Mittal Ashish, Rosinski Alexander, Odeh Khalid, Balcescu Cristian, Ungurean Victor, Ungurean Victor, Kondrashov Dimitriy G
St. Mary's Medical Center, San Francisco Orthopaedic Residency Program, San Francisco, CA, USA.
The Taylor Collaboration, San Francisco, CA, USA.
Int J Spine Surg. 2023 Feb;17(1):17-24. doi: 10.14444/8352. Epub 2022 Aug 2.
Revision spinal deformity surgery has a high rate of complications. Fixation may be challenging due to altered anatomy. Screws through a fusion mass are an alternative to pedicle screw fixation.
The purpose of this retrospective study was to further elucidate the safety and efficacy of fusion mass screws (FMSs) in revision spinal deformity surgery.
Retrospective case series.
Fifteen freehand FMSs were placed in 6 patients with adult spinal deformity between 2016 and 2018 by the senior author. FMSs were combined with pedicle screws, at times at the same level. FMSs were used to save distal levels from fusion, assist in closing a 3-column osteotomy and provide additional fixation in cases of severe instability. Computed tomography (CT) was used to assess bone mineral density (BMD) and thickness of each fusion mass preoperatively along with accuracy of FMS placement postoperatively.
The mean BMD of the fusion mass was 397 Hounsfield units (HU; range: 156-628 HU). The mean AP thickness of the fusion mass was 15.5 ± 4.8 mm (range: 8.6-24.4 mm). The mean FMS length was 35.3 ± 5.5 mm (range: 25-40 mm). There was no evidence of FMS loosening, breakage, or pseudarthrosis at latest follow-up (mean: 2.2 years, range: 1.4-3.1 years). No neurologic deficits were observed. 1/15 screws had a low-grade breach into the canal (<2 mm). No patients required revision surgery.
FMSs may be used to augment fixation in revision spinal deformity cases when pedicle screw placement may be challenging. FMSs may also provide an additional anchor at levels with pedicular fixation.
脊柱翻修畸形手术并发症发生率高。由于解剖结构改变，固定可能具有挑战性。穿过融合块的螺钉是椎弓根螺钉固定的一种替代方法。
本回顾性研究的目的是进一步阐明融合块螺钉（FMS）在脊柱翻修畸形手术中的安全性和有效性。
回顾性病例系列研究。
2016年至2018年间，资深作者为6例成人脊柱畸形患者置入了15枚徒手FMS。FMS有时与椎弓根螺钉在同一节段联合使用。FMS用于避免远端节段融合，辅助闭合三柱截骨，并在严重不稳定的情况下提供额外固定。术前使用计算机断层扫描（CT）评估每个融合块的骨密度（BMD）和厚度，术后评估FMS置入的准确性。
融合块的平均BMD为397亨氏单位（HU；范围：156 - 628 HU）。融合块的平均前后径厚度为15.5±4.8 mm（范围：8.6 - 24.4 mm）。FMS的平均长度为35.3±5.5 mm（范围：25 - 40 mm）。在最新随访时（平均：2.2年，范围：1.4 - 3.1年），没有证据表明FMS松动、断裂或假关节形成。未观察到神经功能缺损。1/15枚螺钉有低度椎管侵犯（<2 mm）。没有患者需要翻修手术。
当椎弓根螺钉置入可能具有挑战性时，FMS可用于增强脊柱翻修畸形病例的固定。FMS还可在椎弓根固定节段提供额外的锚定。
