Transpedicular screw-rod fixation of the lumbar spine: operative technique and outcome in 104 cases

Abstract

A total of 104 patients underwent transpedicular spinal instrumentation using the Cotrel-Dubousset (71 cases) or the Texas Scottish Rite Hospital (33) screw-rod system. Surgery was performed for lumbar vertebral column instability secondary to fractures (28 cases), spondylolisthesis (29), tumors (four), vertebral osteomyelitis (two), or postoperative causes (41). Pseudoarthrodesis due to failure of a prior fusion was present in 37 cases. The 55 men and 49 women (mean age 47 years, range 18 to 87 years) all presented with severe back pain. Signs or symptoms of neural compression were noted in 96 patients. Surgery consisted of neural decompression, internal fixation, and autogenous iliac bone grafting. Spondylolistheses were fused in situ, without reduction; otherwise, major spinal deformities were corrected. A total of 516 pedicle screws were placed. The mean extent of fusion was 2.7 motion segments (range one to six motion segments). A 96% fusion rate was obtained with a mean follow-up period of 20 months. There were no operative deaths. Major complications included one spinal epidural hematoma, three isolated nerve root deficits (two transient, one permanent), and three wound infections (two deep, one superficial). Instrument failure eventually developed in 18 patients; nine were asymptomatic with a solid fusion and did not require further treatment and the other nine were symptomatic or had a pseudoarthrosis and required operative revision. Pedicle screw-rod fixation offers biomechanical advantages compared to other forms of internal fixation for the lumbar spine. It enables short-segment fixation with preservation of lumbar lordosis and adjacent normal motion segments. This technique provides a highly successful method to obtain arthrodesis, even with prior pseudoarthrosis.

Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture: grading the evidence through a systematic review and meta-analysis

“…The MINORS quality scores of the nonRCTs are presented in Table 1. The mean score was 12.8 (range, [8][9][10][11][12][13][14][15][16], which corresponded to a 53 % score. This result indicated that there was considerable variability in the evidence base.…”

“…Because of the poor quality of osteoporotic bone, classical open surgery with metal implants often fails and contributes to persistent back pain, neurological symptoms and functional limitations [9,35]. In particular, open procedures have been limited by neurological deficits and spinal sequence instability.…”

Topographic relations between the neural and ligamentous structures of the lumbosacral junction: in-vitro investigation

“…Topographic relations between the neural and ligamentous structures of the lumbosacral junction: in-vitro investigation Introduction Peripheral neurologic deficits have been described by several authors [7,33,39] as a complication after the surgical reduction and fusion of unstable segments of the lumbar spine with spondylolisthesis. Lehmer and co-workers [18] pointed to the increased vulnerability of the L5 nerve root.…”

Characteristics of an extended internal fixation system for polysegmental transpedicular reduction and stabilization of the thoracic, lumbar, and lumbosacral spine

“…The purpose of the present in vitro study was to investigate the primary stability of the prototypes in multidirectional biomechanical stability tests and to compare their stiffness characteristics and stabilizing effects with that of the clinically approved CD system [7,11,26]. We propose that the new device must provide at least as high stability as the CD system in order to maintain surgically achieved reduction and to gain a high fusion rate.…”

“…Clinical and experimental investigations imply that an increase in biomechanical stability of a construction accelerates the union of a fusion mass and increases fusion rates. Stiffer implants reduce the rate of pseudoarthrosis and loss of achieved reduction [2,7,11,17,21,27,29]. In all known systems for stable-angle stabilization of the spine, the fusion rate is always more favorable for the thoracic and thoraco-lumbar regions, for patients with normal or low body weight, and for less physically active patients.…”