Complications Associated with Pedicle Screws*

Lonstein, John E.; Denis, Francis; Perra, Joseph H.; Pinto, Manuel R.; Smith, Michael D.; Winter, Robert B.

doi:10.2106/00004623-199911000-00003

Cited by 479 publications

(311 citation statements)

References 16 publications

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“…The failure rates ranged from 0.4 to 22% [10][11][12][13][14][15][16][17]. Interestingly, some characteristics of the implant failures in this study differed from those involving lumbar or thoracolumbar fusions reported in the literature.…”

Section: The Characteristics As For Cervical Instrumentation Failurementioning

(Expert classified)

Mechanical implant failure in posterior cervical spine fusion

et al. 2011

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Purpose The aim of this study was to determine whether the recent refinement and downsizing of the implants for posterior cervical fusion increase the occurrence of implant failure. Methods One hundred forty-two consecutive cases of cervical fusion, using either cannulated Magerl screws or a multiaxial pedicle screw-rod system, were reviewed retrospectively after an average follow-up period of more than 3 years, and the rate and characteristics of the failure of these implants were evaluated. Results Implant failure occurred in six (4.2%) patients: five with rheumatoid arthritis and one with athetoid cerebral palsy. Occipital plate fracture occurred in two patients, Magerl screw breakage in one patient, cervical pedicle screw fracture in two patients, and disassembly of the pedicle screw and rod in two patients (one with an occipital plate fracture). There was no rod fracture. The implant failures were asymptomatic, except in one patient. Disassembly of the pedicle screw and rod was observed immediately after another surgical procedure under general anesthesia in two patients. Conclusions The failure rate of 4.2% was similar to the rates reported in the literature for posterior lumbar spinal fusion, confirming the reliability of the recent cervical screw-rod system.

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Section: The Characteristics As For Cervical Instrumentation Failurementioning

(Expert classified)

Mechanical implant failure in posterior cervical spine fusion

et al. 2011

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“…We have documented two cases. In a recent review of nearly 5000 pedicle screws, Lonstein et al [6] showed malpositioning in 2.8% of screws inserted. Only 0.2% of the total screws inserted caused nerve root irritation requiring screw revision or removal.…”

Section: Discussionmentioning

confidence: 99%

Graf ligament stabilisation: mid- to long-term follow-up

Rigby¹,

Selmon

Foy

et al. 2001

Eur Spine J

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IntroductionMechanical instability in the lumbar spine is a term often used to describe an altered pattern of segmental movement causing pain. This is usually due to degenerative disease. Historically, symptoms of mechanical instability have been treated surgically with spinal fusion.In an attempt to modify the movement pattern of an abnormal motion segment, the Graf ligament system was introduced. It consists of modified titanium pedicle screws inter-connected with bands of braided polypropylene. This arrangement attempts to recreate the lumbar lordosis and allows limited movement to occur, hence the concept of 'flexible intervertebral stabilisation'. The operation is quicker, less destructive and requires less rehabilitation than a definitive spinal fusion.Previous authors [3,4,7] have reviewed early results of the system, which have been encouraging. We reviewed over 50 patients who underwent this procedure with an average follow-up time of over 5 years. Patients and methodsWe retrospectively reviewed 69 patients who underwent Graf ligament stabilisation between 1993 and 1997. Of these, 51 patients were available for follow-up. There were 23 women and 28 men. The mean age was 41 years (range, 22-67 years). All patients had chronic low back pain. Eight patients had had previous spinal surgery in the form of discectomy. Conservative management of back pain had failed in all the patients. This included physiotherapy, epidurals and facet joint injection. All patients were assessed preoperatively with an Oswestry Disability Index for low back pain. Our indication for stabilisation with the Graf ligament was intractable low back pain for which conservative measures of treatment had failed. All patients had magnetic resonance imaging (MRI) or computed tomography (CT) scans. Abnormal degenerative discs, end-plate changes or marked facet degeneration were targeted for stabilisation. Patients with equivocal scans were further investigated using discography. The surgery was performed by the two senior authors (M.A.F. and A.J.B.F.) exclusively. Fifteen patients had significant leg pain with clinical and radiological signs of nerve root entrapment and consequently underwent nerve root decompression at the same time as the spinal stabilisation. The majority of patients (n=31) had single-level stabilisation, while 17 had two-level and 3 had three-level stabilisation.Patient notes were examined. Previous history and details of surgery were recorded. Post-operative complications and length of Abstract Previous studies have looked at early follow-up of the Graf ligament stabilisation system. We present mid-to long-term results of this procedure. A retrospective review of Graf ligaments inserted since 1993 was undertaken. A total of 51 patients were reviewed. Pre-operative Oswestry Disability Index scores were compared to post-operative scores recorded via a postal questionnaire. There were 28 men and 23 women. The average age was 41 years (range, 22-67 years). The mean pre-operative score was 46 (range, 22-78), the mean follow...

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“…Because of the unique neurologic and vascular anatomy of the spinal canal and thoracic cavity, optimal screw placement is especially important for thoracic pedicle screws. Consequences of screw malposition can be devastating when it occurs in the proximity of neurovascular and visceral structures [3,4].…”

Section: Introductionmentioning

confidence: 99%

Use of computed tomographic reconstruction to establish the ideal entry point for pedicle screws in idiopathic scoliosis

Zhang²,

Peng

et al. 2011

Eur Spine J

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Objective To determine the ideal entry point for individual pedicle screw in the surgical treatment of idiopathic scoliosis using computed tomographic (CT) three-dimensional (3D) reconstruction. Methods Twenty patients with moderate or severe idiopathic scoliosis from two groups received surgical treatment using ''Free Hand technique'' and ''Assisted Free Hand technique''. Computed tomographic scanning with 3D reconstruction of the thoracic and lumbar spine was conducted to determine the entry point and to evaluate the placement accuracy. Results The accuracy of placement was 88.2% in convexity and 84.5% in concavity for the ''Free Hand'' group, and 94.1% in convexity and 94% in concavity for the ''Assisted Free Hand'' group. Evidence showed that ''Assisted Free Hand'' group had higher accuracy when screws were placed in the thoracic spine (P = 0.02), while no obvious difference was seen in the lumbar spine placement (P = 0.47). Conclusions We conclude that in the surgical treatment of severe scoliosis, individual screw placement guided by entry points determined by CT reconstruction can result in improved accuracy and ease of the procedure.

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Complications Associated with Pedicle Screws*

Cited by 479 publications

References 16 publications

Mechanical implant failure in posterior cervical spine fusion

Mechanical implant failure in posterior cervical spine fusion

Graf ligament stabilisation: mid- to long-term follow-up

Use of computed tomographic reconstruction to establish the ideal entry point for pedicle screws in idiopathic scoliosis

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