Screw fixation failure after 360° fusion at the lumbar level

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Abstract


Aim: to identify possible predictors of screw loosening (SL) in patients after decompression and fusion at the lumbar level for degenerative spinal diseases.

Methods. The data of patients with degenerative lumbar diseases who underwent primary decompression and fusion and who were re-hospitalized were analyzed. Clinical data (demography, characteristics of primary surgical procedures and characteristics of the perioperative period), results of radiological methods (presence and characteristics of resorption around screws, bone density (BMD) by densitometry and CT, intervertebral fusion grade and implant subsidence) were evaluated.

Results. The study included 19 patients with SL and 37 patients without resorption, median age 59.1 [51.4; 63.1] years, men 20 (35.7%). When comparing patients with and without SL, there was no significant difference in gender, age, method of surgery, length of the fixation (p > 0.05). According to CT scans, the bone density of the vertebrae between the groups did not differ significantly (p > 0.05). In the group with SL, fusion failure was more common than in the group without SL (22.6% versus 20.7%), but the differences are not significant (p > 0.05). In the intergroup comparison, it was determined that, in general, there were more complications in the group with SL than in the group without SL (p = 0.00015) due to the greater number of infectious complications (p = 0.00044). Also, patients with SL had a significantly longer duration of primary hospital stay (p = 0.000021).

Conclusion. Patients with SL after primary surgery have a significantly longer hospital stay duration, mainly (45.8%) due to infectious complications. Patients with SL have comparable bone density in both the vertebral bodies and pedicles compared to patients without SL.


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About the authors

Olga N. Leonova

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

Author for correspondence.
Email: onleonova@gmail.com
ORCID iD: 0000-0002-9916-3947

Russian Federation, Novosibirsk

MD, PhD, Cand. Sci. (Med.), Research scientist

Evgenii S. Baykov

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

Email: Evgen-bajk@mail.ru
ORCID iD: 0000-0002-4430-700X
SPIN-code: 5367-5438
Scopus Author ID: 57189456380

Russian Federation, Novosibirsk

MD, PhD, Cand. Sci. (Med.), Head of the Department of Neurosurgery No. 2

Aleksandr V. Krutko

N.N. Priorov National Medical Research Center for Traumatology and Orthopedics

Email: ortho-ped@mail.ru
ORCID iD: 0000-0002-2570-3066
Scopus Author ID: 54795500200

Russian Federation, Moscow

Dr. Sci. (Med.), Senior Researcher

References

  1. Yavin D, Casha S, Wiebe S, et al. Lumbar fusion for degenerative disease: a systematic review and meta-analysis. Clin Neurosurg. 2017;80(5):701–715. doi: 10.1093/neuros/nyw162.
  2. Irmola TM, Häkkinen A, Järvenpää S, et al. Reoperation rates following instrumented lumbar spine fusion. Spine (Phila Pa 1976). 2018;43(4):295–301. doi: 10.1097/BRS.0000000000002291.
  3. Kim JB, Park SW, Lee YS, et al. The effects of spinopelvic parameters and paraspinal muscle degeneration on S1 screw loosening. J Korean Neurosurg Soc. 2015;58(4):357–362. doi: 10.3340/jkns.2015.58.4.357.
  4. Zou D, Muheremu A, Sun Z, et al. Computed tomography Hounsfield unit–based prediction of pedicle screw loosening after surgery for degenerative lumbar spine disease. J Neurosurg Spine. 2020;32(5):716–721. doi: 10.3171/2019.11.SPINE19868.
  5. Guo HZ, Tang YC, Guo DQ, et al. Pedicle screw fixation in single-level, double-level, or multilevel posterior lumbar fusion for osteoporotic spine: a retrospective study with a minimum 2-year follow-up. World Neurosurg. 2020;140:e121–e128. doi: 10.1016/j.wneu.2020.04.198.
  6. Kim DH, Hwang RW, Lee GH, et al. Comparing rates of early pedicle screw loosening in posterolateral lumbar fusion with and without transforaminal lumbar interbody fusion. Spine J. 2020;20(9):1438–1445. doi: 10.1016/j.spinee.2020.04.021.
  7. Афаунов А.А., Басанкин И.В., Кузьменко А.В., Шаповалов В.К. Осложнения хирургического лечения поясничных стенозов дегенеративной этиологии. Хирургия позвоночника. 2016;13(4):66–72. [Afaunov AA, Basankin IV, Kuz’menko AV, Shapovalov VK. Complications of surgical treatment of degenerative lumbar stenosis. Khirurgiya pozvonochnika. 2016;13(4):66–72. (In Russ).] doi: 10.14531/ss2016.4.66-72.
  8. Galbusera F, Volkheimer D, Reitmaier S, et al. Pedicle screw loosening: a clinically relevant complication? Eur Spine J. 2015;24(5):1005–1016. doi: 10.1007/s00586-015-3768-6.
  9. Tan GH, Goss BG, Thorpe PJ, Williams RP. CT-based classification of long spinal allograft fusion. Eur Spine J. 2007;16(11):1875–1881. doi: 10.1007/s00586-007-0376-0.
  10. Zhou QS, Chen X, Xu L, et al. Does vertebral end plate morphology affect cage subsidence after transforaminal lumbar interbody fusion? World Neurosurg. 2019;130:e694–701. doi: 10.1016/j.wneu.2019.06.195.
  11. Tokuhashi Y, Matsuzaki H, Oda H, Uei H. Clinical course and significance of the clear zone around the pedicle screws in the lumbar degenerative disease. Spine (Phila Pa 1976). 2008;33(8):903–908. doi: 10.1097/BRS.0b013e31816b1eff.
  12. Zou D, Sun Z, Zhou S, et al. Hounsfield units’ value is a better predictor of pedicle screw loosening than the T-score of DXA in patients with lumbar degenerative diseases. Eur Spine J. 2020;29(5):1105–1111. doi: 10.1007/s00586-020-06386-8.
  13. Bredow J, Boese CK, Werner CM, et al. Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery. Arch Orthop Trauma Surg. 2016;136(8):1063–1067. doi: 10.1007/s00402-016-2487-8.
  14. Sakai Y, Takenaka S, Matsuo Y, et al. Hounsfield unit of screw trajectory as a predictor of pedicle screw loosening after single level lumbar interbody fusion. J Orthop Sci. 2018;23(5):734–738. doi: 10.1016/j.jos.2018.04.006.
  15. Matsukawa K, Abe Y, Yanai Y, Yato Y. Regional Hounsfield unit measurement of screw trajectory for predicting pedicle screw fixation using cortical bone trajectory: a retrospective cohort study. Acta Neurochir (Wien). 2018;160(2):405–11. doi: 10.1007/s00701-017-3424-5.
  16. Chen CH, Chen DC, Huang HM, et al. Level-based analysis of screw loosening with cortical bone trajectory screws in patients with lumbar degenerative disease. Medicine (Baltimore). 2020;99(40):e22186. doi: 10.1097/MD.0000000000022186.
  17. Pearson HB, Dobbs CJ, Grantham E, et al. Intraoperative biomechanics of lumbar pedicle screw loosening following successful arthrodesis. J Orthop Res. 2017;35(12):2673–2681. doi: 10.1002/jor.23575.
  18. Афаунов А.А., Басанкин И.В., Кузьменко А.В., Шаповалов В.К. Анализ причин ревизионных операций при хирургическом лечении больных с поясничными стенозами дегенеративной этиологии. Хирургия позвоночника. 2014;(1):86–93. [Afaunov AA, Basankin IV, Kuz’menko AV, Shapovalov VK. Analiz prichin revizionnykh operatsii pri khirurgicheskom lechenii bol’nykh s poyasnichnymi stenozami degenerativnoi etiologii. Khirurgiya pozvonochnika. 2014;(1):86–93. (In Russ).]
  19. Marie-Hardy L, Pascal-Moussellard H, Barnaba A, et al. Screw loosening in posterior spine fusion: prevalence and risk factors. Glob Spine J. 2020;10(5):598–602. doi: 10.1177/2192568219864341.
  20. Chen P, Li Z, Hu Y. Prevalence of osteoporosis in China: a meta-analysis and systematic review. BMC Public Health. 2016;16(1):1039. doi: 10.1186/s12889-016-3712-7.
  21. Abul-Kasim K, Ohlin A. Evaluation of implant loosening following segmental pedicle screw fixation in adolescent idiopathic scoliosis: a 2 year follow-up with low-dose CT. Scoliosis. 2014;9:13. doi: 10.1186/1748-7161-9-13.
  22. Ohba T, Ebata S, Oba H, et al. Risk factors for clinically relevant loosening of percutaneous pedicle screws. Spine Surg Relat Res. 2019;3(1):79–85. doi: 10.22603/ssrr.2018-0018.
  23. Razak HR, Dhoke P, Tay KS, et al. Single-level minimally invasive transforaminal lumbar interbody fusion provides sustained improvements in clinical and radiological outcomes up to 5 years postoperatively in patients with neurogenic symptoms secondary to spondylolisthesis. Asian Spine J. 2017;11(2):204–212. doi: 10.4184/asj.2017.11.2.204.
  24. Васильев А.И. Хирургическое лечение пациентов с дегенеративными деформациями поясничного отдела позвоночника: Дис. … канд. мед. наук. Новосибирск; 2018. [Vasil’ev AI. Khirurgicheskoe lechenie patsientov s degenerativnymi deformatsiyami poyasnichnogo otdela pozvonochnika. [dissertation] Novosibirsk; 2018. (In Russ).]
  25. Malham GM, Parker RM, Blecher CM, Seex KA. Assessment and classification of subsidence after lateral interbody fusion using serial computed tomography. J Neurosurg Spine. 2015;23(5):589–597. doi: 10.3171/2015.1.SPINE14566.
  26. Le TV, Baaj AA, Dakwar E, et al. Subsidence of polyetheretherketone intervertebral cages in minimally invasive lateral retroperitoneal transpsoas lumbar interbody fusion. Spine (Phila Pa 1976). 2012;37(14):1268–1273. doi: 10.1097/BRS.0b013e3182458b2f.
  27. Bratschitsch G, Puchwein P, Zollner-Schwetz I, et al. Spinal surgery site infection leading to implant loosening is influenced by the number of prior operations. Glob Spine J. 2020;1–6. doi: 10.1177/2192568220957268.
  28. Prinz V, Bayerl S, Renz N, et al. High frequency of low-virulent microorganisms detected by sonication of pedicle screws: a potential cause for implant failure. J Neurosurg Spine. 2019;31(3):424–429. doi: 10.3171/2019.1.SPINE181025.
  29. Leitner L, Malaj I, Sadoghi P, et al. Pedicle screw loosening is correlated to chronic subclinical deep implant infection: a retrospective database analysis. Eur Spine J. 2018;27(10):2529–2535. doi: 10.1007/s00586-018-5592-2.
  30. Rao PJ, Maharaj M, Chau C, et al. Degenerate-disc infection study with contaminant control (DISC): a multicenter prospective case-control trial. Spine J. 2020;20(10):1544–1553. doi: 10.1016/j.spinee.2020.03.013.

Supplementary files

Supplementary Files Action
1.
Fig. 1. Bone resorption around screws in the vertebral body and in the arch pedicles in 11 months after the first surgical procedure

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2.
Fig. 2. Bone resorption around the screws in the vertebral arch pedicles

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3.
Fig. 3. Bone resorption around screws and interbody implant, subsidence of interbody implant in 7 months after the first surgical procedure

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