Abstract
BackgroundNo studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors.MethodsThis was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis.ResultsPedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out.ConclusionsOur findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.
Highlights
No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery
We investigated the frequency of pedicle screw pull-out by comparing intraoperative cone-beam computed tomography (CBCT)
A hook system was used in 6 cases (7.9%) and the percutaneous pedicle screw (PPS) method was used in 57 cases (75.0%)
Summary
No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. Many authors have described the efficacy of posterior pedicle screw instrumentation [1, 2], which is widely used in patients with spinal diseases. Many institutions can perform spinal instrumentation surgery using intraoperative cone-beam computed tomography (CBCT) in a hybrid operating room [6, 7] or an O-arm imaging system (Medtronic, Minneapolis, MN) [8, 9]. CBCT is a three-dimensional (3D) imaging modality that reconstructs projection data obtained by a rotational Carm with a flat panel detector [7]. It can visualize lowcontrast objects, such as soft tissue or small vessels, as well as high-contrast structures, including enhanced vessels or bone. Intraoperative CBCT has made it possible to confirm the presence or absence of screw deviation during surgery
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