Pedicle screw fixation in spinal disorders: A European view

Abstract

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.

CT Provides Precise Size Assessment of Implanted Titanium Alloy Pedicle Screws

“…The use of thoracic pedicle screws in the treatment of pediatric spinal deformity has increased in popularity [3,10,15,20,27,34]. Several studies have been devoted to developing safe techniques for screw placement [3,5,8,9], whereas others focus on anatomic structures at risk during screw placement [5, 7, 12, 16, 19-22, 29, 30, 32, 33].…”

“…Several studies have been devoted to developing safe techniques for screw placement [3,5,8,9], whereas others focus on anatomic structures at risk during screw placement [5, 7, 12, 16, 19-22, 29, 30, 32, 33]. Although rare, neurologic injury as a result of malpositioned pedicle screws has been reported [4,6,18,23].…”

“…The use of pedicle screws for treatment of spinal deformities has increased in popularity [3,10,15,20,27,34]. Pedicle screws are purported to provide several advantages over other available implants: higher pullout strength, ability to save distal fusion levels, better apical vertebral derotation, and improved curve correction, to name a few.…”

Dynamic stabilization devices in the treatment of low back pain

“…Introduction of pedicle instrumentation in the1980s, and cage devices in the 1990s, and frequent use of circumferential fusion have increased the successful fusion rate close to 98%, but failed to improve the overall clinical success rate. [1] A recent review of the Cochrane database of the prospective randomized controlled trials fails to establish any significant improvement of the natural history of low back pain by spinal fusion. [2] A subsequent multicentric prospective randomized controlled trial in Sweden suggests better outcome with fusion compared to conservative treatment, but no difference in outcome between the different fusion techniques.…”

“…[1] Several studies in the recent literature questioned the efficacy of spinal fusion in the treatment of low back pain. [2] In addition, a significant apprehension of adjacent segment disease in the long term follow-up after spinal fusion always concerned the spinal [3][4][5][6][7][8] surgeon.…”