Efficacy of pedicle screw fixation in the treatment of spinal instability and failed back surgery: a 5-year review

R, Masferrer; Gómez, Carlos Harrison; Karahalios, Dean G.; Sonntag, Volker K. H.

doi:10.3171/jns.1998.89.3.0371

Cited by 66 publications

(21 citation statements)

References 59 publications

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“…In the literature, the rate of screw misplacement ranged from 0%-2% up to 25%-95% in patients with scoliosis in different series, and to nearly 4.2% in those with degenerative diseases [1,5]. However, in this series, 6% had screw misplacement, equally distributed in both failure and control groups, questioning its significance.…”

Section: Discussionmentioning

confidence: 65%

“…Failure of the implant after spinal fusions might be the result of doing it for the wrong patient, with the wrong diagnosis, by the wrong surgeon [1,2,3,4]. We add to these causes: using the wrong implant, and/or doing the wrong technique.…”

Section: Discussionmentioning

confidence: 99%

“…Failure to provide adequate stabilization can necessitate additional surgical procedures to achieve spinal fusion [1]. An understanding of fundamental biomechanical principles of the spine and fixation strategies is essential to avoid unnecessary subsequent failures [1,2]. …”

Section: Introductionmentioning

confidence: 99%

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Lumbar Transpedicular Implant Failure: A Clinical and Surgical Challenge and Its Radiological Assessment

Eldin

Ali

2014

Asian Spine J

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Study DesignIt is a multicenter, controlled case study review of a big scale of pedicle-screw procedures from January 2000 to June 2010. The outcomes were compared to those with no implant failure.PurposeThe purpose of this study was to review retrospectively the outcome of 100 patients with implant failure in comparison to 100 control-patients, and to study the causes of failure and its prevention.Overview of LiteratureTranspedicular fixation is associated with risks of hardware failure, such as screw/rod breakage and/or loosening at the screw-rod interface and difficulties in the system assembly, which remain a significant clinical problem. Removal or revision of the spinal hardware is often required.MethodsTwo hundred patients (88 women, 112 men) were divided into 2 major groups, with 100 patients in group I (implant failure group G1) and 100 patients in group II (successful fusion, control group G2). We subdivided the study groups into two subgroups: subgroup a (single-level instrumented group) and subgroup b (multilevel instrumented group). The implant status was assessed based on intraoperative and follow-up radiographs.ResultsImplant failure in general was present in 36% in G1a, and in 64% in G1b, and types of implant failure included screw fracture (34%), rod fracture (24%), rod loosening (22%), screw loosening (16%), and failure of both rod and screw (4%). Most of the failures (90%) occurred within 6 months after surgery, with no reported cases 1 year postoperatively.ConclusionsWe tried to address the problem and study the causes of failure, and proposed solutions for its prevention.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

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Lumbar Transpedicular Implant Failure: A Clinical and Surgical Challenge and Its Radiological Assessment

Eldin

Ali

2014

Asian Spine J

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“…Spinal fusion using pedicle screws has many advantages over other internal fixators in biomechanical properties, fusion rate, early mobilisation and versatility [7]. But, pedicle screw fixation has its own risks, so that spinal fixation using pedicle screws is technically demanding [2,5,7,10,12,13] and many reports have been published about complications following transpedicular instrumentation [2,4,6,17,20]. Facet joint violation by pedicle screw at the proximal adjacent segment is one of these complications.…”

Section: Discussionmentioning

confidence: 99%

Facet joint violation during pedicle screw insertion: a cadaveric study of the adult lumbosacral spine comparing the two pedicle screw insertion techniques

Chung¹,

Suh²,

Swapnil³

et al. 2006

International Orthopaedics (SICO

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This article analyses the incidence of facet joint violation by pedicle screws inserted via the two most commonly used techniques, intersection and mammillary. Pedicle screws were inserted on each side of fresh-frozen human cadevaric specimen lumbosacral spines using the two techniques. All facet joints which were violated were found to be on the right side, where the mamillary process technique was employed. The incidence of facet joint violation was higher in the mammillary technique, which was statistically significant. The intersection technique appears to be safer than the mamillary with respect to violation of the adjacent superior facet joint.

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“…The initial use of pedicle screws began in the lumbar spine and as surgeons became more comfortable with the complex anatomy required for accurate screw placement, they evolved the use of pedicle instrumentation in thoracolumbar and thoracic spine [23,24,31]. Transpedicular screw fixation has many advantages over other spinal instrumentations such as Harrington rod fixation, Luque's instrumentation, etc., in various pathologies [1,27,31,39,45]. Pedicle screws also prevent the need to place instrumentation within the spinal canal like sublaminar wiring [6], which creates the risk of neurological injury.…”

Section: Introductionmentioning

confidence: 99%

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

et al. 2008

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It is a retrospective analytic study of 1,009 transpedicular screws (689 thoracic and 320 lumbosacral), inserted with free-hand technique in neuromuscular scoliosis using postoperative CT scan. The aim of paper was to determine the accuracy and safety of transpedicular screw placement with free-hand technique in neuromuscular scoliosis and to compare the accuracy at different levels in such population. All studies regarding accuracy and safety of pedicle screw in scoliosis represent idiopathic scoliosis using various techniques such as free-hand, navigation, image intensifier, etc., for screw insertion. Anatomies of vertebrae and pedicle are distorted in scoliosis, hence accurate and safe placement of pedicle screw is prerequisite for surgery. Between 2004 and 2006, 37 consecutive patients, average age 20 years (9-44 years), of neuromuscular scoliosis were operated with posterior pedicle screw fixation using free-hand technique. Accuracy of pedicle screws was studied on postoperative CT scan. Placement up to 2 mm medial side and 4 mm lateral side was considered within-safe zone. Of the 1,009 screws, 273 screws were displaced medially, laterally or on the anterior side showing that 73% screws (68% in thoracic and 82.5% in lumbar spine) were accurately placed within pedicle. Considering the safe zone, 93.3% (942/1009, 92.4% in thoracic and 95.3% in lumbar spine) of the screws were within the safe zone. Comparing accuracy according to severity of curve, accuracy was 75% in group 1 (curve \90°) and 69% in group 2 (curve [90°) with a safety of 94.8 and 91.2%, respectively (P = 0.35). Comparing the accuracy at different thoracic levels, it showed 67, 64 and 72% accuracy in upper, middle and lower thoracic levels with safety of 96.6, 89.2 and 93.1%, respectively, exhibiting no statistical significant difference (P = 0.17). Pedicle screw placement in neuromuscular scoliosis with free-hand technique is accurate and safe as other conditions.

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Efficacy of pedicle screw fixation in the treatment of spinal instability and failed back surgery: a 5-year review

Cited by 66 publications

References 59 publications

Lumbar Transpedicular Implant Failure: A Clinical and Surgical Challenge and Its Radiological Assessment

Lumbar Transpedicular Implant Failure: A Clinical and Surgical Challenge and Its Radiological Assessment

Facet joint violation during pedicle screw insertion: a cadaveric study of the adult lumbosacral spine comparing the two pedicle screw insertion techniques

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

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