Problems and Solutions of Pedicle Screw Plate Fixation of Lumbar Spine

Matsuzaki, Hiromi; Tokuhashi, Yasuaki; Fujio, Mizue; Hoshino, Masahiro; Kiuchi, Tetuya; Toriyama, S

doi:10.1097/00007632-199011010-00014

Cited by 181 publications

(86 citation statements)

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“…The overall incidence of nerve root or spinal cord injury is rare, ranging between 0.6% and 11%. 40 Our study showed an overall mean incidence of dural lesions of 0.18% per pedicle screw and an overall mean incidence of nerve root irritations of 0.19% per pedicle screw (Fig. 2).…”

Section: Management Of Screw-related Complicationssupporting

confidence: 53%

Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws

Gautschi

Schatlo²,

Schaller³

et al. 2011

FOC

210

149

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Object The technique of pedicle screw insertion is a mainstay of spinal instrumentation. Some of its potential complications are clinically relevant and may require reoperation or further postoperative care. Methods A literature search was performed using MEDLINE (between 1999 and June 2011) for studies on pedicle screw placement in thoracolumbar surgery. The authors included randomized controlled trials, case-control studies, and case series (≥ 20 patients) from the English-, German-, and French-language literature. The authors assessed study type, the number of patients, the anatomical area, the number of pedicle screws, duration of follow-up, type of pedicle screw placement, incidence of complications, and type of complication. The management of specific complications is discussed. Results Thirty-nine articles with 46 patient groups were reviewed with a total of 35,630 pedicle screws. One study was a randomized controlled trial, 8 were case-control studies, and the remaining articles were case series. Dural lesions and irritation of nerve roots were reported in a mean of 0.18% and 0.19% per pedicle screws, respectively. Thirty-two patients in 10 studies (of 5654 patients from all 39 studies) required further revision surgeries for misplaced pedicle screws causing neurological problems. None of the analyzed studies reported vascular complications, and only 2 studies reported visceral complications of clinical significance. Conclusions Pedicle screw placement in the thoracolumbar region is a safe procedure with an overall high accuracy and a very low rate of clinically relevant complications.

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Section: Management Of Screw-related Complicationssupporting

confidence: 53%

Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws

Gautschi

Schatlo²,

Schaller³

et al. 2011

FOC

210

149

View full text Add to dashboard Cite

show abstract

“…Our screw fracture rate of 1.6% is on the lower end of reported screw breakages for lumbar fusion, which are reported from 1.3% to 21% but are mostly within the 4%-6% range. 12,13,38,63,69,72 These results suggest that the Dynesys system offers more biomechanical flexibility than rigid instrumented fusion constructs, which minimizes the incidence of broken screws. 27,56 This flexibility, however, may be the cause of screw loosening, which was found in a significant number of patients.…”

Section: Discussionmentioning

confidence: 92%

Complications associated with the Dynesys dynamic stabilization system: a comprehensive review of the literature

Pham¹,

Mehta²,

Patel

et al. 2016

FOC

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The Dynesys dynamic stabilization system is an alternative to rigid instrumentation and fusion for the treatment of lumbar degenerative disease. Although many outcomes studies have shown good results, currently lacking is a comprehensive report on complications associated with this system, especially in terms of how it compares with reported complication rates of fusion. For the present study, the authors reviewed the literature to find all studies involving the Dynesys dynamic stabilization system that reported complications or adverse events. Twenty-one studies were included for a total of 1166 patients with a mean age of 55.5 years (range 39–71 years) and a mean follow-up period of 33.7 months (range 12.0–81.6 months). Analysis of these studies demonstrated a surgical-site infection rate of 4.3%, pedicle screw loosening rate of 11.7%, pedicle screw fracture rate of 1.6%, and adjacent-segment disease (ASD) rate of 7.0%. Of studies reporting revision surgeries, 11.3% of patients underwent a reoperation. Of patients who developed ASD, 40.6% underwent a reoperation for treatment. The Dynesys dynamic stabilization system appears to have a fairly similar complication-rate profile compared with published literature on lumbar fusion, and is associated with a slightly lower incidence of ASD.

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“…Of these 169 complications, nerve root violation, including transient and permanent injuries, occurred in 29 cases and cerebrospinal fluid leak in 12 cases. After evaluation of 57 cases of pedicular screw fixation, Matsuzaki et al found that six patients (11%) had nerve root compression after surgery; two of them were due to direct impingement of the nerve root [9]. Luque reported 50 patients with two complications [7].…”

Section: Discussionmentioning

confidence: 99%

“…Pedicle screw placement does not pose the same high risk of damage to the spinal cord, dural sac, and nerve roots in the lumbar region as it does in thoracic and cervical spine. However, accurate anatomic knowledge is needed to perform a safe surgical intervention in the lumbar region [2,9,11]. Despite the growing interest in pedicle instrumentation in the lumbar spine, the anatomic relationships of lumbar pedicle have not yet been analyzed adequately for the safe performance of these clinical applications.…”

mentioning

confidence: 99%

Lumbar pedicle: surgical anatomic evaluation and relationships

Attar

Ugur

et al. 2001

European Spine Journal

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IntroductionTranspedicular screw fixation can be used for the treatment of unstable lumbar spine caused by trauma, tumors, infections, and degenerative conditions. Instrumentation techniques of the spine using the pedicle from posterior into the vertebral body have become popular recently, because of the advantages of these systems [1, 3,4,5,6,10,11,12,13]. Pedicle screw placement does not pose the same high risk of damage to the spinal cord, dural sac, and nerve roots in the lumbar region as it does in thoracic and cervical spine. However, accurate anatomic knowledge is needed to perform a safe surgical intervention in the lumbar region [2,9,11]. Despite the growing interest in pedicle instrumentation in the lumbar spine, the anatomic relationships of lumbar pedicle have not yet been analyzed adequately for the safe performance of these clinical applications. Even though some of the measurements duplicate previous studies, and the data presented in this study are limited to the surrounding tissues of the pedicle, we consider such that information is necessary for building Abstract Although several clinical applications of transpedicular screw fixation in the lumbar spine have been documented for many years, few anatomic studies concerning the lumbar pedicle and adjacent neural structures have been published. The lumbar pedicle and its relationships to adjacent neural structures were investigated through an anatomic study. Our objective is to highlight important considerations in performing transpedicular screw fixation in the lumbar spine. Twenty cadavers were used for observation of the lumbar pedicle and its relations. After removal of whole posterior bony elements including spinous processes, laminae, lateral masses, and inferior and superior facets, the isthmus of the pedicle was exposed. Pedicle width and height (PW and PH), interpedicular distance (IPD), pedicle-inferior nerve root distance (PIRD), pedicle-superior nerve root distance (PSRD), pedicle-dural sac distance (PDSD), root exit angle (REA), and nerve root diameter (NRD) were measured. The results indicated that the average distance from the lumbar pedicle to the adjacent nerve roots superiorly, inferiorly and to the dural sac medially at all levels ranged from 2.9 to 6.2 mm, 0.8 to 2.8 mm, and 0.9 to 2.1 mm, respectively. The mean PH and PW at L1-L5 ranged from 10.4 to 18.2 mm and 5.9 to 23.8 mm, respectively. The IPD gradually increased from L1 to L5. The mean REA increased consistently from 35°to 39°. The NRD was between 3.3 and 3.9 mm. Levels of significance were shown for the P<0.05 and P<0.01 levels. On the basis of this study, we can say that improper placement of the pedicle screw medially and inferiorly should be avoided.

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Problems and Solutions of Pedicle Screw Plate Fixation of Lumbar Spine

Cited by 181 publications

References 0 publications

Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws

Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws

Complications associated with the Dynesys dynamic stabilization system: a comprehensive review of the literature

Lumbar pedicle: surgical anatomic evaluation and relationships

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