Complications Associated with the Technique of Pedicle Screw Fixation A Selected Survey of ABS Members

Esses, Stephen I.; Sachs, Barton L.; Dreyzin, Vadim

doi:10.1097/00007632-199311000-00015

Cited by 659 publications

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“…Relevant studies present the potential risk of damaging the nerve roots, dural sac, vascular structures, and pleura as a major limitation of pedicle screw instrumentation in lumbar spine. Such injuries occur mainly because of the adjacent neural structures rather than the size of pedicle [5,6,8,10,11,12]. There are many clinical applications of lumbar transpedicular fixation.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies documenting this procedure, however, pay only minimal attention to complications and their incidence, and they report results based on relatively short follow-up periods. Esses et al reported an overall total of 169 complications associated with transpedicular screw placement, based on 617 cases [5]. Of these 169 complications, nerve root violation, including transient and permanent injuries, occurred in 29 cases and cerebrospinal fluid leak in 12 cases.…”

Section: Discussionmentioning

confidence: 99%

“…Instrumentation techniques of the spine using the pedicle from posterior into the vertebral body have become popular recently, because of the advantages of these systems [1, 3,4,5,6,10,11,12,13]. Pedicle screw placement does not pose the same high risk of damage to the spinal cord, dural sac, and nerve roots in the lumbar region as it does in thoracic and cervical spine.…”

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confidence: 99%

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Lumbar pedicle: surgical anatomic evaluation and relationships

Attar

Ugur

et al. 2001

European Spine Journal

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IntroductionTranspedicular screw fixation can be used for the treatment of unstable lumbar spine caused by trauma, tumors, infections, and degenerative conditions. Instrumentation techniques of the spine using the pedicle from posterior into the vertebral body have become popular recently, because of the advantages of these systems [1, 3,4,5,6,10,11,12,13]. Pedicle screw placement does not pose the same high risk of damage to the spinal cord, dural sac, and nerve roots in the lumbar region as it does in thoracic and cervical spine. However, accurate anatomic knowledge is needed to perform a safe surgical intervention in the lumbar region [2,9,11]. Despite the growing interest in pedicle instrumentation in the lumbar spine, the anatomic relationships of lumbar pedicle have not yet been analyzed adequately for the safe performance of these clinical applications. Even though some of the measurements duplicate previous studies, and the data presented in this study are limited to the surrounding tissues of the pedicle, we consider such that information is necessary for building Abstract Although several clinical applications of transpedicular screw fixation in the lumbar spine have been documented for many years, few anatomic studies concerning the lumbar pedicle and adjacent neural structures have been published. The lumbar pedicle and its relationships to adjacent neural structures were investigated through an anatomic study. Our objective is to highlight important considerations in performing transpedicular screw fixation in the lumbar spine. Twenty cadavers were used for observation of the lumbar pedicle and its relations. After removal of whole posterior bony elements including spinous processes, laminae, lateral masses, and inferior and superior facets, the isthmus of the pedicle was exposed. Pedicle width and height (PW and PH), interpedicular distance (IPD), pedicle-inferior nerve root distance (PIRD), pedicle-superior nerve root distance (PSRD), pedicle-dural sac distance (PDSD), root exit angle (REA), and nerve root diameter (NRD) were measured. The results indicated that the average distance from the lumbar pedicle to the adjacent nerve roots superiorly, inferiorly and to the dural sac medially at all levels ranged from 2.9 to 6.2 mm, 0.8 to 2.8 mm, and 0.9 to 2.1 mm, respectively. The mean PH and PW at L1-L5 ranged from 10.4 to 18.2 mm and 5.9 to 23.8 mm, respectively. The IPD gradually increased from L1 to L5. The mean REA increased consistently from 35°to 39°. The NRD was between 3.3 and 3.9 mm. Levels of significance were shown for the P<0.05 and P<0.01 levels. On the basis of this study, we can say that improper placement of the pedicle screw medially and inferiorly should be avoided.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Lumbar pedicle: surgical anatomic evaluation and relationships

Attar

Ugur

et al. 2001

European Spine Journal

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“…Besides the advantages of pedicular screw, its use is not without complications [7,15,16], especially when it penetrates in to the spinal canal. Because of its close proximity to spinal canal and surrounding vessels, misplacement of pedicle screw can lead to disastrous complication.…”

Section: Introductionmentioning

confidence: 99%

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

et al. 2008

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It is a retrospective analytic study of 1,009 transpedicular screws (689 thoracic and 320 lumbosacral), inserted with free-hand technique in neuromuscular scoliosis using postoperative CT scan. The aim of paper was to determine the accuracy and safety of transpedicular screw placement with free-hand technique in neuromuscular scoliosis and to compare the accuracy at different levels in such population. All studies regarding accuracy and safety of pedicle screw in scoliosis represent idiopathic scoliosis using various techniques such as free-hand, navigation, image intensifier, etc., for screw insertion. Anatomies of vertebrae and pedicle are distorted in scoliosis, hence accurate and safe placement of pedicle screw is prerequisite for surgery. Between 2004 and 2006, 37 consecutive patients, average age 20 years (9-44 years), of neuromuscular scoliosis were operated with posterior pedicle screw fixation using free-hand technique. Accuracy of pedicle screws was studied on postoperative CT scan. Placement up to 2 mm medial side and 4 mm lateral side was considered within-safe zone. Of the 1,009 screws, 273 screws were displaced medially, laterally or on the anterior side showing that 73% screws (68% in thoracic and 82.5% in lumbar spine) were accurately placed within pedicle. Considering the safe zone, 93.3% (942/1009, 92.4% in thoracic and 95.3% in lumbar spine) of the screws were within the safe zone. Comparing accuracy according to severity of curve, accuracy was 75% in group 1 (curve \90°) and 69% in group 2 (curve [90°) with a safety of 94.8 and 91.2%, respectively (P = 0.35). Comparing the accuracy at different thoracic levels, it showed 67, 64 and 72% accuracy in upper, middle and lower thoracic levels with safety of 96.6, 89.2 and 93.1%, respectively, exhibiting no statistical significant difference (P = 0.17). Pedicle screw placement in neuromuscular scoliosis with free-hand technique is accurate and safe as other conditions.

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“…Osteoporosis is the most frequent skeletal disease in this context, affecting up to 50% of women older than 65 years. The technical difficulties and high rate of complications associated with osteoporotic bone fixation are well documented in the literature [6]. The torque and pullout strength of pedicle screws have a linear correlation with bone mineral density [7,8].…”

Section: Introductionmentioning

confidence: 99%

Instrumented lumbar arthrodesis in elderly patients: prospective study using cannulated cemented pedicle screw instrumentation

et al. 2011

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Introduction Lumbar fusion in elderly patients is increasingly common. This study prospectively investigated the clinical and radiological outcome of osteoporotic patients [70 years with degenerative lumbar instability treated with fusion using a new cannulated, cemented, pedicle screw instrumentation augmented with PMMA. Materials and Methods The surgical protocols, patient records, densitometry, imaging studies, and pre-and postoperative patient-reported outcome questionnaires of 23 patients (mean age, 77 years) with a follow-up of 20-49 months were reviewed. All patients underwent postoperative 3D CT scan control to assess cement leakage and instrumentation position. Serial radiological controls were analyzed for secondary complications, i.e., adjacent fractures, hardware mobilization and radiological evidence of fusion. Results Pain and function improved at 6 months and were maintained at the final follow-up. No clinical complications secondary to PMMA leakage developed. No clinical or radiological cases of non-union were observed with a mean of 1.8 levels fused. No fractures occurred in adjacent segments. There were four cases of adjacent disc disease. Three deep infections required surgical revision without removal of material and one superficial infection, all with complete remission. ConclusionThis new instrumentation for degenerative lumbar disease in elderly patients is safe and effective.

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Complications Associated with the Technique of Pedicle Screw Fixation A Selected Survey of ABS Members

Cited by 659 publications

References 0 publications

Lumbar pedicle: surgical anatomic evaluation and relationships

Lumbar pedicle: surgical anatomic evaluation and relationships

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

Instrumented lumbar arthrodesis in elderly patients: prospective study using cannulated cemented pedicle screw instrumentation

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