Intraoperative biomechanics of lumbar pedicle screw loosening following successful arthrodesis

Pearson, Hope B; Dobbs, Christopher J.; Grantham, Eric; Niebur, Glen L.; Chappuis, James L.; Boerckel, Joel D.

doi:10.1002/jor.23575

Cited by 28 publications

(23 citation statements)

References 51 publications

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“…22 A combination of factors such as initial or subsequent poor bone density/quality, instrumentation-induced stress shielding and subsequent disuse osteopenia, plastic deformation at the bone-metal interface, or high static stress combined with cyclic loading also contribute to instrumentation failure. 2 These processes are often accompanied by new or recurrent pain, altered biomechanics, and deformity. Implant failure can occur at variable time intervals after instrumentation from weeks to years.…”

Section: Discussionmentioning

confidence: 99%

“…Altered biomechanics and/or bone fragility may lead to instrumentation failure, bone resorption, or new fractures with consequent instability and recurrent or progressive pain. 1,2 The most commonly encountered types of instrumentation failure are implant fracture or disassembly, bone resorption around the screws, or impaction fracture adjacent to an implanted cage. 1 In addition, vertebral insufficiency fractures can occur within the instrumented segment or at adjacent levels (junctional fractures).…”

mentioning

confidence: 99%

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Spinal Instrumentation Rescue with Cement Augmentation

Cianfoni

Giamundo

Pileggi³

et al. 2018

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Spinal Instrumentation Rescue with Cement Augmentation

Cianfoni

Giamundo

Pileggi³

et al. 2018

AJNR Am J Neuroradiol

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“…Pedicle screw constructs are widely used to treat fractures, degenerative diseases, tumors and infection of the thoracolumbar spine as well as to correct spinal deformity [8]. Loosening of pedicle screws, however, may result in loss of reduction, spinal instability, painful nonunion after fusion and possibly even in recurrent pain despite successful fusion, and therefore may necessitate revision surgery [9][10][11][12]. There is an ongoing debate on how to improve pedicle screw anchorage and prevent screw loosening, and various strategies have been considered and evaluated.…”

Section: Introductionmentioning

confidence: 99%

Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading

Lindtner

Schmid

Nydegger³

et al. 2018

Eur Spine J

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Using nonmetallic CF/PEEK instead of standard titanium as pedicle screw material did not affect screw loosening in the chosen test setup, whereas cement augmentation enhanced screw anchorage of CF/PEEK screws. While comparable to titanium screws in terms of screw loosening, radiolucent CF/PEEK pedicle screws offer the significant advantage of not interfering with postoperative imaging and radiotherapy. These slides can be retrieved under Electronic Supplementary Material.

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“…2,3,10,11 Both approaches require a steep learning curve for less-experienced spine surgeons, 3,12 nevertheless, image-guided techniques offer additional information because surgical instruments can be intraoperatively tracked and visualized, 13 and therefore assist spine surgeons toward a more accurate screw placement. 4,10 However, if an imageguided insertion technique is used or, for example, in the case of a low bone density that reduces screw fixation, 14,15 pedicle screw placement plans should be determined preoperatively. 16 While manual planning is a time-consuming and often impractical procedure, computer-assisted planning methods represent a viable alternative.…”

mentioning

confidence: 99%

Computer‐assisted pedicle screw trajectory planning using CT‐inferred bone density: A demonstration against surgical outcomes

et al. 2019

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Purpose Image‐guided spine surgery and preoperative computer‐assisted planning provide spine surgeons with tools to improve the safety, accuracy, and reliability of pedicle screw placement. The purpose of this study is to demonstrate a computer‐assisted pedicle screw placement planning tool in comparison to screws as delivered by a spine surgeon. Methods We describe a novel computer‐assisted tool for preoperative pedicle screw placement planning in computed tomography (CT) images, designed with respect to the vertebral shape and structure, and augmented with respect to the considerations of surgical practice. The approach is based on three‐dimensional (3D) modeling of the vertebral body and pedicles, and planning of the pedicle screw size and insertion trajectory by maximizing the screw fastening strength, evaluated through CT‐inferred bone density maps. The approach is augmented by yielding screw plans consistent with the straight‐forward surgical technique of aligning screws parallel to vertebral endplates, and the screw entry points following the spinal curvature to facilitate rod attachment. For a cohort of 25 patients, placement plans were retrospectively obtained for 204 pedicle screws with the computer‐assisted tool from preoperative CT images, while reference trajectories of inserted pedicle screws were reconstructed in 3D from postoperative biplanar radiographs. Results The best performing version of the computer‐assisted tool achieved clinically acceptable preoperative pedicle screw placement plans in 96.6% of the cases, while the comparison to the postoperative reconstructions resulted in 3.4 ± 2.5 mm for the screw entry point location, 2.7 ± 1.6 mm for the screw crossing point location, and 7.4 ± 5.3∘ for the screw sagittal inclination (mean absolute difference ± standard deviation). Conclusion Quantitative comparison revealed that the preoperative placement plans are consistent with the postoperative results, and that the computer‐assisted tool integrating bone density and surgical constraints can successfully incorporate important aspects of pedicle screw placement. The results therefore confirm the accuracy of the tool prior to being integrated in an image‐guidance system.

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Intraoperative biomechanics of lumbar pedicle screw loosening following successful arthrodesis

Cited by 28 publications

References 51 publications

Spinal Instrumentation Rescue with Cement Augmentation

Spinal Instrumentation Rescue with Cement Augmentation

Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading

Computer‐assisted pedicle screw trajectory planning using CT‐inferred bone density: A demonstration against surgical outcomes

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