The Effect of Paraspinal Muscle Degeneration on Distal Pedicle Screw Loosening Following Corrective Surgery for Degenerative Lumbar Scoliosis

Spine ◽  
2020 ◽  
Vol 45 (9) ◽  
pp. 590-598 ◽  
Author(s):  
Junsheng Leng ◽  
Gengyu Han ◽  
Yan Zeng ◽  
Zhongqiang Chen ◽  
Weishi Li
Keyword(s):  
Pedicle Screw ◽  
Paraspinal Muscle ◽  
Degenerative Lumbar Scoliosis ◽  
Muscle Degeneration ◽  
Screw Loosening ◽  
Corrective Surgery ◽  
Lumbar Scoliosis ◽  
Pedicle Screw Loosening

Paraspinal Muscle Degeneration as an Independent Risk for Loss of Local Alignment in Degenerative Lumbar Scoliosis Patients After Corrective Surgery

2021 ◽  
pp. 219256822110222
Author(s):  
Gengyu Han ◽  
Wei Wang ◽  
Siyu Zhou ◽  
Wei Li ◽  
Bo Zhang ◽  
...  
Keyword(s):  
Paraspinal Muscle ◽  
Local Alignment ◽  
Global Alignment ◽  
Degenerative Lumbar Scoliosis ◽  
Muscle Degeneration ◽  
Corrective Surgery ◽  
Paraspinal Muscles ◽  
Lumbar Scoliosis ◽  
Maintenance Group

Study Design: Retrospective study. Objectives: To investigate the effect of paraspinal muscle degeneration on the maintenance of local and global alignment among degenerative lumbar scoliosis (DLS) patients after corrective surgery. Methods: 98 DLS patients with a mean follow-up period of 38.3 months after corrective surgery were included. The T1 pelvic angle (TPA), lumbar lordosis (LL), pelvic incidence were measured preoperatively, immediate postoperatively and at last follow-up. All patients were divided into LL maintenance group (n = 21) and LL loss group (n = 77). For patients with well-aligned correction (immediate postoperative TPA ≤ 20°, n = 73), they were divided into TPA maintenance group (last follow-up TPA ≤ 20°) and TPA loss group (last follow-up TPA > 20°). The relative gross cross-sectional area (rGCSA) and fat infiltration (FI) of multifidus (MF) and erector spinae (ES), and the relative functional CSA (rFCSA) of psoas major (PS) were measured at L3, L4 and L5 on preoperative magnetic resonance imaging. Results: MF rGCSA were significantly smaller in LL loss group than in LL maintenance group. Both MF rGCSA and PS rFCSA were significantly smaller and MF FI was significantly higher in TPA loss group than in TPA maintenance group. Binary logistic regression revealed that the MF rGCSA was an independent factor of LL loss; Large immediate postoperative TPA was an independent risk factor of TPA loss, but not the parameters of paraspinal muscles. Conclusion: The effect of paraspinal muscles in lower lumbar segments might be mainly focused on the maintenance of local alignment rather than the global alignment.

scholarly journals Incidence, Risk, and Outcome of Pedicle Screw Loosening in Degenerative Lumbar Scoliosis Patients Undergoing Long-Segment Fusion

2021 ◽  
pp. 219256822110174
Author(s):  
Lei Yuan ◽  
Xinling Zhang ◽  
Yan Zeng ◽  
Zhongqiang Chen ◽  
Weishi Li
Keyword(s):  
Risk Factors ◽  
Pedicle Screw ◽  
Degenerative Lumbar Scoliosis ◽  
Screw Loosening ◽  
Fusion Surgery ◽  
Lumbar Scoliosis ◽  
Lateral Subluxation ◽  
Incidence Risk ◽  
Pedicle Screw Loosening

Study Design: Retrospective study. Objective: To investigate the incidence, risk factors, and outcomes of pedicle screw loosening in degenerative lumbar scoliosis (DLS) undergoing long-segment spinal fusion surgery. Methods: One hundred and thirty DLS patients who underwent long-segment fusion surgery with at least a 12-month follow-up were studied. The incidence and risk factors of screw loosening were investigated. VAS, SRS-22, and ODI scores were obtained preoperatively and at follow-up. Results: One hundred and sixty-eight of 1784 (9.4%) screws showed evidence of loosening in 71 (54.6%) patients. Three patients required revision surgery. Screw loosening rates according to vertebral insertion level were lowest instrumented vertebra (LIV): 45.4%; uppermost instrumented vertebra (UIV):17.7%; one vertebra above the LIV: 0.5%; 2 vertebrae above the LIV: 0.4%. Multiple logistic regression analysis of possible risk factors indicated that preoperative lateral subluxation ≥8 mm (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 1.16-6.20), osteopenia (OR: 5.52, 95% CI: 1.64-18.56), osteoporosis (OR: 8.19, 95% CI: 2.40-27.97), fusion to sacrum (OR: 2.55, 95% CI: 1.12-5.83), postoperative TLK greater than 10° (OR: 2.63, 95% CI: 1.14-6.04) and SVA imbalance (OR: 3.44, 95% CI: 1.17-10.14) were statistically significant. No difference was noted in preoperative, follow-up, and change of VAS, ODI, and SRS-22 scores. Conclusions: Screw loosening in DLS underwent long-segment surgery is common and tends to occur in the LIV or UIV. Lateral subluxation ≥8 mm, osteopenia, osteoporosis, fusion to the sacrum, postoperative TLK greater than 10°, and SVA imbalance were the independent influencing factors. Screw loosening can be asymptomatic, while longer-term follow-up is required.

INVESTIGATION INTO WHETHER OR NOT PMMA BONE CEMENT TRANSPEDICULAR SCREW AUGMENTATION STABILIZES PEDICLE SCREW LOOSENING

2019 ◽  
Vol 19 (02) ◽  
pp. 1940024
Author(s):  
PO-YI LIU ◽  
SHENG-CHIH LIN ◽  
PO-LIANG LAI ◽  
CHUN-LI LIN
Keyword(s):  
Bone Cement ◽  
Pedicle Screw ◽  
Fatigue Resistance ◽  
Fatigue Testing ◽  
Pedicle Screw Fixation ◽  
Screw Loosening ◽  
General Technique ◽  
Screw Augmentation ◽  
Pmma Bone Cement ◽  
Pedicle Screw Loosening

Pedicle screw loosening at the bone–screw interface is the main complication in pedicle screw fixation. The transpedicular polymethylmethacrylate screw augmentation technique has recently become the general technique used to re-operatively overcome pedicle screw loosening. This study investigates the fatigue resistance of PMMA bone cement augmentation. Twenty-seven porcine thoracic vertebral bodies were collected. The BMD was measured using dual X-ray absorptiometry. Each vertebral body was instrumented with one pedicle screw and mounted in a material testing system. Fatigue testing was performed by implementing a cranio-caudal sinusoidal, cyclic (5[Formula: see text]Hz) load. This study shows that transpedicular pedicle screw augmentation with PMMA exhibits similar fatigue resistance as traditional pedicle screw implantation. However, in histomophometrical analysis, the transpedicular pedicle screw augmentation with PMMA has greater anti-deformation capacity than traditional pedicle screw implantation. Transpedicular pedicle screw augmentation with PMMA improves more screw holding power to prevent pedicle screw loosening.

Hounsfield unit of screw trajectory as a predictor of pedicle screw loosening after single level lumbar interbody fusion

2018 ◽  
Vol 23 (5) ◽  
pp. 734-738 ◽  
Author(s):  
Yusuke Sakai ◽  
Shota Takenaka ◽  
Yohei Matsuo ◽  
Hiroyasu Fujiwara ◽  
Hirotsugu Honda ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Hounsfield Unit ◽  
Lumbar Interbody Fusion ◽  
Screw Loosening ◽  
Single Level ◽  
Pedicle Screw Loosening

Pedicle screw loosening is correlated to chronic subclinical deep implant infection: a retrospective database analysis

2018 ◽  
Vol 27 (10) ◽  
pp. 2529-2535 ◽  
Author(s):  
Lukas Leitner ◽  
Isabella Malaj ◽  
Patrick Sadoghi ◽  
Florian Amerstorfer ◽  
Mathias Glehr ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Loosening ◽  
Database Analysis ◽  
Implant Infection ◽  
Retrospective Database Analysis ◽  
Pedicle Screw Loosening ◽  
Retrospective Database

scholarly journals The Role of Prophylactic Vertebroplasty at UIV+1 and Cement-augmented Fenestrated Pedicle Screw for Prevention of PJK/PJF  in Patients With Osteoporosis: A Propensity Score–matched Analysis

2020 ◽  
Author(s):  
Qi Wang ◽  
Chi Wang ◽  
Wenhao Hu ◽  
Fanqi Hu ◽  
Weibo Liu ◽  
...  
Keyword(s):  
Propensity Score ◽  
Pedicle Screw ◽  
Adult Spinal Deformity ◽  
Cement Leakage ◽  
Cement Augmentation ◽  
Screw Loosening ◽  
Group A ◽  
Pedicle Screw Loosening ◽  
Fenestrated Pedicle Screw

Abstract Objective: To elucidate the role of prophylactic vertebroplasty (PV) at UIV+1 and cement-augmented fenestrated pedicle screw (CAFPS) in prevention of PJK and PJF.Background: Cement augmentation at UIV and UIV+1 was found to prevent PJK and PJF. But most studies are retrospective and have a selection bias due to multifactorial etiology of PJF, making it difficult to identify the efficacy of prophylactic cement augmentation. Methods: We enrolled 208 surgically treated adult spinal deformity (ASD) patients who were followed for at least 2 years, to elucidate whether prophylactic cement augmentation was truly minimizing the risk of PJK and PJF in a uniform population from one center database. Patients were classified into two groups. Two comparable groups were propensity-matched with one to one nearest neighbor matching. The main outcome variables including PJK, PJF, pedicle screw loosening and cement leakage were compared.Results：After propensity score matching, there were 58 propensity-matched patients in group A and B (n=29 in each group) whose parameters including age, BMI, BMD, number of instrumented vertebrae, SVA, spinal-pelvic parameters and the frequency of UIV and LIV were similar. The incidence of PJK showed no significantly statistical difference between group A and B (10.3% vs 13.8%, p >0.99). Compared to group A, group B had a higher proportion of patients developing PJF (24.1% vs 0%, p=0.01). Pedicle screw loosening at UIV and (or) LIV showed no difference (24.1% vs 3.4%, p=0.052) between two groups. In group A, cement leakage was detected in 5 cases via fluoroscopy, but none of them had neurological deficit or pulmonary cement embolism.Conclusion: Combined application of CAFPS and PV could reduce the incidence of PJF, but it could not prevent the development of PJK in the surgical management of ASD with low BMD or osteoporosis.

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