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      Risk Factors for Clinically Relevant Loosening of Percutaneous Pedicle Screws.

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          Abstract

          (1) To evaluate the influence of pedicle screw loosening on clinical outcomes; (2) to clarify the association between the pull-out length and screw loosening 1 year after surgery; and (3) to determine radiographically which screw parameters predominantly influence the pull-out resistance of screws.

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          The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae.

          Takashi Nakamura, Masashi Neo, Shunsuke Fujibayashi … (2005)
          Postoperative outcomes of cervical pedicle screw (CPS) placement were evaluated. The screws were inserted in degenerative vertebrae using anatomic landmarks. To evaluate the risks of this procedure caused by misplacements and subsequent complications. The CPS gives superior vertebral fixation but risks causing vertebral artery and spinal cord injury. However, few clinical reports have been published concerning CPS misplacement and subsequent complications. Therefore, the risk of this procedure is still unclear. There were 18 consecutive patients, who submitted to CPS fixation of degenerative vertebrae C2-C6, evaluated using computerized tomography (CT). In 5 of 9 patients in whom the screw critically violated the transverse foramen, viability of the vertebral artery was evaluated using multi-detector row CT angiography. There were no intraoperative vertebral artery or spinal cord injuries and no serious postoperative complications. A total of 86 screws were inserted, and 25 (29%) breached the pedicle cortex. Of them, 84% deviated laterally and violated the transverse foramen. There were 13 screws (15%) that deviated more than 2 mm. However, multi-detector row CT angiography showed the continuity of the vertebral artery in all cases. The deviation rate of CPS placement using anatomic landmarks was higher than anticipated, although no serious complications were encountered. Refinement of the technique (e.g., using a computer-assisted navigation system) is strongly recommended.
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            Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery.

            Jan Bredow, C. K. Boese, C M L Werner … (2016)
            Pedicle screw fixation is the standard technique for the stabilization of the spine, a clinically relevant complication of which is screw loosening. This retrospective study investigates whether preoperative CT scanning can offer a predictor of screw loosening.
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              A comparative study on screw loosening in osteoporotic lumbar spine fusion between expandable and conventional pedicle screws.

              Zi-xiang Wu, Fu-tai Gong, Li Liu … (2012)
              The aim of this study is to compare the rate of screw loosening and clinical outcomes of expandable pedicle screws (EPS) with those of conventional pedicle screws (CPS) in patients treated for spinal stenosis (SS) combined with osteoporosis. One hundred and fifty-seven consecutive patients with SS received either EPS fixation (n = 80) or CPS fixation (n = 77) to obtain lumbosacral stabilization. Patients were observed for a minimum of 24 months. Outcome measures included screw loosening, fusion rate, Japanese Orthopaedic Association (JOA) scores and Oswestry disability index (ODI) scoring system, and complications. In the EPS group, 20 screws became loose (4.1%) in 6 patients (7.5%), and two screws (0.4%) had broken. In the CPS group, 48 screws became loose (12.9%) in 15 patients (19.5%), but no screws were broken. The fusion rate in the EPS group (92.5%) was significantly higher than that of the CPS group (80.5%). The rate of screw loosening in the EPS group (4.1%) was significantly lower than that of the CPS group (12.9%). Six EPS (1.8%) screws were removed. In the EPS group, two screws had broken but without neural complications. Twelve months after surgeries, JOA and ODI scores in the EPS group were significantly improved. There were four cases of dural tears, which healed after corresponding treatment. EPS can decrease the risk of screw loosening and achieve better fixation strength and clinical results in osteoporotic lumbar spine fusion.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Spine Surg Relat Res
                Title: Spine surgery and related research
                Publisher: Japanese Society for Spine Surgery and Related Research
                ISSN (Electronic): 2432-261X
                ISSN (Print): 2432-261X
                Publication date (Electronic): Jan 25 2019
                Volume: 3
                Issue: 1
                Affiliations
                [1 ] Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan.
                [2 ] Department of Orthopaedic Surgery, Shinshu University, School of Medicine, Matsumoto-city, Japan.
                Article
                DOI: 10.22603/ssrr.2018-0018
                PMC ID: 6690121
                PubMed ID: 31435556
                SO-VID: a75cdbe2-7a68-4921-8bc0-5af180578c50
                History

                Keywords: screw trajectory angle,screw pull-out,screw loosening,percutaneous pedicle screw,intraoperative CT navigation
                Data availability:
                Keywords: screw trajectory angle, screw pull-out, screw loosening, percutaneous pedicle screw, intraoperative CT navigation

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