Vertebral body compression fracture after removal of pedicle screws: a report of two cases

Waelchli, Beat; Min, Kan; Cathrein, Philippe; Boos, Norbert

doi:10.1007/s00586-002-0417-7

Cited by 23 publications

(17 citation statements)

References 13 publications

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“…Some authors recommend implant removal to all patients once fusion is achieved [1,2], but this surgical procedure has some potential complications like progressive loss of correction [23] or vertebral body compression fractures [28]. The economic cost of removing implants to all patients with posterior spinal instrumentations is also quite considerable.…”

Section: Discussionmentioning

confidence: 99%

Metal levels in corrosion of spinal implants

Rı́o¹,

Beguiristáin²,

Duart³

2007

Eur Spine J

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Corrosion affects spinal instrumentations and may cause local and systemic complications. Diagnosis of corrosion is difficult, and nowadays it is performed almost exclusively by the examination of retrieved instrumentations. We conducted this study to determine whether it is possible to detect corrosion by measuring metal levels on patients with posterior instrumented spinal fusion. Eleven asymptomatic patients, with radiological signs of corrosion of their stainless steel spinal instrumentations, were studied by performing determinations of nickel and chromium in serum and urine. Those levels were compared with the levels of 22 patients with the same kind of instrumentation but without evidence of corrosion and to a control group of 22 volunteers without any metallic implants. Statistical analysis of our results revealed that the patients with spinal implants without radiological signs of corrosion have increased levels of chromium in serum and urine (P < 0.001) compared to volunteers without implants. Corrosion significantly raised metal levels, including nickel and chromium in serum and urine when compared to patients with no radiological signs of corrosion and to volunteers without metallic implants (P < 0.001). Metal levels measured in serum have high sensibility and specificity (area under the ROC curve of 0.981). By combining the levels of nickel and chromium in serum we were able to identify all the cases of corrosion in our series of patients. The results of our study confirm that metal levels in serum and urine are useful in the diagnosis of corrosion of spinal implants and may be helpful in defining the role of corrosion in recently described clinical entities such as late operative site pain or late infection of spinal implants.

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Section: Discussionmentioning

confidence: 99%

Metal levels in corrosion of spinal implants

Rı́o¹,

Beguiristáin²,

Duart³

2007

Eur Spine J

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“…This treatment option has been reported in several case reports of patients with a wide range of problems and procedures. [3][4][5]12 The sequelae of hardware removal are largely unknown, but have been studied best in the scoliosis literature. Potter and colleagues have reported on the loss of coronal correction following instrumentation removal for adolescent idiopathic scoliosis, but note the lack of change in the sagittal plane.…”

Section: Discussionmentioning

confidence: 99%

“…5 Finally, Waelchli and colleagues reported on 2 patients who experienced a refracturing of their thoracolumbar fracture after hardware removal. 12 To our knowledge, ours is the first single series of such patients, enabling closer examination of the possible risk factors for this serious complication following implant removal.…”

mentioning

confidence: 92%

Fracture of fusion mass after hardware removal in patients with high sagittal imbalance

Sedney¹,

Daffner

Stefanko

et al. 2016

SPI

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OBJECT As spinal fusions become more common and more complex, so do the sequelae of these procedures, some of which remain poorly understood. The authors report on a series of patients who underwent removal of hardware after CT-proven solid fusion, confirmed by intraoperative findings. These patients later developed a spontaneous fracture of the fusion mass that was not associated with trauma. A series of such patients has not previously been described in the literature. METHODS An unfunded, retrospective review of the surgical logs of 3 fellowship-trained spine surgeons yielded 7 patients who suffered a fracture of a fusion mass after hardware removal. Adult patients from the West Virginia University Department of Orthopaedics who underwent hardware removal in the setting of adjacent-segment disease (ASD), and subsequently experienced fracture of the fusion mass through the uninstrumented segment, were studied. The medical records and radiological studies of these patients were examined for patient demographics and comorbidities, initial indication for surgery, total number of surgeries, timeline of fracture occurrence, risk factors for fracture, as well as sagittal imbalance. RESULTS All 7 patients underwent hardware removal in conjunction with an extension of fusion for ASD. All had CT-proven solid fusion of their previously fused segments, which was confirmed intraoperatively. All patients had previously undergone multiple operations for a variety of indications, 4 patients were smokers, and 3 patients had osteoporosis. Spontaneous fracture of the fusion mass occurred in all patients and was not due to trauma. These fractures occurred 4 months to 4 years after hardware removal. All patients had significant sagittal imbalance of 13–15 cm. The fracture level was L-5 in 6 of the 7 patients, which was the first uninstrumented level caudal to the newly placed hardware in all 6 of these patients. Six patients underwent surgery due to this fracture. CONCLUSIONS The authors present a case series of 7 patients who underwent surgery for ASD after a remote fusion. These patients later developed a fracture of the fusion mass after hardware removal from their previously successfully fused segment. All patients had a high sagittal imbalance and had previously undergone multiple spinal operations. The development of a spontaneous fracture of the fusion mass may be related to sagittal imbalance. Consideration should be given to reimplanting hardware for these patients, even across good fusions, to prevent spontaneous fracture of these areas if the sagittal imbalance is not corrected.

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“…[7][8][9][10] More recently, compression fractures following pedicle screw removal have been reported. 11 These complications are attributed to two primary mechanisms: (1) implant failure or (2) bony failure. Previous pedicle screw loading studies have focused on pedicle screw loading and failure, and the pedicle screw-vertebrae complex.…”

Section: Introductionmentioning

confidence: 99%