Comparing rates of early pedicle screw loosening in posterolateral lumbar fusion with and without transforaminal lumbar interbody fusion

Kim, David H.; Hwang, Raymond; Lee, Gyu Ho; Joshi, Riya; Baker, Kevin C.; Arnold, Paul M.; Sasso, Rick C.; Park, Daniel; Fischgrund, Jeffrey S.

doi:10.1016/j.spinee.2020.04.021

Cited by 31 publications

(26 citation statements)

References 23 publications

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“…The effect of circumferential fixation on obtaining successful radiographic fusion in the lumbar spine has been well demonstrated in the literature. [30][31][32] In the setting of 1-and 2-level MIS-TLIF, placement of the "ideal" pedicle screw may maximize construct stability and, thereby, prevent undue motion in the time it takes to obtain interbody fusion. Placement of larger pedicle screws entails unique considerations.…”

Section: Discussionmentioning

confidence: 99%

Does robot-assisted navigation influence pedicle screw selection and accuracy in minimally invasive spine surgery?

Shafi

Pompeu

Vaishnav

et al. 2022

Neurosurgical Focus

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OBJECTIVE The accuracy of percutaneous pedicle screw placement has increased with the advent of robotic and surgical navigation technologies. However, the effect of robotic intraoperative screw size and trajectory templating remains unclear. The purpose of this study was to compare pedicle screw sizes and accuracy of placement using robotic navigation (RN) versus skin-based intraoperative navigation (ION) alone in minimally invasive lumbar fusion procedures. METHODS A retrospective cohort study was conducted using a single-institution registry of spine procedures performed over a 4-year period. Patients who underwent 1- or 2-level primary or revision minimally invasive surgery (MIS)–transforaminal lumbar interbody fusion (TLIF) with pedicle screw placement, via either robotic assistance or surgical navigation alone, were included. Demographic, surgical, and radiographic data were collected. Pedicle screw type, quantity, length, diameter, and the presence of endplate breach or facet joint violation were assessed. Statistical analysis using the Student t-test and chi-square test was performed to evaluate the differences in pedicle screw sizes and the accuracy of placement between both groups. RESULTS Overall, 222 patients were included, of whom 92 underwent RN and 130 underwent ION MIS-TLIF. A total of 403 and 534 pedicle screws were placed with RN and ION, respectively. The mean screw diameters were 7.25 ± 0.81 mm and 6.72 ± 0.49 mm (p < 0.001) for the RN and ION groups, respectively. The mean screw length was 48.4 ± 4.48 mm in the RN group and 45.6 ± 3.46 mm in the ION group (p < 0.001). The rates of “ideal” pedicle screws in the RN and ION groups were comparable at 88.5% and 88.4% (p = 0.969), respectively. The overall screw placement was also similar. The RN cohort had 63.7% screws rated as good and 31.4% as acceptable, while 66.1% of ION-placed screws had good placement and 28.7% had acceptable placement (p = 0.661 and p = 0.595, respectively). There was a significant reduction in high-grade breaches in the RN group (0%, n = 0) compared with the ION group (1.2%, n = 17, p = 0.05). CONCLUSIONS The results of this study suggest that robotic assistance allows for placement of screws with greater screw diameter and length compared with surgical navigation alone, although with similarly high accuracy. These findings have implied that robotic platforms may allow for safe placement of the “optimal screw,” maximizing construct stability and, thus, the ability to obtain a successful fusion.

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Section: Discussionmentioning

confidence: 99%

Does robot-assisted navigation influence pedicle screw selection and accuracy in minimally invasive spine surgery?

Shafi

Pompeu

Vaishnav

et al. 2022

Neurosurgical Focus

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“…Most instrumentation techniques to stabilize the spine through fusion consist of rod constructs fixed with pedicle screws (Verlaan et al 2004;Mirza and Deyo 2007). Screw loosening has been identified as one of the major risk factors for functional deterioration of spinal stabilization after instrumentation (Tokuhashi et al 2008;Kim et al 2020). The reported incidence of loosening at the screw-bone interface spans a wide range, mainly between 10 and 30%, with highest rates observed in patients with poor bone quality (Ohlin et al 1994;Abul-Kasim and Ohlin 2014;Bredow et al 2016;Kim et al 2020;Zou et al 2020).…”

Section: Introductionmentioning

confidence: 99%

“…Screw loosening has been identified as one of the major risk factors for functional deterioration of spinal stabilization after instrumentation (Tokuhashi et al 2008;Kim et al 2020). The reported incidence of loosening at the screw-bone interface spans a wide range, mainly between 10 and 30%, with highest rates observed in patients with poor bone quality (Ohlin et al 1994;Abul-Kasim and Ohlin 2014;Bredow et al 2016;Kim et al 2020;Zou et al 2020). The most commonly reported cause for failed fusion is low bone mineral density (BMD) (Krishnan et al 2020), which can lead to postoperative pain and ultimately requiring revision surgery to stabilize the spinal segment.…”

Section: Introductionmentioning

confidence: 99%

Bone density optimized pedicle screw instrumentation improves screw pull-out force in lumbar vertebrae

Caprara

Fasser

Spirig

et al. 2021

Computer Methods in Biomechanics and Biomedical Engineering

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“…Screw loosening is one of the most frequently reported complications of pedicle screw fixation. Several surgical strategies can be performed to treat the effects of loosening screws, i.e., implant failure and subsequent clinical symptoms 16,17 .…”

Section: Discussionmentioning

confidence: 99%

Improved fixation stability for repairing pedicle screw loosening using a modified cement filling technique in porcine vertebrae

Hsieh

et al. 2022

Sci Rep

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Polymethylmethacrylate (PMMA) has been applied clinically and biomechanically repair loose pedicle screws. Controversies have arisen over data due to uncontrolled cement properties, various locations and sizes of fenestrated holes in repair screws, irregular holes and different bone densities of specimens. In this study, the pullout strength was compared for two techniques, the modified technique to use PMMA to augment a threaded hole and the traditional technique with retrograde injection of a PMMA filling, for standard loose screws in porcine vertebrae. Both techniques provided statistically significant results for sufficiently randomized specimens and experimental procedures. The difference in the pullout strength between conical and cylindrical screws for the aforementioned cement augmentation techniques was also investigated. Twenty-four single-level fresh-frozen lumbar vertebrae from L1 to L6 were harvested from four mature pigs. A total of 0.8 ml of PMMA was retrograde injected into screw holes with a 5.5 mm diameter, followed by insertion of a 5.0 mm diameter repair screw in the traditional group (n = 12). A stiff threaded PMMA hole was created with a 4.5 mm tapping screw before insertion of repair screws in the modified group (n = 12). Two screw geometries were randomly assigned as cylindrical (n = 6) and conical (n = 6) in each group. The correlations between filling techniques, screw geometries and axial pullout strength were analyzed. An appropriate screw trajectory and insertion depth were confirmed using X-ray imaging prior to pullout testing in both groups. For a given screw geometry (cylindrical or conical), the pullout force of the modified group was significantly higher than that of the traditional group. There was no significant difference in the pullout force between the screw geometries for a given filling technique. The cement augmentation technique is far more influential than the screw outer geometry. The modified PMMA technique created a greater anchor force than the traditional method and could be an alternative for revision of pedicle screw loosening.

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Comparing rates of early pedicle screw loosening in posterolateral lumbar fusion with and without transforaminal lumbar interbody fusion

Cited by 31 publications

References 23 publications

Does robot-assisted navigation influence pedicle screw selection and accuracy in minimally invasive spine surgery?

Does robot-assisted navigation influence pedicle screw selection and accuracy in minimally invasive spine surgery?

Bone density optimized pedicle screw instrumentation improves screw pull-out force in lumbar vertebrae

Improved fixation stability for repairing pedicle screw loosening using a modified cement filling technique in porcine vertebrae

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