Satoshi Sumiya1,2, Kazuyuki Fukushima3,4, Yoshiro Kurosa3, Takashi Hirai4, Hiroyuki Inose4, Toshitaka Yoshii4, Atsushi Okawa3. 1. Department of Orthopaedic Surgery, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, 385-0051, Saku City, Nagano, Japan. sumiya.orth.7077@gmail.com. 2. Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan. sumiya.orth.7077@gmail.com. 3. Department of Orthopaedic Surgery, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, 385-0051, Saku City, Nagano, Japan. 4. Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Abstract
BACKGROUND: No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors. METHODS: This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis. RESULTS: Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02-1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12-10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out. CONCLUSIONS: Our findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.
BACKGROUND: No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors. METHODS: This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis. RESULTS: Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02-1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12-10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out. CONCLUSIONS: Our findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.
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