Peterson Jeremy C, Arnold Paul M, Smith Zachary A, Hsu Wellington K, Fehlings Michael G, Hart Robert A, Hilibrand Alan S, Nassr Ahmad, Rahman Ra'Kerry K, Tannoury Chadi A, Tannoury Tony, Mroz Thomas E, Currier Bradford L, De Giacomo Anthony F, Fogelson Jeremy L, Jobse Bruce C, Massicotte Eric M, Riew K Daniel
University of Kansas Medical Center, Kansas City, KS, USA.
Northwestern University, Chicago, IL, USA.
Global Spine J. 2017 Apr;7(1 Suppl):46S-52S. doi: 10.1177/2192568216687527. Epub 2017 Apr 1.
A multicenter, retrospective case series.
In the past several years, screw fixation of the cervical spine has become commonplace. For the most part, this is a safe, low-risk procedure. While rare, screw backout or misplaced screws can lead to morbidity and increased costs. We report our experiences with this uncommon complication.
A multicenter, retrospective case series was undertaken at 23 institutions in the United States. Patients were included who underwent cervical spine surgery from January 1, 2005, to December 31, 2011, and had misplacement of screws requiring reoperation. Institutional review board approval was obtained at all participating institutions, and detailed records were sent to a central data center.
A total of 12 903 patients met the inclusion criteria and were analyzed. There were 11 instances of screw backout requiring reoperation, for an incidence of 0.085%. There were 7 posterior procedures. Importantly, there were no changes in the health-related quality-of-life metrics due to this complication. There were no new neurologic deficits; a patient most often presented with pain, and misplacement was diagnosed on plain X-ray or computed tomography scan. The most common location for screw backout was C6 (36%).
This study represents the largest series to tabulate the incidence of misplacement of screws following cervical spine surgery, which led to revision procedures. The data suggest this is a rare event, despite the widespread use of cervical fixation. Patients suffering this complication can require revision, but do not usually suffer neurologic sequelae. These patients have increased cost of care. Meticulous technique and thorough knowledge of the relevant anatomy are the best means of preventing this complication.
多中心回顾性病例系列研究。
在过去几年中，颈椎螺钉固定已变得很常见。在很大程度上，这是一种安全、低风险的手术。虽然罕见，但螺钉退出或位置不当可能导致发病并增加成本。我们报告我们在这种罕见并发症方面的经验。
在美国23家机构进行了一项多中心回顾性病例系列研究。纳入2005年1月1日至2011年12月31日期间接受颈椎手术且螺钉位置不当需要再次手术的患者。所有参与机构均获得了机构审查委员会的批准，并将详细记录发送至中央数据中心。
共有12903例患者符合纳入标准并进行了分析。有11例螺钉退出需要再次手术，发生率为0.085%。有7例后路手术。重要的是，由于这种并发症，与健康相关的生活质量指标没有变化。没有新的神经功能缺损；患者最常表现为疼痛，通过普通X线或计算机断层扫描诊断出位置不当。螺钉退出最常见的部位是C6（36%）。
本研究是统计颈椎手术后螺钉位置不当导致翻修手术发生率的最大系列研究。数据表明，尽管颈椎固定广泛应用，但这是一种罕见事件。发生这种并发症的患者可能需要翻修，但通常不会出现神经后遗症。这些患者的护理成本增加。细致的技术和对相关解剖结构的透彻了解是预防这种并发症的最佳方法。
