The Role of External Spinal Skeletal Fixation in the Assessment of Low-Back Disorders

Esses, Stephen I.; Botsford, D J; Kostuik, John P.

doi:10.1097/00007632-198906000-00009

Cited by 120 publications

(42 citation statements)

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“…In this previously reported series the incidence of neurological deficit attributed to screw mal-position was 16.6% (5 out of 30 patients). Percutaneous insertion of pedicle screws has already been used for temporary fixation of the lumbar spine mainly in a diagnostic setting, the so called ''external fixation test'' [2,13]. Evaluation of this type of percutaneous screw insertion has been undertaken using a human cadaver model [17].…”

Section: Discussionmentioning

confidence: 99%

Computer tomography assessment of pedicle screw insertion in percutaneous posterior transpedicular stabilization

et al. 2006

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Percutaneous insertion of cannulated pedicle screws has been recently developed as a minimally invasive alternative to the open technique during instrumented fusion procedures. Given the reported rate of screw misplacement using open techniques (up to 40%), we considered it important to analyze possible side effects of this new technique. Placement of 60 pedicle screws in 15 consecutive patients undergoing lumbar or lumbosacral fusion, mainly for spondylolisthesis, were analyzed. Axial, coronal, and sagittal reformatted computer tomography images were examined by three observers. Individual and consensus interpretation was obtained for each screw position. Along with frank penetration, we also looked at cortical encroachment of the pedicular wall by the screw. Thirteen percent of the patients (2/15) had severe frank penetration from the screws, while 80% of them (12/15) had some perforation. On axial images the incidence of severe frank pedicle penetration was 3.3% while the overall rate of screw perforation was 23%. In coronal images the overall screw perforation rate rose to 30% while the rate of severe frank pedicle penetration remained unchanged. One patient (6.6%) suffered S1 root symptoms due to a frankly medially misplaced screw, requiring re-operation. This study has shown that percutaneous insertion of cannulated pedicle screws in the lumbar spine is an acceptable procedure. The overall rate of perforation in axial images is below the higher rates reported in the literature but does remain important. Frank penetration of the pedicle was nevertheless low. It remains a demanding technique and has to be performed with extreme care to detail.

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Section: Discussionmentioning

confidence: 99%

Computer tomography assessment of pedicle screw insertion in percutaneous posterior transpedicular stabilization

et al. 2006

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“…Combined anterior and posterior fusion (nine cases), using either a translaminar [1] or pedicle screw system [8] posteriorly and femoral allograft anteriorly through a retroperitoneal approach.…”

Section: Resultsmentioning

confidence: 99%

“…Olerud et al reported one case with a cerebrospinal fluid leak and two with root irritation [7]. Esses, however, had only one complication in 35 patients, a serosanguinous leak from a sacral pin [1]. In series reported by Jeannert, 18 complications were reported in 17 patients out of 101 patients [4]; 12 had pin tract infections, and operative debridement and antibiotic therapy for 6 weeks were necessary in 3 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Olerud et al [7], Esses et al [1] and, finally, Jeanneret et al [4] reported results of a trial of temporary external fixation to investigate its value in predicting the outcome of surgical fusion for low back pain [1,4]. The impression given by the above papers is that temporary external fixation of the spine is superior to plain radiographs, discograms and facet blocks in predicting surgical results.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Temporary external fixation for low back pain: Is it worth doing?

1997

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Thirty-three patients with low back pain underwent spinal fusion following a positively predicting external fixation test. Thirty-two spinal fusions and one sacroiliac joint fusion were performed. The complications following the use of the external fixator were significant. The results following spinal fusion were not related to the positive response to the external fixator. Multiple variables affect the results of spinal fusion. We feel that the external fixator test in low back pain management is very invasive, and its use cannot be justified. K e y w o r d s Low back painExternal fixation

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“…Several studies claim a prognostic value of the external fixation test in selecting patients for a subsequent fusion (Esses et al 1989, Soini et al 1993, Jeanneret et al 1994, Bednar and Raducan 1996, Axelsson et al 2003. Divergent results from in vitro studies (Schläpfer et al 1982, Lund et al 1999) have however questioned the mechanical capacity for achieving the requisite stabilization by using the external fixator.…”

Section: Spondylolytic Lumbar Segmentsmentioning

confidence: 99%