Titanium-alloy enhances bone-pedicle screw fixation: mechanical and histomorphometrical results of titanium-alloy versus stainless steel

A 74-year-old man developed bilateral lower limb spastic paresis. He was diagnosed with thoracic spondylotic myelopathy presumably caused by mechanical stress that was generated in the intervertebral space (T1-T2) between a vertebral bone bridge (C5-T1) due to diffuse idiopathic skeletal hyperostosis after anterior fixation of the lower cervical spine and a vertebral bone bridge (T2-T7) due to diffuse idiopathic skeletal hyperostosis in the upper thoracic spine. Treatment included posterior decompression (T1-T2 laminectomy) and percutaneous pedicle screw fixation at the C7-T4 level. Six months after surgery, the patient could walk with a cane, and the vertebral bodies T1-T2 were bridged without bone grafting. For thoracic spondylotic myelopathy associated with diffuse idiopathic skeletal hyperostosis, decompression and percutaneous pedicle screw fixation are effective therapies.

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Posterior thoracolumbar hemivertebra resection and short-segment fusion in congenital scoliosis: surgical outcomes and complications with more than 5-year follow-up

BMC Surgery ◽

10.1186/s12893-021-01165-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Beixi Bao ◽

Qingjun Su ◽

Yong Hai ◽

Peng Yin ◽

Yaoshen Zhang ◽

...

Keyword(s):

Pedicle Screw ◽

Surgical Outcomes ◽

Screw Fixation ◽

Congenital Scoliosis ◽

Pedicle Screw Fixation ◽

Rigid Fixation ◽

Short Segment ◽

Hemivertebra Resection ◽

Main Curve

Abstract Background Treatment of congenital hemivertebra is challenging and data on long-term follow-up (≥ 5 years) are lacking. This study evaluated the surgical outcomes of posterior thoracolumbar hemivertebra resection and short-segment fusion with pedicle screw fixation for treatment of congenital scoliosis with over 5-year follow-up. Methods This study evaluated 27 consecutive patients with congenital scoliosis who underwent posterior thoracolumbar hemivertebra resection and short-segment fusion from January 2007 to January 2015. Segmental scoliosis, total main scoliosis, compensatory cranial curve, compensatory caudal curve, trunk shift, shoulder balance, segmental kyphosis, and sagittal balance were measured on radiographs. Radiographic outcomes and all intraoperative and postoperative complications were recorded. Results The segmental main curve was 40.35° preoperatively, 11.94° postoperatively, and 13.24° at final follow-up, with an average correction of 65.9%. The total main curve was 43.39° preoperatively, 14.13° postoperatively, and 16.06° at final follow-up, with an average correction of 60.2%. The caudal and cranial compensatory curves were corrected from 15.78° and 13.21° to 3.57° and 6.83° postoperatively and 4.38° and 7.65° at final follow-up, with an average correction of 69.2% and 30.3%, respectively. The segmental kyphosis was corrected from 34.30° to 15.88° postoperatively and 15.12° at final follow-up, with an average correction of 61.9%. A significant correction (p < 0.001) in segmental scoliosis, total main curve, caudal compensatory curves and segmental kyphosis was observed from preoperative to the final follow-up. The correction in the compensatory cranial curve was significant between preoperative and postoperative and 2-year follow-up (p < 0.001), but a statistically significant difference was not observed between the preoperative and final follow-up (p > 0.001). There were two implant migrations, two postoperative curve progressions, five cases of proximal junctional kyphosis, and four cases of adding-on phenomena. Conclusion Posterior thoracolumbar hemivertebra resection after short-segment fusion with pedicle screw fixation in congenital scoliosis is a safe and effective method for treatment and can achieve rigid fixation and deformity correction.

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The role of fusion in the management of burst fractures of the thoracolumbar spine treated by short segment pedicle screw fixation

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.94b8.28311 ◽

2012 ◽

Vol 94-B (8) ◽

pp. 1101-1106 ◽

Cited By ~ 42

Author(s):

N. Jindal ◽

S. S. Sankhala ◽

V. Bachhal

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Thoracolumbar Spine ◽

Pedicle Screw Fixation ◽

Short Segment ◽

Burst Fractures

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9:43210. Correction of adolescent idiopathic scoliosis using thoracic pedicle screw fixation vs. traditional hook constructs: a single surgeon retrospective review

The Spine Journal ◽

10.1016/j.spinee.2005.05.213 ◽

2005 ◽

Vol 5 (4) ◽

pp. S108-S109

Author(s):

Stephen Storer ◽

Julie Choe ◽

Joshua Hyman ◽

Francis Lee ◽

Michael Vitale ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Pedicle Screw ◽

Retrospective Review ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Thoracic Pedicle Screw

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Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: Pedicle screw fixation as an adjunct to posterolateral fusion

Journal of Neurosurgery Spine ◽

10.3171/2014.4.spine14277 ◽

2014 ◽

Vol 21 (1) ◽

pp. 75-78 ◽

Cited By ~ 11

Author(s):

Michael W. Groff ◽

Andrew T. Dailey ◽

Zoher Ghogawala ◽

Daniel K. Resnick ◽

William C. Watters ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Clinical Outcome ◽

Pedicle Screw ◽

Chronic Low Back Pain ◽

Screw Fixation ◽

Lumbar Fusion ◽

Pedicle Screw Fixation ◽

Controlled Study ◽

Low Back

The utilization of pedicle screw fixation as an adjunct to posterolateral lumbar fusion (PLF) has become routine, but demonstration of a definitive benefit remains problematic. The medical evidence indicates that the addition of pedicle screw fixation to PLF increases fusion rates when assessed with dynamic radiographs. More recent evidence, since publication of the 2005 Lumbar Fusion Guidelines, suggests a stronger association between radiographic fusion and clinical outcome, although, even now, no clear correlation has been demonstrated. Although several reports suggest that clinical outcomes are improved with the addition of pedicle screw fixation, there are conflicting findings from similarly classified evidence. Furthermore, the largest contemporary, randomized, controlled study on this topic failed to demonstrate a significant clinical benefit with the use of pedicle screw fixation in patients undergoing PLF for chronic low-back pain. This absence of proof should not, however, be interpreted as proof of absence. Several limitations continue to compromise these investigations. For example, in the majority of studies the sample size is insufficient to detect small increments in clinical outcome that may be observed with pedicle screw fixation. Therefore, no definitive statement regarding the efficacy of pedicle screw fixation as a means to improve functional outcomes in patients undergoing PLF for chronic low-back pain can be made. There appears to be consistent evidence suggesting that pedicle screw fixation increases the costs and complication rate of PLF. High-risk patients, including (but not limited to) patients who smoke, patients who are undergoing revision surgery, or patients who suffer from medical conditions that may compromise fusion potential, may appreciate a greater benefit with supplemental pedicle screw fixation. It is recommended, therefore, that the use of pedicle screw fixation as a supplement to PLF be reserved for those patients in whom there is an increased risk of nonunion when treated with only PLF.

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