

W e analysed the complications encountered in 102 consecutive patients who had posterolateral lumbosacral fusion performed with transpedicular screw and rod fixation for non-traumatic disorders after a minimum of two years. Of these, 40 had spondylolysis and spondylolisthesis, 42 a degenerative disorder, 14 instability after previous laminectomy and decompression, and six pain after nonunion of previous attempts at spinal fusion without internal fixation. There were 75 multilevel and 27 single-level fusions. There were 76 individual complications in 48 patients, and none in the other 54. The complications seen were screw misplacement, coupling failure of the device, wound infection, nonunion, permanent neural injury, and loosening, bending and breakage of screws. Screw breakage or loosening was more common in patients with multilevel fusions (p < 0.001). Screws of 5 mm diameter should not be used for sacral fixation. Forty-six patients had at least one further operation for one or several complications, including 20 fusion procedures for nonunion. The high incidence of complications is a disadvantage of this technicallydemanding method.

Multimodal intraoperative monitoring (MIOM) during 409 lumbosacral surgical procedures in 409 patients

“…Even if radiologically successful decompression and fusion is achieved, a neurological complication is extremely disturbing and negatively influencing the otherwise favourable reduction of radicular symptoms or spondylotic pain. Such a complication can occur as a result of nerve root compression, distraction or misplacement of pedicle screws [8].…”

Improved extraction torque of hydroxyapatite-coated pedicle screws

“…Loosening of screws is a frequent problem in spinal instrumentation with pedicle screws [10,11]. It is often only noted as a radiolucency surrounding the pedicular screws, but in many cases loosening of the screws causes an unstable situation and loss of correction.…”

Biomechanical and histological evaluation of an expandable pedicle screw in osteoporotic spine in sheep

“…The stability of the instrumentation depends on the purchase of the pedicle screws in the pedicle and the vertebral body. Despite the fact that satisfactory clinical outcomes have been achieved with pedicle screw instrumentation, loosening of the screws, especially in the osteoporotic spine, still constitutes a significant problem [23,26] because it can lead to loss of correction or nonunion. To improve the stability of pedicle screw instrumentation, we have designed EPS and demonstrated that the instant fixation strength of the EPS was significantly higher than non-EPS.…”