Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary?

Abstract Background While several studies report on accuracy rates of pedicle screws, risk factors associated with inaccurate pedicle screw positioning in patients with thoracolumbar fractures are reported rarely. CT scan as a routine postoperative control is advocated by various authors, however its necessity remains unclear. Methods Two hundred forty-five patients were included in this retrospective study. Percutaneous dorsal instrumentation was most commonly performed (n = 201). Classification of Zdichavsky et al. and Rao et al. were used to classify screw misplacement and anterior perforation was further evaluated according to the extent of perforation (< 2 mm; > 2 mm). Multivariate analysis was performed to identify risk factors for misplacement of screws. Results One thousand sixty-eight pedicle screws were inserted in 245 patients. Misplacement was found in 51 screws (4.8%) in 42 patients (17.1%) according to the classification of Zdichavsky et al. and in 75 screws (7.0%) in 64 patients (26.1%) according to the classification of Rao et al.. An anterior perforation of the vertebral cortex was found in 56 screws (5.2%). Multivariate analysis showed fracture location in the upper thoracic (p = 0.048) and lumbar spine (p = 0.013) to be the only independent predictors for screw misplacement. In addition a significant correlation between pedicle diameter and the occurrence of screw malposition was found (p = 0.003). No consequences were drawn from postoperative routine CT in asymptomatic patients. Conclusion An overall low rate of screw misplacement was found with fracture location in the upper thoracic and lumbar spine being the only factors independently associated with the risk of screw misplacement. No consequences were drawn from postoperative routine CT in asymptomatic patients. Therefore its use has to be discussed critically.

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Pedicle Screws Loosening in Patients With Degenerative Diseases of the Lumbar Spine: Potential Risk Factors and Relative Contribution

Global Spine Journal ◽

10.1177/2192568218772302 ◽

2018 ◽

Vol 9 (1) ◽

pp. 55-61 ◽

Cited By ~ 5

Author(s):

Andrey Bokov ◽

Anatoliy Bulkin ◽

Alexander Aleynik ◽

Marina Kutlaeva ◽

Sergey Mlyavykh

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Potential Risk ◽

Pedicle Screws ◽

Degenerative Diseases ◽

Relative Contribution ◽

Potential Risk Factors

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Prevalence and risk factors for lung involvement on low-dose chest CT (LDCT) in a paucisymptomatic population of 247 patients affected by COVID-19

Insights into Imaging ◽

10.1186/s13244-020-00939-7 ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Maxime Castelli ◽

Arnaud Maurin ◽

Axel Bartoli ◽

Michael Dassa ◽

Baptiste Marchi ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Low Dose ◽

High Sensitivity ◽

Chest Ct ◽

Lung Involvement ◽

Imaging Findings ◽

Asymptomatic Patients ◽

The Mean

Abstract Background Low-dose chest CT (LDCT) showed high sensitivity and ability to quantify lung involvement of COVID-19 pneumopathy. The aim of this study was to describe the prevalence and risk factors for lung involvement in 247 patients with a visual score and assess the prevalence of incidental findings. Methods For 12 days in March 2020, 250 patients with RT-PCR positive tests and who underwent LDCT were prospectively included. Clinical and imaging findings were recorded. The extent of lung involvement was quantified using a score ranging from 0 to 40. A logistic regression model was used to explore factors associated with a score ≥ 10. Results A total of 247 patients were analyzed; 138 (54%) showed lung involvement. The mean score was 4.5 ± 6.5, and the mean score for patients with lung involvement was 8.1 ± 6.8 [1–31]. The mean age was 43 ± 15 years, with 121 males (48%) and 17 asymptomatic patients (7%). Multivariate analysis showed that age > 54 years (odds ratio 4.4[2.0–9.6] p < 0.001) and diabetes (4.7[1.0–22.1] p = 0.049) were risk factors for a score ≥ 10. Multivariate analysis including symptoms showed that only age > 54 years (4.1[1.7–10.0] p = 0.002) was a risk factor for a score ≥ 10. Rhinitis (0.3[0.1–0.7] p = 0.005) and anosmia (0.3[0.1–0.9] p = 0.043) were protective against lung involvement. Incidental imaging findings were found in 19% of patients, with a need for follow-up in 0.6%. Conclusion The prevalence of lung involvement was 54% in a predominantly paucisymptomatic population. Age ≥ 55 years and diabetes were risk factors for significant parenchymal lung involvement. Rhinitis and anosmia were protective against LDCT abnormalities.

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Complications of cervical pedicle screw fixation for nontraumatic lesions: a multicenter study of 84 patients

Journal of Neurosurgery Spine ◽

10.3171/2011.11.spine11102 ◽

2012 ◽

Vol 16 (3) ◽

pp. 238-247 ◽

Cited By ~ 65

Author(s):

Hiroaki Nakashima ◽

Yasutsugu Yukawa ◽

Shiro Imagama ◽

Tokumi Kanemura ◽

Mitsuhiro Kamiya ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Pedicle Screw ◽

Neurological Complications ◽

Cervical Pedicle Screw ◽

Screw Insertion ◽

Screw Misplacement ◽

Cervical Pedicle ◽

Grade Ii ◽

The Mean

Object The cervical pedicle screw (PS) provides strong stabilization but poses a potential risk to the neurovascular system, which may be catastrophic. In particular, vertebrae with degenerative changes complicate the process of screw insertion, and PS misplacement and subsequent complications are more frequent. The purpose of this study was to evaluate the peri- and postoperative complications of PS fixation for nontraumatic lesions and to determine the risk factors of each complication. Methods Eighty-four patients who underwent cervical PS fixation for nontraumatic lesions were independently reviewed to identify associated complications. The mean age of the patients was 60.1 years, and the mean follow-up period was 4.1 years (range 6–168 months). Pedicle screw malpositioning was classified on postoperative CT scans as Grade I (< 50% of the screw outside the pedicle) or Grade II (≥ 50% of the screw outside the pedicle). Risk factors of each complication were evaluated using a multivariate analysis. Results Three hundred ninety cervical PSs and 24 lateral mass screws were inserted. The incidence of PS misplacement was 19.5% (76 screws); in terms of malpositioning, 60 screws (15.4%) were classified as Grade I and 16 (4.1%) as Grade II. In total, 33 complications were observed. These included postoperative neurological complications in 11 patients in whom there was no evidence of screw misplacement (C-5 palsy in 10 and C-7 palsy in 1), implant failure in 11 patients (screw loosening in 5, broken screws in 4, and loss of reduction in 2), complications directly attributable to screw insertion in 5 patients (nerve root injury by PS in 3 and vertebral artery injury in 2), and other complications in 6 patients (pseudarthrosis in 2, infection in 1, transient dyspnea in 1, transient dysphagia in 1, and adjacent-segment degeneration in 1). The multivariate analysis showed that a primary diagnosis of cerebral palsy was a risk factor for postoperative implant failure (HR 10.91, p = 0.03) and that the presence of preoperative cervical spinal instability was a risk factor for both Grade I and Grade II screw misplacement (RR 2.12, p = 0.03), while there were no statistically significant risk factors for postoperative neurological complications in the absence of evidence of screw misplacement or complications directly attributable to screw insertion. Conclusions In the present study, misplacement of cervical PSs and associated complications occurred more often than in previous studies. The rates of screw-related neurovascular complications and neurological deterioration unrelated to PSs were high. Insertion of a PS for nontraumatic lesions is surgically more challenging than that for trauma; consequently, experienced surgeons should use PS fixation for nontraumatic cervical lesions only after thorough preoperative evaluation of each patient's cervical anatomy and after considering the risk factors specified in the present study.

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Classification of endplate lesions in the lumbar spine and association with risk factors, biochemistry, and genetics

European Spine Journal ◽

10.1007/s00586-021-06719-1 ◽

2021 ◽

Author(s):

Alessandra Colombini ◽

Fabio Galbusera ◽

Maria Cristina Cortese ◽

Enrico Gallazzi ◽

Marco Viganò ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Spine

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Thoracic and lumbar spine injuries

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0069 ◽

2019 ◽

pp. 801-812

Author(s):

Bedansh Roy Chaudhary ◽

Shiong Wen Low

Keyword(s):

Lumbar Spine ◽

Pedicle Screws ◽

Scoring Systems ◽

Classification Systems ◽

Thoracolumbar Injury ◽

Spine Injuries ◽

Thoracic And Lumbar Spine ◽

Invasive Techniques

Trauma to the thoracic and lumbar spine may be classified using the Magerl’s or Thoracolumbar Injury Classification and Severity Score (TLICS) classifications. Older thoracolumbar trauma classification systems include those of Holdsworth, which emphasizes the mechanism of injury; Whitesides, which defines the two-column concept being analogous to a construction crane; Punjabi and White, who developed stability scoring systems; and Denis with a mechanistic classification based on instability pertaining to three columns of the spine. Management may be conservative with analgesia and bracing or surgical with posterior, transthoracic, or circumferential spinal fusion. In this chapter the classification of these injuries and their management will be discussed. The techniques to insert pedicle screws and the role of minimally invasive techniques will be explained.

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Letter to the Editor concerning “Classification of endplate lesions in the lumbar spine and association with risk factors, biochemistry, and genetics” by Alessandra Colombini et al. (Eur Spine J; doi: 10.1007/s00586-021-06719-1)

European Spine Journal ◽

10.1007/s00586-021-06844-x ◽

2021 ◽

Author(s):

Alessandra Colombini ◽

Fabio Galbusera ◽

Enrico Gallazzi ◽

Maria Cristina Cortese ◽

Domenico Albano ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Letter To The Editor

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Effects of pilot hole preparation technique on pedicle screw fixation in different regions of the osteoporotic thoracic and lumbar spine

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.3.5.0364 ◽

2005 ◽

Vol 3 (5) ◽

pp. 364-370 ◽

Cited By ~ 47

Author(s):

Jonathan J. Carmouche ◽

Robert W. Molinari ◽

Tad Gerlinger ◽

John Devine ◽

Troy Patience

Keyword(s):

Lumbar Spine ◽

Thoracic Spine ◽

Pedicle Screws ◽

Preparation Technique ◽

Content Type ◽

Pilot Hole ◽

Pullout Resistance ◽

Insertional Torque ◽

Upper Thoracic ◽

Fine Print

Object. The authors evaluated the effects of pilot hole preparation technique on insertional torque and axial pullout resistance in osteoporotic thoracic and lumbar vertebrae. Methods. Using a probe technique and fluoroscopy, 102 pedicle screws were placed in 51 dual-energy x-ray absorptiometry—proven osteoporotic thoracic and lumbar levels. Screws were inserted using the same-size tapping, one-size-under tapping, or no-tapping technique. Insertional torque and axial pullout resistance were measured. Analysis of variance, Fisher exact test, and regression analysis were performed. Same-size tapping decreased pullout resistance in the lumbar spine. There was no effect on pullout resistance in the thoracic spine. Pullout resistance values were lower for all insertion techniques in the upper thoracic spine. Insertional torque and bone mineral density correlated with pullout resistance in the thoracic and lumbar spine. Conclusions. Tapping decreased pedicle screw pullout resistance in the osteoporotic human lumbar spine, although it did not affect pullout strength in the thoracic spine. Tapping decreased insertional torque in upper thoracic levels. Surgeons should optimize overall construct rigidity when placing thoracic pedicle screws in patients with spinal segment osteoporosis.

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A Multivariate Analysis of Perioperative Risk Factors on the 10 Year Survival of Patients with Acute Type A Aortic Dissection

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1571542 ◽

2016 ◽

Vol 64 (S 01) ◽

Author(s):

A. Engel ◽

C. Fiessler ◽

M. Weyand ◽

F. Harig

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Aortic Dissection ◽

Type A ◽

Perioperative Risk ◽

Acute Type ◽

Type A Aortic Dissection ◽

Perioperative Risk Factors

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Four-Corner Arthrodesis versus Proximal Row Carpectomy: Risk Factors and Complications Associated with Prolonged Postoperative Opioid Use

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1715426 ◽

2020 ◽

Author(s):

Neill Y. Li ◽

Alexander S. Kuczmarski ◽

Andrew M. Hresko ◽

Avi D. Goodman ◽

Joseph A. Gil ◽

...

Keyword(s):

Risk Factors ◽

International Classification Of Diseases ◽

Opioid Use ◽

Proximal Row Carpectomy ◽

Use Patterns ◽

Patient Demographics ◽

Implant Complications ◽

Increased Risk ◽

Classification Of Diseases

Abstract Introduction This article compares opioid use patterns following four-corner arthrodesis (FCA) and proximal row carpectomy (PRC) and identifies risk factors and complications associated with prolonged opioid consumption. Materials and Methods The PearlDiver Research Program was used to identify patients undergoing primary FCA (Current Procedural Terminology [CPT] codes 25820, 25825) or PRC (CPT 25215) from 2007 to 2017. Patient demographics, comorbidities, perioperative opioid use, and postoperative complications were assessed. Opioids were identified through generic drug codes while complications were defined by International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification codes. Multivariable logistic regressions were performed with p < 0.05 considered statistically significant. Results A total of 888 patients underwent FCA and 835 underwent PRC. Three months postoperatively, more FCA patients (18.0%) continued to use opioids than PRC patients (14.7%) (p = 0.033). Preoperative opioid use was the strongest risk factor for prolonged opioid use for both FCA (odds ratio [OR]: 4.91; p < 0.001) and PRC (OR: 6.33; p < 0.001). Prolonged opioid use was associated with an increased risk of implant complications (OR: 4.96; p < 0.001) and conversion to total wrist arthrodesis (OR: 3.55; p < 0.001) following FCA. Conclusion Prolonged postoperative opioid use is more frequent in patients undergoing FCA than PRC. Understanding the prevalence, risk factors, and complications associated with prolonged postoperative opioid use after these procedures may help physicians counsel patients and implement opioid minimization strategies preoperatively.

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