Fusion of the Lumbar and Sacral Spine by Internal Fixation with Screw Plates

Louis, René

doi:10.1097/00003086-198602000-00004

Cited by 193 publications

(64 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Only at the L5 level should the angle of insertion be higher, usually about 25 ° [14]. However, individual characteristics of pedicle anatomy have to be respected [8,14]. In our department, the lateral approach described by Magerl and Weinstein is used [9,15,16], so the angles may be somewhat greater.…”

Section: Discussionmentioning

confidence: 98%

Verification of the position of pedicle screws in lumbar spinal fusion

et al. 1997

View full text Add to dashboard Cite

Medial or lateral pedicle screw penetration with the potential to affect neural structures in a wellknown and frequent problem associated with posterior spinal fusion. We evaluated the placement of pedicle screws (n = 141) in 36 patients following posterior lumbar spinal fusion with Socon or Kluger instrumentation via a lateral transpedicular approach. The examination was based on CT and MR images performed after removal of the instrumentation, on average 1 year after implantation. We found seven pedicle screws with lateral cortical penetration of the pedicle and five screws with medial cortical penetration of the pedicle (8.5% pedicle penetration overall). No severe radicular complications accompanied these pedicle penetrations. The mean insertion angles of the pedicle screws at the L4 level were 22.6 ° and 23.1 ° for the left and the right side, respectively. At the L5 level the mean insertion angle was 20.5 ° on the left side and 21.5 ° on the right, and at the S1 level the mean angle was 16.2 ° on the left and 15.2 ° on the right. The results of this study indicate that the lateral transpedicular approach is a safe procedure for pedicle screw insertion.

show abstract

Section: Discussionmentioning

confidence: 98%

Verification of the position of pedicle screws in lumbar spinal fusion

et al. 1997

View full text Add to dashboard Cite

show abstract

“…By contrast, several authors have recommended that placement of S1 pedicle screws in a central position should be avoided because of the risk this placement carries of damage to the iliac vessels, the sympathetic chain, and the lumbosacral trunk, which are all close to the sacrum [19][20][21][22][23][24]. Therefore, from both biomechanical and anatomical points of view, it is recommended that S1 pedicle screws should be inserted inwardly with an acceptable angle reported as about 30°to 40°, almost the same as that of the S1 facet angle [27][28][29][30][31]. However, in general, S1 pedicle screws are inserted from a medial entry point with an outward angle, because of the prominent dorsal overhang of the posterior iliac crest and paravertebral muscle mass [30,[32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

L5 spinal nerve injury caused by misplacement of outwardly-inserted S1 pedicle screws

Inoue

Ozawa

et al. 2012

Eur Spine J

View full text Add to dashboard Cite

show abstract

“…In the medical literature, Raymond Roy-Camille [141] is widely credited with the first application of screws through the pedicles of the vertebrae [103]. From 1963, Roy-Camille used pedicle screw plates with clinical success.…”

Section: Historical Evolutionmentioning

confidence: 99%

“…After initial experience, Louis and Maresca [104,105] modified Roy-Camille's implant and technique better to fulfill the requirement for stabilization of the lumbosacral junction. In 1986, Louis [103] summarized his experience with this technique reviewing 455 patients. The rate of solid fusion was 97.4% in single-stage posterior procedures and 100% in patients treated by a combined approach.…”

Section: Historical Evolutionmentioning

confidence: 99%

“…This is certainly not an easy task for the inexperienced surgeon. However, the results in the literature demonstrate that the risk is minimal in the hands of experienced spine surgeons [103,143,159,192]. The potential risk of neurological damage to the spinal cord or nerve roots is also encountered with hook-rod system or Luque instrumentation.…”

Section: Complications and Safetymentioning

confidence: 99%

See 1 more Smart Citation

Pedicle screw fixation in spinal disorders: A European view

1997

View full text Add to dashboard Cite

Continuing controversy over the use of pedicular fixation in the United States is promoted by the lack of governmental approval for the marketing of these devices due to safety and efficacy concerns. These implants have meanwhile become an invaluable part of spinal instrumentation in Europe. With regard to the North American view, there is a lack of comprehensive reviews that consider the historical evolution of pedicle screw systems, the rationales for their application, and the clinical outcome from a European perspective. This literature review suggests that pedicular fixation is a relatively safe procedure and is not associated with a significantly higher complication risk than non-pedicular instrumentation. Pedicle screw fixation provides short, rigid segmental stabilization that allows preservation of motion segments and stabilization of the spine in the absence of intact posterior elements, which is not possible with non-pedicular instrumentation. Fusion rates and clinical outcome in the treatment of thoracolumbar fractures appear to be superior to that achieved using other forms of treatment. For the correction of spinal deformity (i.e., scoliosis, kyphosis, spondylolisthesis, tumor), pedicular fixation provides the theoretical benefit of rigid segmental fixation and of facilitated deformity correction by a posterior approach, but the clinical relevance so far remains unknown. In low-back pain disorders, a literature analysis of 5,600 cases of lumbar fusion with different techniques reveals a trend that pedicle screw fixation enhances the fusion rate but not clinical outcome. The most striking finding in the literature is the large range in the radiological and clinical results. For every single fusion technique poor and excellent results have been described. This review argues that European spine surgeons should begin to back up the evident benefits of pedicle screw systems for specific spinal disorders by controlled prospective clinical trials. This may prevent forthcoming medical licensing authorities from restricting the use of pedicle screw devices and dictating the practice of spinal surgery in Europe in the near future.

show abstract

Fusion of the Lumbar and Sacral Spine by Internal Fixation with Screw Plates

Cited by 193 publications

References 0 publications

Verification of the position of pedicle screws in lumbar spinal fusion

Verification of the position of pedicle screws in lumbar spinal fusion

L5 spinal nerve injury caused by misplacement of outwardly-inserted S1 pedicle screws

Pedicle screw fixation in spinal disorders: A European view

Contact Info

Product

Resources

About