Department of Orthopedic Surgery, Gakkentoshi Hospital, Kyoto, Japan.
Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Spine (Phila Pa 1976). 2022 Nov 1;47(21):1525-1531. doi: 10.1097/BRS.0000000000004398. Epub 2022 Jun 29.
A multicenter retrospective analysis.
This study aims to investigate reoperation of misplaced pedicle screws (MPSs) after posterior spinal fusion (PSF), focusing on neurological complications.
The management strategy for MPSs and the clinical results after reoperation are poorly defined.
Subjects were 10,754 patients (73,777 pedicle screws) who underwent PSF at 11 hospitals over 15 years. The total number of reoperations for MPS and patient clinical data were obtained from medical records at each hospital.
The rate of reoperation for screw misplacement per screw was 0.17%. A total of 69 patients (mean age, 67.4±16.5 yr) underwent reoperation because of 82 MPS. Reasons for reoperation were neurological symptoms (58 patients), contact with vessels (5), suboptimal bone purchase (4), and misplacement recognized during operation (2). Neurological symptoms were the major reason for reoperation in cervical (5/5 screws, 100%) and lumbo-sacral (60/67 screws, 89.6%) regions. Contact with vessels was the major reason for reoperation in the thoracic spine (6/10 screws, 60.0%). We further evaluated 60 MPSs in the lumbo-sacrum necessitating reoperation because of neurological symptoms. The majority of MPSs necessitating reoperation were placed in the lower lumbar spine (43/60 screws, 71.7%). The mean pedicle breach tended to be larger in the incomplete recovery group than in the complete recovery group (6.8±2.4 vs . 5.9±2.2 mm, P =0.146), and the cutoff value resulting in incomplete resolution was 5.0 mm. Multivariate analysis revealed that medial-caudal breaches ( vs . medial breach, odds ratio: 25.8, 95% confidence interval: 2.58-258, P =0.0057) and sensory and motor disturbances ( vs . sensory only, odds ratio: 8.57, 95% confidence interval: 1.30-56.6, P =0.026) were significant factors for incomplete resolution of neurological symptoms.
After reoperation, 70.1% of the patients achieved complete resolution of neurological symptoms. Factors associated with residual neurological symptoms included sensory and motor disturbance, medial-caudal breach, and larger pedicle breach (>5 mm).
多中心回顾性分析。
本研究旨在探讨后路脊柱融合术后（PSF）发生的椎弓根螺钉位置不当（MPSs）的再次手术，重点关注神经并发症。
MPSs 的处理策略和再次手术后的临床结果定义较差。
共纳入 11 家医院 15 年间接受 PSF 的 10754 例患者（73777 枚椎弓根螺钉）。从每家医院的病历中获得了螺钉再手术总数和患者临床数据。
螺钉位置不当的螺钉再手术率为 0.17%。共有 69 例患者（平均年龄 67.4±16.5 岁）因 82 例 MPS 接受了再手术。再手术的原因是神经症状（58 例）、与血管接触（5 例）、骨购不足（4 例）和术中发现的位置不当（2 例）。神经症状是颈椎（5/5 枚螺钉，100%）和腰骶部（60/67 枚螺钉，89.6%）区域再手术的主要原因。与血管接触是胸椎（6/10 枚螺钉，60.0%）再手术的主要原因。我们进一步评估了 60 例因神经症状而需要再次手术的腰骶部 MPSs。需要再次手术的 MPSs 大多位于下腰椎（43/60 枚螺钉，71.7%）。不完全恢复组的椎弓根破裂倾向于比完全恢复组更大（6.8±2.4 比 5.9±2.2 mm，P =0.146），5.0 mm 为不完全缓解的临界值。多变量分析显示，内侧尾侧破裂（比内侧破裂，比值比：25.8，95%置信区间：2.58-258，P =0.0057）和感觉和运动障碍（比仅感觉障碍，比值比：8.57，95%置信区间：1.30-56.6，P =0.026）是神经症状不完全缓解的显著因素。
再次手术后，70.1%的患者完全缓解了神经症状。与残留神经症状相关的因素包括感觉和运动障碍、内侧尾侧破裂和更大的椎弓根破裂（>5 mm）。
