Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: pedicle screw fixation as an adjunct to posterolateral fusion for low-back pain

2005 ◽  
Vol 2 (6) ◽  
pp. 700-706 ◽  
Author(s):  
Daniel K. Resnick ◽  
Tanvir F. Choudhri ◽  
Andrew T. Dailey ◽  
Michael W. Groff ◽  
Larry Khoo ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Degenerative Disease ◽  
Posterolateral Fusion ◽  
Low Back

scholarly journals 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

2014 ◽  
Vol 21 (1) ◽  
pp. 75-78 ◽  
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.

Full Percutaneous Lumbar Interbody Fusion: Technical Note

2017 ◽  
Vol 78 (06) ◽  
pp. 601-606 ◽  
Author(s):  
Mitsuto Taguchi ◽  
Shu Nakamura
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Low Back ◽  
Lumbar Interbody Fusion ◽  
Less Invasive ◽  
Disk Degeneration

Introduction Although lumbar interbody fusion is effective for low back pain caused by severe disk degeneration, it is a highly invasive procedure. Less invasive procedures such as transforaminal lumbar interbody fusion (TLIF) and lumbar lateral interbody fusion have become available; however, there is still scope for improvement. We performed full percutaneous endoscopic lumbar interbody fusion (PELIF), a technique designed as a safe and less invasive percutaneous fusion. Method and Subjects Our technique is indicated for patients with chronic low back pain in whom conservative treatment was not effective, thinning of the intervertebral disk was prominent, and temporary pain relief was achieved with a disk block. In the operation, percutaneous endoscopic diskectomy was performed with a 7.5-mm sheath inserted through a small incision, and a cage was inserted percutaneously using an L-shaped retractor. Instead of pedicle screw fixation, hybrid facet screw fixation was performed. Low back pain was improved, and bone union was confirmed on radiography. This technique was used in six patients, and no surgery-related complications occurred. Discussion The L-shaped retractor used in this series can protect the exiting nerve by inserting it into the sheath, then removing the sheath and placing the rounded corner of the retractor on the lateral cranial side. This technique is safe with no other associated risks. Cages larger than the sheath can be inserted, and commercially available cages for TLIF are applicable. Hybrid facet screw fixation can overcome the problems associated with both conventional transfacet pedicle screw fixation and translaminar facet screw fixation by combining these two procedures. Conclusion PELIF is an easy, safe, and fully percutaneous technique with very low invasiveness that uses an L-shaped retractor and hybrid facet screw fixation. This procedure can be a treatment option for patients with severe low back pain related to disk degeneration.

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7: intractable low-back pain without stenosis or spondylolisthesis

2005 ◽  
Vol 2 (6) ◽  
pp. 670-672 ◽  
Author(s):  
Daniel K. Resnick ◽  
Tanvir F. Choudhri ◽  
Andrew T. Dailey ◽  
Michael W. Groff ◽  
Larry Khoo ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Degenerative Disease ◽  
Low Back

Comparison of Biomechanics of Lumbar-Pelvis Segment With Posterior Screw-Rod Versus Interspinous Plate Fixation System

2010 ◽  
Author(s):  
A. Kiapour ◽  
J. O’Donnell ◽  
V. K. Goel ◽  
A. Biyani
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Screw Fixation ◽  
Plate Fixation ◽  
Pedicle Screw Fixation ◽  
Low Back ◽  
Lumbar Degenerative Disease ◽  
Segmental Instability ◽  
Fixation System ◽  
Surgical Option

Spinal fusion is the traditional surgical option to improve the clinical outcome of patients with advanced lumbar degenerative disease. Various techniques including posterolateral arthrodesis, interbody arthrodesis, and circumferential arthrodesis are being pursued as fusion strategies to eliminate segmental instability, which is a recognized cause of low back pain [1]. There are several drawbacks associated with pedicle-screw fixation constructs including failure of implant components and back-out of the screws [2,3].

scholarly journals Efficacy of pedicle screw fixation in the treatment of spinal instability and failed back surgery: a 5-year review

1998 ◽  
Vol 5 (1) ◽  
pp. E1
Author(s):  
Roberto Masferrer ◽  
Carlos H. Gomez ◽  
Dean G. Karahalios ◽  
Volker K. H. Sonntag
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Current Status ◽  
Safe Procedure ◽  
Hospital System ◽  
Failed Back Surgery ◽  
Osseous Union

Object The goal of this study was to review retrospectively the outcome of 95 patients with various disorders leading to instability of the thoracolumbar and lumbar spine who were treated consecutively via a posterior surgical approach with pedicle screw fixation in which the Texas Scottish Rite Hospital system was used. Methods All cases were managed according to the same protocol. Follow-up review averaged 29.6 months. Radiographic evidence of osseous union and the patient's current status were analyzed. Four screws were malpositioned, and there were two dural lacerations of a nerve root and one pedicle fracture. Deep wound infections developed in five patients (5.2%) and three patients had postoperative radicular pain. In one case, the rods disengaged from the screws; in four cases, hardware was removed but there were no broken screws. Neurological deficits improved in 85% of the patients and no patient was worse neurologically after surgery. The rate of osseous union was 96.8%. Three patients developed pseudarthrosis, one of whom was asymptomatic. Back pain improved in 80 patients (85%). A solid bone fusion, however, was not necessarily associated with decreased back pain. Conclusions These results support the use of pedicle screw fixation as an effective and safe procedure for fusion of the thoracolumbar and lumbar spine and support the finding that complications can be minimal when a meticulous surgical technique is used. The proper selection of patients for surgery is probably the most important factor associated with good outcomes.

scholarly journals Multiple-level lumbar spondylolysis and spondylolisthesis

2015 ◽  
Vol 22 (3) ◽  
pp. 283-287 ◽  
Author(s):  
Xinyu Liu ◽  
Lianlei Wang ◽  
Suomao Yuan ◽  
Yonghao Tian ◽  
Yanping Zheng ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Japanese Orthopaedic Association ◽  
Pedicle Screw Fixation ◽  
Low Back ◽  
Multiple Level ◽  
Lumbar Spondylolysis ◽  
Pars Interarticularis

OBJECT Lumbar spondylolysis and isthmic spondylolisthesis occur most commonly at only one spinal level. The authors report on 13 cases of lumbar spondylolysis with spondylolisthesis at multiple levels. METHODS During July 2007–March 2012, multiple-level spondylolysis associated with spondylolisthesis was diagnosed in 13 patients (10 male, 3 female) at Qilu Hospital of Shandong University. The mean patient age was 43.5 ± 14.6 years. The duration of low-back pain was 11.7 ± 5.1 months. Spondylolysis occurred at L-2 in 2 patients, L-3 in 4 patients, L-4 in all patients, and L-5 in 5 patients. Spondylolysis occurred at 3 spinal levels in 3 patients and at 2 levels in 10 patients. All patients had spondylolisthesis at 1 or 2 levels. Japanese Orthopaedic Association and visual analog scale scores were used to evaluate preoperative and postoperative neurological function and low-back pain. All patients underwent pedicle screw fixation and interbody fusion or direct pars interarticularis repair. RESULTS Both low-back pain scores improved significantly after surgery (p < 0.05). Postoperative radiographs or CT scans showed satisfactory interbody fusion or pars interarticularis healing. No breakage, dislodging, or loosening of the pedicle screw hardware was observed for any patient. CONCLUSIONS Multiple-level lumbar spondylolysis and spondylolisthesis occurred more often in men. Most multiplelevel lumbar spondylolysis occurred at 2 spinal levels and was associated with sports, trauma, or heavy labor. Multiplelevel lumbar spondylolysis occurred mostly at L3–5; associated spondylolisthesis usually occurred at L-4 and L-5, mostly at L-4. The treatment principle was the same as that for single-level spondylolisthesis.

Efficacy of pedicle screw fixation in the treatment of spinal instability and failed back surgery: a 5-year review

1998 ◽  
Vol 89 (3) ◽  
pp. 371-377 ◽  
Author(s):  
Roberto Masferrer ◽  
Carlos H. Gomez ◽  
Dean G. Karahalios ◽  
Volker K. H. Sonntag
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Safe Procedure ◽  
Content Type ◽  
Failed Back Surgery ◽  
Osseous Union ◽  
Fine Print

Object. The goal of this study was to review retrospectively the outcome of 95 patients with various disorders leading to instability of the thoracolumbar and lumbar spine who were treated consecutively via a posterior surgical approach with pedicle screw fixation in which the Texas Scottish Rite Hospital system was used. Methods. All cases were managed according to the same protocol. Follow-up review averaged 29.6 months. Radiographic evidence of osseous union and the patient's current status were analyzed. Four screws were malpositioned, and there were two dural lacerations of a nerve root and one pedicle fracture. Deep wound infections developed in five patients (5.2%), and three patients had postoperative radicular pain. In one case, the rods disengaged from the screws; in four cases, hardware was removed but there were no broken screws. Neurological deficits improved in 85% of the surviving patients, and no patient was worse neurologically after surgery. The rate of osseous union was 96.8%. Three patients developed pseudarthrosis, one of whom was asymptomatic. Back pain improved in 80 patients. A solid bone fusion, however, was not necessarily associated with decreased back pain. Conclusions. These results support the use of pedicle screw fixation as an effective and safe procedure for fusion of the thoracolumbar and lumbar spine and support the finding that complications can be minimal when a meticulous surgical technique is used. The proper selection of patients for surgery is probably the most important factor associated with good outcomes.

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: injection therapies, low-back pain, and lumbar fusion

2005 ◽  
Vol 2 (6) ◽  
pp. 707-715 ◽  
Author(s):  
Daniel K. Resnick ◽  
Tanvir F. Choudhri ◽  
Andrew T. Dailey ◽  
Michael W. Groff ◽  
Larry Khoo ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Lumbar Fusion ◽  
Degenerative Disease ◽  
Low Back
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