Clinically significant pedicle screw malposition is an underestimated cause of radiculopathy

Woo, Emily Jane; DiCuccio, Michael

doi:10.1016/j.spinee.2017.11.006

Cited by 18 publications

(6 citation statements)

References 38 publications

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“…It is still unclear whether this increased radiological accuracy, usually measured as the degree of deviation from the desired transpedicular trajectory, translates to a clinical benefit to patients. It is hypothesised that, when using computer assistance, the lower rate of pedicular cortical encroachment leads to a lower incidence of radiculopathy,24 52 thus preventing revision surgery,6 decreasing overall treatment costs53 and improving overall patient-oriented outcomes 38. A meta-analysis has demonstrated that both RG and navigation lower the incidence of revision surgery for malpositioned pedicle screws 5.…”

Section: Discussionmentioning

confidence: 99%

The European Robotic Spinal Instrumentation (EUROSPIN) study: protocol for a multicentre prospective observational study of pedicle screw revision surgery after robot-guided, navigated and freehand thoracolumbar spinal fusion

et al. 2019

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IntroductionRobotic guidance (RG) and computer-assisted navigation (NV) have seen increased adoption in instrumented spine surgery over the last decade. Although there exists some evidence that these techniques increase radiological pedicle screw accuracy compared with conventional freehand (FH) surgery, this may not directly translate to any tangible clinical benefits, especially considering the relatively high inherent costs. As a non-randomised, expertise-based study, the European Robotic Spinal Instrumentation Study aims to create prospective multicentre evidence on the potential comparative clinical benefits of RG, NV and FH in a real-world setting.Methods and analysisPatients are allocated in a non-randomised, non-blinded fashion to the RG, NV or FH arms. Adult patients that are to undergo thoracolumbar pedicle screw instrumentation for degenerative pathologies, infections, vertebral tumours or fractures are considered for inclusion. Deformity correction and surgery at more than five levels represent exclusion criteria. Follow-up takes place at 6 weeks, as well as 12 and 24 months. The primary endpoint is defined as the time to revision surgery for a malpositioned or loosened pedicle screw within the first postoperative year. Secondary endpoints include patient-reported back and leg pain, as well as Oswestry Disability Index and EuroQOL 5-dimension questionnaires. Use of analgesic medication and work status are recorded. The primary analysis, conducted on the 12-month data, is carried out according to the intention-to-treat principle. The primary endpoint is analysed using crude and adjusted Cox proportional hazards models. Patient-reported outcomes are analysed using baseline-adjusted linear mixed models. The study is monitored according to a prespecified monitoring plan.Ethics and disseminationThe study protocol is approved by the appropriate national and local authorities. Written informed consent is obtained from all participants. The final results will be published in an international peer-reviewed journal.Trial registration numberClinical Trials.gov registryNCT03398915; Pre-results, recruiting stage.

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Section: Discussionmentioning

confidence: 99%

The European Robotic Spinal Instrumentation (EUROSPIN) study: protocol for a multicentre prospective observational study of pedicle screw revision surgery after robot-guided, navigated and freehand thoracolumbar spinal fusion

et al. 2019

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“…[15]. Перфорация медиальной стенки корня дуги и выстояние винта в канал должны были быть более 4 мм в соответствии со стандартными рекомендациями [16]. При аксиальном болевом синдроме показаниями были псевдоартроз с нестабильностью компонентов фиксирующей системы, проксимальная смежная нестабильность (proximal junctional -PJF), признаки сегментарной нестабильности в виде сагиттальной трансляции тел позвонков более 4 мм при функциональной спондилографии, признаки выраженного нарушения сагиттального баланса со следующими параметрами: сагиттальная вертикальная ось (sagittal vertical axis) более 9,5 см; угол наклона таза (pelvic tilt -PT) более 30°; разность тазового угла (pelvic tilt -PI) и поясничного лордоза (lumbar lordosis -LL) более 20°.…”

Section: материал и методыunclassified

Diagnosis and interventional treatment of pain syndromes after surgery for degenerative lumbar spine diseases

et al. 2018

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Послеоперационные болевые синдромы сопровождают до 20% операций при дегенеративно-дистрофических заболеваниях позвоночника (ДДЗП). Данные о структуре этих синдромов противоречивы, клиническая и лучевая диагностика зачастую демонстрирует низкую эффективность, а возможности интервенционных методов диагностики и лечения изучены недостаточно. Цель исследования-изучить структуру болевых синдромов после операций по поводу ДДЗП на поясничном уровне с использованием комплексной диагностики и оценить возможности интервенционного лечения. Материал и методы. Обследованы 310 пациентов с послеоперационными болевыми синдромами. Пациентов с очевидными показаниями к повторному вмешательству исключили из анализа, оставшимся проводились селективные диагностические блокады с последующим интервенционным (пункционным) лечением. Положительным результатом считалось снижение болевого синдрома по цифровой шкале боли на 50%, индексу Освестри на 20%, индексу радикулопатии на 8 баллов, с сохранением эффекта не менее 12 мес. Проводился поиск факторов риска развития болевых синдромов. Результаты. 162 (52,6%) пациента из 310 не имели очевидных показаний к повторному вмешательству по поводу основного заболевания. У этих больных выявлены следующие болевые синдромы: корешковый-у 56 (18,6%) из 310 пациентов, положительный эффект лечения достигнут у 38 (67,9%) из них; фасеточный-у 29 (9,4%), эффект достигнут у 23 (79,3%); дискогенный у 12 (3,9%), эффект достигнут у 5 (41,6%); дисфункция крестцово-подвздошного сочленения-у 42 (13,6%), эффект достигнут у 36 (85,7%). Миофасциальный и конкурирующие болевые синдромы диагностированы у 12 (3,9%) человек. У 11 (3,6%) пациентов причины боли не установлены. Основными факторами риска были нарушения нормальных параметров позвоночно-тазовых взаимоотношений (параметры сагиттального баланса). Заключение. При комплексной диагностике послеоперационные болевые синдромы, не имеющие причин, подлежащих хирургической коррекции, выявлены в 52,6% случаев, болевые синдромы с установленными причинами выявлены в 49,9% случаев. Интервенционное лечение было эффективно в целом в 64,8% случаев, у 16,1% пациентов из 310 отсутствие эффекта позволяло предполагать формирование синдрома неудачной операции. Ключевые слова: синдром неудачной операции на позвоночнике, послеоперационный болевой синдром, фасеточный болевой синдром, ДДЗП, интервенционное лечение боли, диагностическая блокада.

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“…Subtle deviations in the placement of instrumented hardware can lead to pedicle screw cortical breach and catastrophic patient complications relating to neu-rovascular compromise or deformity, necessitating repeat operations. 1,2 There have been several studies that have analyzed the morphometry of pedicles in the lumbar spine between races. 3,4 Each study demonstrated significant pedicle variability in the lumbar spine among different races; emphasizing the need for preoperative planning when performing pedicle screw fixation.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, approximately 80% of the measured cortical diameter is the maximum safe width into which a pedicle screw can be inserted. Therefore, both pedicle screw diameter and length are important for safe screw placement, 1,2 and to maximize pullout strength. 13,14 However, the exact diameter and length of the vertebral pedicle is rarely measured prior to screw insertion.…”

Section: Introductionmentioning

confidence: 99%

Demographic Analysis of Pedicle Diameter, and Estimated Pedicle Screw Length of the Lumbar Spine in a Diverse Population

et al. 2021

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Background: Recent literature confirms the importance of understanding the variability in pedicle morphology among races. These studies suggest that more detailed and reliable measurements of pedicles should be undertaken. However, there is limited data on average pedicle diameters (PDs) or estimated pedicle screw lengths (EPSLs) between diverse racial populations. We sought to determine the differences in PD and EPSL in the lumbar spine between various races: ''Asian,'' ''Black,'' ''White,'' and ''Hispanic'' to aid in perioperative planning during instrumented spinal fusion.Methods: Axial cuts of 404 patients were inspected to obtain their transverse outer cortical PD as measured through the isthmus, and EPSL by measuring the posterior entry point at the longest distance, which perpendicularly transected the measured isthmic diameter, to the anterior vertebral cortex from L1 to L5. We examined the average PD and PD range at each level for each race. To determine the significance, we used a mixed analysis of variance and a post hoc analysis.Results: In this retrospective chart review the races were found to be significantly different in PD and EPSL (P , .001). Post hoc analysis using Dunn-Bonferroni correction showed that Asians had significantly smaller PDs than Blacks and Whites (P , .002 and P , .014, respectively). The White and Hispanic population had significantly longer EPSLs when compared to Blacks and Asians from L1 to L5 (P , .01).Conclusions: This study demonstrates that there are significant differences in pedicle morphology among races that must be taken into consideration when inserting pedicle screws during lumbar spinal fusion. Knowledge of these differences is of the utmost importance in order to limit complications while improving fixation.Level of Evidence: 3. Clinical Relevance: Pedicle morphology is variable between races and understanding these differences is important for the safe placement of pedicle screws.

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Clinically significant pedicle screw malposition is an underestimated cause of radiculopathy

Cited by 18 publications

References 38 publications

The European Robotic Spinal Instrumentation (EUROSPIN) study: protocol for a multicentre prospective observational study of pedicle screw revision surgery after robot-guided, navigated and freehand thoracolumbar spinal fusion

The European Robotic Spinal Instrumentation (EUROSPIN) study: protocol for a multicentre prospective observational study of pedicle screw revision surgery after robot-guided, navigated and freehand thoracolumbar spinal fusion

Diagnosis and interventional treatment of pain syndromes after surgery for degenerative lumbar spine diseases

Demographic Analysis of Pedicle Diameter, and Estimated Pedicle Screw Length of the Lumbar Spine in a Diverse Population

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